Sign Up Here

Frequently Asked Questions

Replace with: Here is a list of frequently asked questions by benefit type.
If your question is not addressed here, contact the Administrative Office
at 714-898-2200 or 1-800-499-8121.

For Active Employees  See Retiree FAQs

Why is it necessary to provide a statement about accident details when the accident was not work related?

Although the services may not be work related, there are still other instances where there is a "Third Party Liability (TPL)". Some examples are automobile accidents, slip and falls, etc. If services are not a result of a TPL, simply provide the details on the questionnaire, sign, date and return it to the Trust Fund office. This information cannot be taken over the phone through the Customer Service line.

If services are a result of a TPL and benefits are payable, the Fund, as a condition for furnishing benefits, requires a statement acknowledging that reimbursement is due to the Fund for monies collected.

Why do you delay claims asking if my dependents have other insurance coverage? Why can't this be handled during open enrollment?

Each year, questionnaires are sent when the first claim is filed. Although your dependent did not have other coverage in the past, it is still necessary to document the file for the current claim year. Obtaining this information during the open enrollment period may not be applicable to the period when the charges are incurred.

If there is other insurance coverage for your dependent children, the Fund uses the "Birthday Rule" for the coordination of benefits. This means the plan of the parent whose birthday falls earlier in the calendar year (regardless of birth year) will be primary.

How long do newly eligible people have to stay in the HMO and prepaid dental plan?

You will be able to make different plan selections during the first open enrollment (held in November) after your benefits start, for coverage starting the January 1 after that open enrollment.

How can I find out whether I live in an HMO’s or prepaid dental plan’s service area?

Service areas are determined by zip code. You can get a list of HMO service area zip codes from the Administrative Office.

How can I find out what doctors and dentists are in the PPO networks?

The Administrative Office can provide you with copies of the most recent provider directories free of charge. You can also visit the websites shown in the Resources section.

Can I choose one plan for myself and a different plan for my dependents?

No, your family must be enrolled in the same medical and dental plan you select for yourself.

Do I need to take a medical exam before I can enroll in benefits?

A medical examination is not required. Eligible individuals and their eligible dependents will be covered regardless of their physical condition.

What happens to my benefits if I become disabled?

If you lose eligibility as an active employee due to an injury or illness, you may become eligible as a disabled employee if a disability extension of benefits has been negotiated on your behalf. Find out more at the Disability Extension of Benefits page. Other options may be self-payment and COBRA Continuation of Coverage.

Do I have to pay anything for benefits during a disability extension?

You do not have to pay anything toward the cost of coverage. You will, of course, have to pay any out-of-pocket expenses you incur if you use your health care benefits (deductibles, co-pays, etc.).

Will I get a monthly bill for my COBRA coverage?

No, the Administrative Office will not send monthly bills or warning notices. It is the responsibility of the qualified participant to submit payments when due.

Can I choose to continue medical but drop my other health care benefits?

No, your health care benefits are treated as a package. You may either continue all of the health care benefits you had at the time of the qualifying event or choose to let all such benefits end.

When I elect COBRA, can I change from one medical plan to another or from one dental plan to another?

When you initially elect COBRA, you must remain in the plans you are in at the time (unless you move out of an HMO’s or prepaid plan’s service area). You may choose a different medical and/or dental plan during open enrollment in November, with the change effective for coverage starting the following January 1.

Can I get mental health and substance abuse benefits through the medical plan?

No. To receive benefits for mental health or substance abuse treatment, non-Kaiser participants must use the program services provided by Optum Health (formally PCBH)—no mental health or substance abuse benefits will be paid under any other Trust Fund program.

Will my other benefits continue during the time I’m disabled?

If a disability extension has been negotiated for you (or for the bargaining unit employees of your employer), your benefits can be continued for up to 12 months or up to 18 months, whichever has been negotiated. Check your Schedule of Benefits to see whether a disability extension is included. Go to the Disability Extension of Benefits page for more information.

Your employer may be required to continue contributions for your coverage before a disability extension begins. If you have questions about your coverage, check with the Administrative Office or refer to the applicable Collective Bargaining Agreement.

Would my taking an accelerated benefit affect the amount my beneficiary would receive after my death?

Yes. Once the accelerated benefit has been paid, your life insurance amount will be reduced by the amount of the accelerated benefit payment. For example, if your life insurance benefit were $10,000 and you took $5,000 as an accelerated benefit, your beneficiary would receive $5,000 after your death.

Does dependent life insurance include accelerated benefits in cases of terminal illness?

No, the accelerated benefits program is available only for employees.

Is Gastric Bypass surgery covered by my plan?

No. Gastric Bypass surgery is NOT a covered benefit under any of the LAMBT plans. Please refer to page 25 of the Summary Plan Description, under the "Exclusions from Coverage" section.

How can I find out whether a particular service or supply is covered by the Plan?

You can refer to the Summary Plan Description, under the "Exclusions from Coverage" section, to find a listing of all Plan exclusions.

back to top

For Retirees  See Active Employee FAQs

How can I find out what doctors and dentists are in the networks?

The Administrative Office can provide you with copies of the most recent provider directories free of charge. You can also visit the websites shown in the Resources section.

What if I’m eligible for Medicare but my spouse isn’t?

In that case, your spouse will be enrolled in the closest counterpart for participants not eligible for Medicare (for example, the Kaiser HMO if you enroll in Kaiser Senior Advantage, the PacifiCare (UHC) HMO if you enroll in PacifiCare Secure Horizons). You and your spouse can choose either the high or the low option under your program.

Can I enroll myself in Kaiser and my spouse in Blue Shield?

No, you must either both be in Kaiser or both be in Blue Shield.

If I decide to get dental care through my HMO, can I enroll my spouse separately in United Concordia?

No, you may enroll your spouse in United Concordia only if you enroll yourself.

Do I need to take a medical exam before I can enroll in benefits?

No medical examination is required. Eligible retirees and their eligible spouses will be covered regardless of their physical condition.

Can a spouse who’s already eligible for Medicare elect COBRA continuation coverage?

Yes (other than the extended coverage allowed for HMO participants in California). However, if your spouse becomes eligible for Medicare after electing COBRA continuation coverage, the COBRA continuation coverage will end.

Will my spouse get a monthly bill for COBRA continuation coverage?

No. The Administrative Office will not send monthly bills or warning notices. It is your spouse’s responsibility to submit payments when due.

Can my spouse change from one medical plan to another?

Not at the time of initially electing COBRA continuation coverage. If another option is available, your spouse may change plans during Open Enrollment in November, with the change effective for coverage starting the following January 1.

What happens if I go to a provider that is not part of the Blue Shield network?

You will have to pay the entire cost of treatment. Your benefits will not cover treatment at a non-contracting provider, except in the case of an emergency.

What if I need help in the evening? Or over a weekend?

Call Blue Shield at 800-776-4466. The phone lines are staffed around the clock.

back to top