Following is a list of some of the most frequently asked questions regarding your insurance benefits. Please refer to the OLDC-OCA Summary Plan Description (SPD) for a more detailed explanation of all of your insurance benefits.

When will I be eligible for insurance benefits?

• Once you work 450 hours in six consecutive month period and your contractors report and pay the fringes due, you will establish your initial eligibility.
• Remember that there is a one month lag in contractors reporting working hours. (Example: June hours are not due to be reported until July 15th.).

How do I maintain my insurance coverage?

• Once you meet initial eligibility requirements, your eligibility will continue if you work at least:
  • 225 hours in the first three months of the five months immediately preceding the month of coverage; or
  • 225 hours in the first three months of the four months immediately preceding the month of coverage; or
  • 900 hours in the first 12 months of the 14 months immediately preceding the month of coverage; or
  • 900 hours in the first 12 months of the 13 months immediately preceding the month of coverage
• If your eligibility ends, you will be offered continued coverage through self-payments and COBRA.

Why did I receive a bill for my insurance?

• Your eligibility for insurance benefits has terminated and continued eligibility is available by paying the bill.

Why do I owe so much money to maintain my insurance coverage?

• The payment due is based off of your previous working hours, and you are billed for the least amount of hours needed to maintain eligibility.
• Insurance payments currently will not exceed $1080.00 for a three (3) month period. The $1080.00 is not broken down evenly over the three months, the amount due varies from month to month.
• Rates are based on the current contractors’ contribution rate which is currently $4.80 per hour. When contractors’ contribution rates are changed so will the self contribution rate

Do I have a death benefit from the Insurance Fund?

• Yes, if you are a member that is eligible for insurance benefits. If you are not eligible for insurance benefits on the date of your death, there is no death benefit available.
• $14,000 for Class I (active) members and $2,500 for Class II, III & IV members (retirees).

Why was my claim not paid?

• Please contact Medical Mutual of Ohio, Envision Rx Options, Costco, or National Vision Administrators for information on specific claims. OLFBP does not process the claims.

Why is my ex-spouse (and/or step children) still on my insurance?

• Because you have not submitted a complete copy of the final divorce decree and an enrollment card. These are both needed before a spouse and/or dependents can be removed from your insurance.

What if I have a new mailing address?

• For your protection, OLFBP requires all address changes be made in writing. Just send a note or Address Change Card to the Fund Office that includes the following:
  • Your previous address
  • Your new address
  • Your telephone number
  • Your Social Security number
  • Your signature

How much did I pay for health insurance for tax purposes?

• Upon receipt of a signed request letter, OLFBP will mail you a letter.

How long are my dependents eligible to have health insurance?

• Enrolled dependents are eligible for insurance on the same dates the member is eligible.
• Children can be covered until they turn 19 or until they turn 23 if they are enrolled full-time in an accredited college.
• Eligibility for permanently disabled children may be extended.
• Spouses can be covered while married to the member.

What are my total hours?

• You can check your hours through NETime Benefits on this website. Simply log in by clicking the hard hat on the right side of this website. Initially you will need to request a PIN#.
• Or you can call the OLFBP Fund Office.

How do I enroll a newborn or dependent child?

• An enrollment card must be completed in full and returned to the OLFBP Fund Office along with the child’s birth certificate. You have one year to get the birth certificate to the Fund Office for newborns.
• Additional information is needed for a child if you are divorced or unmarried.

Why must I complete a Coordination of Benefits form and what is it for?

• A Coordination of Benefits form is used to determine if you and your spouse have another insurance plan in addition to the OLDC-OCA Insurance plan. OLFBP will then determine whether claims will be paid as primary or secondary.

Can I cancel my insurance, but keep a dependent on the plan?

• No. The insurance is for the member.
• If you are a retired member, cancelling your insurance also cancels the eligibility for any dependents.
• If you are an active member, you cannot simply cancel your insurance, but whether or not you use it is up to you. Your eligibility is based on hours reported by contractors.

When I retire, how will my insurance work and how much will it cost?

• The health insurance will be the same as under Class I, except the death benefit decreases and you are no longer eligible for Short Term Disability benefits.
• Once you reach Medicare age, the Fund becomes secondary. Please see the next question.
• The cost of retiree insurance depends on the number of pension credits you have and whether or not you cover your spouse and or dependent children. The more pension credits you have, the cheaper the retiree insurance is.

I am turning age 65 and will be starting Medicare. How will that affect my health insurance?

• Medicare will become your primary health insurance and NEBCO (instead of Medical Mutual of Ohio) becomes your supplemental health insurance.
• This does not affect any members who are still under Class I (active) insurance. Only if you are covered under a retiree plan.

How do I get a Letter of Credible Coverage?

• By simply calling the OLFBP Fund Office and requesting one.

Can I add my girlfriend/boyfriend to my insurance coverage?

• No. Only spouses and children are considered covered dependents under the Plan.

I have been working out of state; why is my health insurance canceling?

• Contributions must be submitted to the fund’s jurisdiction in which they are worked.
• You may be able to have the hours transferred if we have a reciprocal agreement with the insurance fund that covers the jurisdiction in which you worked. You can contact the OLFBP Fund office to see if we have reciprocity with the fund in question.

I am going to the hospital; does my stay have to be pre-certified?

• Yes. Precertification is done through Medical Mutual of Ohio.
• Precertification is also required for MRI’s and PET scans.

Does the Fund cover substance abuse and alcoholism treatments?

• Yes. The Fund has a limited benefit.