OHIO LABORERS INSURANCE
Since 1965, the Ohio Laborers’ District Council has been providing quality health insurance along with a variety of other benefits to our members. For over 50 years we have been working diligently to keep costs down while maintaining excellent benefits and a high level of member friendly, helpful and knowledgeable service from our Benefits Office staff. It is important to us to take care of our members the same way they take care of Ohio’s infrastructure.
I am a proud member of LiUNA and Local #500. I had always known we had pretty good benefits, but On April 13th of 2020, I found out – in one of the worst ways – exactly how blessed we are with our benefits. While working on a job, I was injured. I was expecting to hear a kinked neck, maybe pulled muscles, but the words I heard changed my life forever. “You have cancer.” To say I was scared is an understatement. So many questions. The biggest concern of mine was I had watched a mother battle this disease, and I knew the amount it costs to get good quality care. I wasn’t sure if my healthcare would cover things. I was worried, now that I couldn’t work, did I have to make decisions between paying for health costs or feeding my two amazing children. After speaking with Alexis (in the Insurance Department at Ohio Laborers Benefits), she assured me everything would be ok. I was able to use Short-Term Disability to help with things like groceries, but also my medical insurance would make sure I had the care necessary to beat this disease – I mean we are Laborers, nothing can beat us. Thanks to our benefits, I was able to meet with some of the top doctors in the country for my form of cancer, which is Plasma Cell Myeloma (blood cancer), my treatments have cost well over $85,000 a month and I’ve paid next to nothing. I was given access to some of the best facilities, medicines, doctors… this saved my life. Today I am in remission and on maintenance chemo, even that costs $34,000 a month, and I pay $0.00. We are blessed as LiUNA members to have access to healthcare that we do, I have unfortunately seen others not so blessed. I can’t thank the Ohio Laborers, my Local (500), and Alexis enough. They’ve been with me every step of the way. Faith, hope, love. Psalms 91
Did YOU know… there is an annual limit for in-network medical expenses? For 2021, maximum out-of-pocket medical expenses are capped at $3,975 per person.
Did you work enough hours to keep your insurance eligibility?
During the winter months when many Laborers get laid off, some may not have worked enough hours in the previous laboring season to extend insurance eligibility until work picks up and hours start being reported again. If you are concerned about how long your insurance eligibility is extended, you can check your eligibility a few different ways: First, you can access your MemberXG account at ohiolaborers.com. With a MemberXG account, you can do many more things as well – from checking how your pension benefit is growing to uploading enrollment forms and documents. Secondly, you can always call the staff at the Benefits Office (800-236-6437) to ask about your eligibility or other benefit questions. And finally, you can track on your own eligibility, by understanding how the OLDC-OCA Insurance Fund calculates it.
Understanding Insurance Eligibility
In general, the more hours you work, the longer your eligibility is extended. Once you meet the Initial Eligibility requirements (450 hours in a six consecutive month period), we look at every month individually when calculating continued insurance eligibility. And for each month, we look at your work history for three different time periods. There are 3, 6, and 12 month look backs. And, if work enough hours in any of the three time periods for a particular month, you will be eligible for insurance for that month. Specifically, your eligibility will continue, if, you work at least:
250 hours or more in the first 3 months of the 4 months immediately preceding the month of coverage; or
500 hours or more in the first 6 months of the 7 months immediately preceding the month of coverage; or
1,000 hours or more in the first 12 months of the 13 months immediately preceding the month of coverage.
We acknowledge this isn’t the easiest to follow without examples, so please click HERE for a monthly scenarios table. In general, if you work 250 hours or more in every 3-month period, you will not lose your insurance. Or, if you work 500 hours in every 6-month period, or 1000 hours for every 12-month period, you will not lose your insurance. This 12-month calculation leads to one of the more common misunderstandings amongst Laborers around the state. Many people think, if you work one thousand hours in a calendar year, you are covered for insurance for the entire next year. That is not true; the Insurance Fund does not have any annual eligibility calculations. As noted above, we look at each month individually when calculating insurance eligibility. No one expects you to fully remember these calculations, but you should at least be familiar with how your benefits work. So, if you do get laid off, or if your hours dip significantly, you can have a broad understanding of why.
Additional notes: Your contractor must report and pay the contributions due before your eligibility will be extended. There is generally a one-month lag in contractors reporting working hours.
What happens if you don’t work enough hours and lose your insurance eligibility?
Hopefully, you will always have enough hours to maintain your insurance, but chances are, sometime in your career your hours will dip, and you may lose eligibility. So, what happens then?
First, you will be notified a couple weeks before your eligibility is scheduled to end. At that time, you will need to decide if you want (or need) to make a monthly payment to keep the insurance for you and your family. If you decide to make a payment, the rate will vary from month to month based on your individual work history. Currently, self-contribution payments will not exceed $1,750.00 for a three-month period. The monthly billed amount is based on the least number of hours needed to maintain eligibility for that particular month based on the 250, 500, or 1,000 hours rules previously discussed.
