Frequent Questions & Answers

Have a question? First check to see if your question can be answered in the following list.
If it's not there, let us know. Fund Office
As we receive inquiries from our members, we will post the most common questions, with the answers here.

Scroll down through the Q&A or click on a specific category on the right.

Q & A

Medical

Q.  What Network are we in?
A.  District Council No. 3 Painters and Allied Trades access a combination of networks through Blue Cross And Blue Shield of Kansas City.

Q.  Do I have to go to a network provider?
A.  No.  However, if you utilize an out-of-network provider you and the Fund may pay more because there is no discount.

Q.  What is our deductible?
A.  Your deductible is:
In Network is $500 per person per calendar year and $1000 per family per calendar year.
Out of Network is $1000 per person per calendar year and $2000 per family per calendar year.

Q.  What is the most I could pay in a year for my major medical benefits?
A. In Network (excluding deductible): $6,000 per person and $12,000 per family.
Out of Network (excluding deductible): $12,000 per person and $24,000 per family. 

Q.  Who is covered under my benefits?
A. Yourself plus all of your eligible dependents as defined by the Plan.

Q.  How can I find a doctor?
A.  The link below will take you to a network web site where you can look through provider directories.
www.BlueKC.com

Q.  Why do I have to complete a form after an injury/accident claim?
A.  The Plan receives limited information from medical providers, and as a result, when the Plan receives a bill with a diagnosis of an accident or a possible accident, the Plan is required to obtain additional information, in writing, from the participant.  The Plan must determine, through the completion of the accident letter, whether the accident was work related, auto related or third-party liability.

Q.  How long are children covered under the Plan?
A.  An eligible employee or eligible retiree’s unmarried child who is living in the same household and dependent upon the eligible employee or  eligible retiree for the major portion of the child’s support and maintenance will be eligible until the end of the month of the child's 26th birthday.

Q.  Is there a short-term disability benefit available?
A.  If you meet the requirements as an eligible member there is a weekly disability benefit available for a maximum of 26 weeks (a total of 360 disability hours) within a 12-month period.  Please refer to the SPD or call your claims adjuster for additional information.

Vision

Q.  How do I file a vision claim myself?
A. Your eye care provider will submit services directly to the fund office. If your eye care provider is unable to submit services on your behalf, then you will need to send your itemized receipts to the fund office. 

Q.  Where can I go for vision services?
A. You may see any vision provider you wish. There is no network for routine vision services.

Q.  Do we have a max on our vision benefits?
A. Yes. Please refer to the mailing titled "Summary of Material Modifications" dated December 2011. 

Dental

Q.  What network are we in?
A.  There is a dental network, Connection Dental. They can be reached at 800-544-3014.

Q.  Where do I send my dental bills?
A.  Connection Dental/PHP, PO Box 25938, Shawnee Mission, KS 66225

Q .  Do I need a dental card?
A.  There is a dental identification card separate from your medical identification card. However, if you utilize an out-of-network dentist you and the Fund may pay more because there is no discount.

Q.  What dentists can I go to?
A.  You can see any dentist you wish.

Q.  What is the coverage period for the schedule of benefits?
A.  A calendar year.

Q.  How long are children covered under the dental Plan?
A.  An eligible employee or eligible retiree’s unmarried child who is living in the same household and dependent upon the eligible employee or  eligible retiree for the major portion of the child’s support and maintenance will be eligible until the end of the month of the child's 26th birthday.

Q.  If I don’t use all my benefits, can they rollover to the next year?
A.  No. Unused benefits cannot be rolled over to the next year.

Q.  Can I use my dental insurance out of state?
A.  Yes.

Q.  Is there any procedure that my dental insurance won’t cover?
A.  Yes. The following is a list of exclusions:

  1. Dental treatment for cosmetic reasons, including realignment of teeth.
  2. Dietary planning, plaque control, or oral hygiene instructions.
  3. Replacement of a lost or stolen Prosthetic Device or any other device or appliance.
  4. Expenses incurred after termination of coverage except for Prosthetic Devices (including bridges and crowns) which were fitted and ordered prior to termination and which were delivered within 30 days after the date of termination.
  5. Prosthetic services (including bridges and crowns) started or underway prior to the effective date of coverage.
  6. Any loss caused by war or act of war.
  7. Loss incurred while engaged in military, naval, or air service.
  8. Rebase on reline of a denture in less than six months from the date of initial placement and not more often than once in any two year period.
  9. Precious metal used for filling material unless no other filling material can be utilized.
  10. Procedures, restorations and appliances to alter vertical dimension or to restore occlusion.
  11. Replacement of prosthetics less than five years form the preceding placement, except as specified under Basic Dental Expenses (Defined in your SPD) and Major Dental Expenses (Defined in your SPD).
  12. Any condition, disability or expense sustained as a result of being engaged in an activity primarily for wage, profit or gain, or that could entitle the Covered Person to a benefit under the Worker's Compensation Act or similar legislation.
  13. Services of supplies for which there is no legal obligation to pay, or expenses which would not be made except for the availability of benefits under this Plan.
  14. Services that, to any extent, are payable under the Covered medical Expense benefits of the Plan.
  15. Expenses or charges for treatment of Temporomandibular Joint (TMJ) Syndrome or craniomandibular disorders.

