1. When am I eligible for hospitalization?  
In order to be eligible for Hospitalization Plan A coverage, you need to have worked 390 hours in the previous eligibility period.  See the Summary Plan Description, page 4 for a list of these periods.

2. When do I get my prescription coverage?    
There is a 3-month waiting period for the prescription coverage.  You must be covered under Plan A for one quarter before being eligible for the Prescription Drug Plan.

3. What do I do if I want to know if a specific service is covered?
Call the Fund Office at 216-361-6190.

4. What networks do we use? 
Medical Mutual Super Med Plus for medical and Delta Dental for dental

5. Do I have to use an in-network provider? 
You do not need to see a Medical Mutual/Super-Med Plus- affiliated doctor.  However there is a savings for using an in-network provider.

6. How can I find an in-network doctor? 
The best resource is www.medmutual.com

7. How can I get a replacement medical/dental/prescription card? 
Contact the Fund Office.

8. I just got married, had a new baby or got divorced, what should I do? 
Contact the Fund office as soon as possible and you will be sent the necessary paperwork.

9. My son/daughter is 19 are they covered?   
Full-time college students (12 credit hours) are covered until their 23rd birthday.  A full-time student form must be completed each quarter/semester they are enrolled.

10. Where can I get a full-time student form? 
or contact the Fund Office.

11. I just received an Explanation of Benefits from Medical Mutual and I don’t understand it.  What can I do?  
For active and non-Medicare members, although the Explanation of Benefits is sent from Medical Mutual, all questions should be directed to the Hospitalization Office at 216-361-6190 or 800-421-3959.  For Medicare Advantage members, questions regarding your Explanation of Benefits statements should be directed to Medical Mutual of Ohio at 866-575-5260 or the Fund Office.

12. I just received an Explanation of Benefits with some questions on it.  What do I do?   
This is an accident questionnaire.  Please tell us why you sought medical services that day.  Then sign the form and return it to the Fund Office.  All claims are held pending this information.

13. My wife has insurance too. Who is primary?   
Your insurance is always primary on you; your wife’s insurance is always primary on her.  If you have dependents, we follow the birthday rule – the parent whose birthday occurs first in the year is the primary provider.

14. Do I need a referral to see a specialist?  
No

15. I have the Medicare Advantage Plan, and my provider will not accept my MMO Medicare
Advantage card, should I pay for the service? 
No, you will not be reimbursed.  You must find a provider who accepts the terms and conditions for payment.

16. I am on the Advantage Plan, do I need a separate card for prescriptions?   
No, your MMO Medicare Advantage card is all you need.

17. What are my vision benefits?   
Eligible active members vision benefits are $250 per person with a $750 family maximum.  Members and spouses are eligible once every 24 months, while dependent children are eligible once every 12 months from the date of service.  Retired non-Medicare members and Medicare Advantage members are eligible for $25 toward exam and $50 for glasses once every 24 months (dependent children once every 12 months from the date of service).  Retired Kaiser members do not have a vision benefit.

18. How does the vision benefit work? For active and non-Medicare eligible members, we have a reimbursement system.  You can use any provider you want, pay them and submit a copy of your receipts to the Fund Office.  Please make sure all receipts are itemized and include the member’s Social Security or MMO ID number and patient’s name and birth date.  Hand-written receipts and credit card receipts will not be accepted.  Receipts should be mailed to Carpenters’ Hospitalization Plan, 3611 Chester Avenue, Cleveland, OH 44114. 

This information does not apply to Medicare Advantage members.  Please contact Medical Mutual of Ohio for detailed benefit information.  Retired Kaiser members do not have a vision benefit. 

19. What are my dental benefits?  Dental benefits for active and non-Medicare members are provided by Delta Dental.  Active members’ dental benefits are based on the calendar year (January 1st-December 31st) with a maximum of $1,000 per person/per year.  Non-Medicare, retiree benefits are $500 maximum per person/per calendar year. 

20. How do I find a Delta Dental provider?
www.deltadental.com

21. Do I have a hearing aid benefit?  
Eligible Active members and their covered dependents are eligible for one medically necessary hearing aid per person every two years, up to a maximum of $1000 per person.  Claims should be sent to Carpenters’ Hospitalization Plan, 3611 Chester Avenue, Cleveland, OH  44114.  Retired members (non-Medicare and Medicare-eligible) do not have a hearing aid benefit.