Frequently Asked Questions
How many hours do I need to become eligible?
Your eligibility for benefits from this Plan is determined twice a year—on February 1 and August 1.
You are eligible if:
- You’ve worked 600 hours in the six-month work period immediately prior to the effective date; or
- You’ve worked 1200 hours in the 12-month work period immediately prior to the effective date; or
- You’ve worked 2400 hours in the 18-month work period immediately prior to the effective date.
Who do I contact with questions about my health benefits?
You should contact the Iron Workers Fund office at 617-265-3757 with questions on member eligibility, vision benefits, disability benefits and life insurance.
You should contact Iron Clad Insurance at 617-436-3500 with questions on medical and dental claims, prescription benefits and dependent eligibility.
How do I find a doctor covered under the plan?
The Health and Welfare Fund offers benefits and care from a network of doctors and hospitals through Cigna CareAllies and Tufts CareLink Health Plan. You may contact them at CareAllies: 1-800-768-4695.
What is the copayment for a physician's office visit?
In network providers: A $20 copayment per visit will apply, then the visit is paid at 100% of the PPO rate, no deductible applies.
Out of network providers: You will pay 40% of Reasonable and Customary charges after the yearly deductible has been met.
What is the annual deductible?
What are the copayments for pharmacy benefits?
The Plan provides coverage for prescription medication that you purchase from a retail pharmacy. You may receive a 34-day supply. Your copayment is based on the type of drug prescribed:
- $15 copayment for generic drugs;
- $30 copayment for preferred brand-name drugs;
- $45 copayment for non-preferred brand name drugs.
You can receive up to a 100-day supply of maintenance medication at one time from the mail order service prescription program. When you use the Mail Order Program, your copayments are:
- $30 copayment for generic drugs;
- $60 copayment for preferred brand-name drugs;
- $90 copayment for non-preferred brand-name drugs.
Who do I contact to use my vision benefits?
Vision benefits covered by the Plan are administered by Davis Vision. You can contact them for a list of providers and for benefit information at 1-800-999-5431 or atwww.Davisvision.com.
When you or your dependents need vision care services, call the network provider of your choice and schedule an appointment. You should identify yourself as an Iron Workers District Council of New England Welfare Fund member and the provider’s office will verify your eligibility for services.
Should you choose to use a non-participating provider you must pay for services in full and file your own claim form with Davis Vision. Reimbursements are made according to a schedule.
What are the disability benefits covered under the plan?
Disability benefits are covered for active member coverage only.
The Plan pays a $250 weekly disability benefit if you become totally disabled due to an illness or a non-work related injury and are unable to work while you are covered by this Plan up to a maximum of 26 week for any one continuous period. This benefit also includes hours posted toward Health & Welfare eligibility and Pension credits. Please contact the Fund office for an application and eligibility questions.
The Plan provides coverage for Long Term Disability of $1000.00 per month after a 120 day waiting period. The Long Term Disability plan is administered by Standard Insurance Company, please contact the Fund Office for an application and eligibility questions.
If you have been injured due to a Work related injury, please contact the Fund Office about your benefits, you may be eligible for Long Term Disability benefits and pension credited hours.
What are the life insurance benefits?
Life Insurance benefits are covered for active member coverage only.
The Plan provides coverage for a $30,000 Life Insurance policy and an additional $30,000 Accidental Death and Dismemberment Coverage policy. Life insurance benefits are administered by Aetna Insurance Company. In the event that this benefit becomes payable, beneficiaries should contact the Fund office.
Beneficiary forms are provided at the time of eligibility and can be updated at any time. Please be sure to keep your beneficiary forms up to date, signed original forms should be submitted to the Fund Office.
Documents and Forms
- Summary Plan Description 2016
- Summary of Benefits & Coverage – Active Plan
- Summary of Benefits & Coverage – Retiree Plan
- Summary of Benefits & Coverage – Cobra Plan
- 2021 Women’s Health & Cancer and Credibility Coverage Notice
- Medical ID Card
- Beneficiary Form (Welfare)
- Beneficiary Forms (All Funds)
- Reciprocal Form (All Funds)
- How to Set Up Your Telehealth Account