 

Health and Welfare

Q.  Where is my Savings/Vacation money?
A. Your employer typically pays contributions on hours the month after you work them. For example, Savings money for hours worked during the month of January should be paid by your employer by the end of February. A Savings deposit is made weekly. Each week’s deposit includes all Employer Contributions received at the Fringe office during that 7-day period.

Q.  I just met the eligibility requirement. Why aren’t I eligible for insurance? 
A.  District Council No. 3 Painters and Allied Trades eligibility is monthly. This means that you will become eligible on the first day of the second month in which you are credited with your 480th hour of Employer contributions, provided that such hours are accumulated in a 12 consecutive month period.  Please call the Fringe Office or refer to page 16 of your Summary Plan Description Booklet for a detailed description of your eligibility.

Q.  I know for sure that I am eligible for insurance, why haven’t I gotten any information yet?
A.  Please call the Fringe Benefit Office at (816) 756-3313 or toll-free at (866) 756-3313 to make sure all contributions have been received and that we have a current address on file for you.  Please remember to notify the Fringe Benefit Office of any address changes so we can continue to assist you.

Q.  How will I know if I lose eligibility thru the Plan?
A.  Participants are sent a Loss of Coverage Notice at the end of their last eligible month. This is another reason why it is so important to keep the Fund office updated with your current address.

Q.  How do I bank hours?
A.  Once you have gained eligibility, hours worked and for which contributions are received by the Plan in excess of 120 hours in a work month are reserved in your Hour Bank.  Hours are automatically withdrawn from this bank to assist in maintaining eligibility if you fall short of 120 hours in any future work month.  Your Hour Bank account can never exceed 720 hours.

Q. How do I know if my employer is paying in my benefits correctly?
A.  Each quarter you will receive a statement from the Fund that shows the hours and benefit amounts that were reported to the Fund Office for that Quarter.

Q.  I just got a Quarterly Statement of hours, but it doesn’t have all my hours on it.
A.  A Quarterly Statement is a snapshot of your hours for a certain quarter of the calendar. For example, a Quarterly Statement that you receive in May shows hours received by the Fund Office in February, March and April.  Usually, this means that the hours were worked in January, February, and March because the Fringe Office gets the hours the month after you work them.  If your employer has turned in Fringe Contributions late, or there was an audit performed on a company you worked for, you may see some hours for months that don’t correspond with a calendar quarter.  Likewise, if your employer is turning in contributions late, some hours that should appear on the statement may not have been submitted yet, or could have been turned in after the cut-off for the Statement.

Q. What do I do if I want my hours transferred to another Fund’s jurisdiction?
A.  You need to contact your home Local and request a reciprocity form. Once you receive the form you will need to complete it and forward it to the Local you want your benefits transferred out of.

Q.  How much do I pay in for my Health Insurance?
A.  The District Council No. 3 Painters and Allied Trades Health and Welfare Plan is a multi-employer, self-insured plan, and eligibility for benefit coverage is determined by the number of hours worked and reported to the Plan.  It is an employer-paid Fringe Benefit, and not classified as Wages.

Q.  How much do I pay for my child(ren)’s Health Insurance?
A.  When a participant satisfies the Plan’s eligibility requirements, all dependents (as defined by the plan) are also eligible at no cost to you.

Q.  How do I add or delete dependents?
A.  If you need to add or remove dependents, you must notify the Fund Office in writing. You should be prepared to provide documentation in the form of a birth certificate, decree of adoption, marriage license, etc.  Since the Plan provides Benefits to Eligible Dependents, the Fund Office must know who your dependents are at all times.

Q.  How do I change my beneficiary?
A.  If you wish to change the name of your beneficiary, you must send the change to the Fund office in writing. If you fail to notify the Fund Office of your wishes in writing, the Fund office will be unable to pay any Death Benefits to anyone other than the person(s) in your latest written notification to the Fund Office prior to the time of your death.

Q.  How much do I pay for dues?
A.  Dues, as reported monthly by your employer, are 3% of your gross wages. You will receive a yearly dues statement after the first of the year, but for tax purposes we recommend using your W-2 form or paycheck stubs.

Pension

Q.  How much will I receive for my Pension?
A.  The estimated amount of your monthly benefit is listed on your member pension page. Click here to Login and then click on the Pension link.

Q.  Is there a disability benefit available?
A.  Yes, if you are deemed totally and permanently disabled. Please call the Fund Office for more details.

Q.  Is the pension taxable income?
A.  Yes.  You will have the opportunity to have federal taxes and MO state taxes deducted from your pension check. You should consult with a tax advisor in order to determine what you should have withheld on a monthly basis.

Q.  When should I call the Fund Office to begin the application process to start my pension?

A.  Please call the Fund office at least one month and no more than three months prior to your retirement date