You do have 60 days to decide if you want to make the first monthly payment. This will give you time to assess the situation and decide if you need or want to make the payment to keep your insurance, or not. Items to consider here: Are you back to work already, and will your working hours get you eligible again in a month or two? Are you young and healthy, or do you have dependents on the Plan that need the insurance?
Whether you decide to make monthly payments to continue your insurance eligibility or not, once your hours start coming in again, your eligibility will kick back in based on the 250, 500, or 1,000 hours rules. The only time you will need to reestablish with 450 hours (Initial Eligibility requirement) is if you go 12 consecutive months without insurance eligibility with the Plan.
If you continue to make COBRA payments after 12 months, the monthly amount due will change to a fixed rate starting with your 13th month of COBRA and will continue through month 18. For more information on self-payments/COBRA, review pages 38-41 in the Insurance SPD.
With LiveHealth Online, you have a doctor by your side 24 hours a day, seven days a week. LiveHealth lets you talk face-to-face with a doctor through your mobile device or a computer with a webcam. No appointments, no driving, no waiting in an office with sick people, and most notably – no cost to you. You can even get prescriptions (except for narcotics) through LiveHealth Online (applicable charges will apply for prescriptions). You can use it for common health concerns and for mental health visits; however, appointments are needed for the mental health visits.
Members will need their ID number from their Anthem card to register properly. Members can also add eligible dependents to their LiveHealth Online account. Any eligible dependent 18 years or older will need to create their own account using their own email.
LiveHealth Online services covered under the OLDC-OCA Insurance Plan are paid for by the Fund and are available free of charge to Members – no service fee, no copay. Video visits using LiveHealth Online are a covered benefit of Anthem Blue Cross Blue Shield. Any doctor a Member visits with through LiveHealth Online will be in-network. For more information and to register for LiveHealth Online, download the mobile app or click HERE.
Use LiveHealth Online for common concerns:
- Ear infections
- Watery, puffy eyes
- Pink eye
- Sore throat
- Skin infections
- Medication concerns
- Life transitions
- Coping with Illness
- Panic Attacks
- Bipolar Disorder
- Obsessive Compulsive Disorder
Post-Traumatic Stress Disorder
FREE Wellness Services/Supplies
Preventive care includes health services like screenings, checkups, and patient counseling to prevent illnesses, diseases, and other health problems. With your medical benefits, all eligible members and dependents are urged to get a routine annual physical exam at no cost. Routine physicals are key to finding undiagnosed issues or concerns that could lead to larger health problems.
Even more important than with adults, children need routine preventative care and exams. You want to make sure your child is developing appropriately and getting the required immunizations. All of the recommended well visits for children are covered at no cost as well.
For those coping with diabetes, the OLDC-OCA Insurance Fund covers many Diabetes Testing and Treatment Supplies at no cost through your Prescription Drug Benefit: insulin needles and syringes, lancets and devices (spring or powered), blood glucose testing strips, (normal, low, and high) calibrator solution/chips, and alcohol wipes. To receive these at no cost, you must get a prescription from your doctor. The supplies through Elixir will be subject to mandatory mail order; therefore, you need to ask your doctor for a 90-day prescription. Certain glucometers are also available through Elixir at no cost.
The Centers for Disease Control and Prevention recommends a yearly Influenza Vaccine for everyone 6 months of age and older as the first and most important step in protecting against influenza. Seasonal flu viruses are detected year-round in the United States. However, flu viruses are most common during the fall and winter. The exact timing and duration of flu season can vary, but influenza activity often begins to increase in October.
As you are probably already aware, smoking causes or worsens many medical issues, conditions, and diseases. If you or your eligible dependent(s) want to stop smoking, you can get Smoking Cessation Drugs for free. Simply get a prescription (for either OTC or prescription medication) from your doctor and get it filled at your local pharmacy for at no cost.
Annual Mammograms for those age 40 and older are covered at no cost. These can detect cancer early — when it is most treatable. In fact, mammograms show changes in the breast up to two years before a patient or physician can feel them. Mammograms can also prevent the need for extensive treatment for advanced cancers and improve chances of breast conservation. Current guidelines from the American College of Radiology, the American Cancer Society, and the Society for Breast Imaging recommend that women receive annual mammograms starting at age 40 — even if they have no symptoms or family history of breast cancer.
Preventive Services that have a rating of “A” or “B” in the United States Preventive Services Task Force, routine immunizations, and other screenings as provided for in the Patient Protection and Affordable Care Act are covered at no cost. Age and other restrictions apply to certain services. For example: Colonoscopies only covered for ages 50 to 75, Bone Density Testing is only covered for women age 60 and older, Herpes Zoster (shingles) Vaccine is covered at age 50 and older, HPV Vaccine is covered under age 27.
The Insurance Fund also covers Birth Control for Women and Routine PAP Smear Tests at not cost. All contraceptive methods for women approved by the FDA are covered. Certain restrictions may apply.
In the event of any inconsistency between the information provided here and the official Plan documents of the OLDC-OCA Insurance Fund, the terms of the official Plan document, as interpreted by the Board of Trustees in its sole discretion, will control.