Welfare Summary Plan Description


Q. What documents will need to be provided if I am enrolling/dis-enrolling dependents?

Event Sample Documents Plan Provision
Marriage Marriage Certificate Must be submitted within 60 days following marriage.
Gain Dependent: Birth/Adoption Birth certificate or Certificate of Adoption Must be submitted within 60 days following birth/adoption.
Spouse/Dependent gains coverage through employment Notification from new employer Must be submitted within 60 days of newly becoming eligible under another health plan.
Spouse/Dependent losses employment Notification from prior employer Must be submitted within 60 days of loss of coverage.

Q: I understood that my plan would not charge for a routine physical examination. However, the explanation of benefits I received shows that you applied part of the charges to my deductible and only paid a percentage of the balance.
A. This happens when your physician has indicated on the billing statement that your examination was for a specific symptom or complaint. The billing statement must reflect that the primary purpose for your visit was for preventive care. The Plan and Trust cannot change the physician's billing statement; you will need to contact your physician.

Q. What is the name of our insurance company?
A. Your medical and dental benefit coverage is provided through the Alaska Teamster-Employer Welfare Trust, which is a multi-employer employee benefit plan governed by a federal law called ERISA, the Employee Retirement Income Security Act. Medical and dental benefits (other than Retiree benefits obtained through TEAMStar) are not paid by an insurance company; they are paid directly by the Plan.

Q. The doctor's office needs my group number and identification number to file my claim.
A. The group and ID numbers for your medical, dental and prescription drug benefits are now on your ID card. Please refer to your medical/dental card for your medical and dental ID numbers.

Q: What does the limit to "Usual, Customary and Reasonable" charges mean?
A. The Plan will not pay charges above the "Usual, Customary and Reasonable" rate for medical services or supplies. A charge that does not meet all three of those requirements – by being "usual," "customary," and "reasonable" – will be adjusted by the Plan or eliminated. A charge is "usual" if it is no more than the charge that the medical provider most frequently makes to its patients for that service or supply. A charge is "customary" if it is equal to or less than the 85th percentile rate established for the geographic area by the Plan's third party service, which analyzes appropriate health care charges, and does not exceed Medicare's allowed amount for end-stage renal disease charges. A charge is "reasonable" if the service or supply is justified by the circumstances, and is not performed too frequently or at an unreasonable time.