Topics:
Address Changes
Changes in Family Status
Claim Filing Process
Dental Plan Options
Disability Extension of Benefits
Emergency Care
Hospital Prior Authorization (Medical Review)
How to Enroll
Open Enrollment
Plan Eligibility
Preferred Provider Organization (PPO)
Prescription Drug Coverage
Vision Coverage
Address Changes
Q. How do I change or verify my TBT mailing address?
A. Send a Change of Address Card (below) to the TBT Plan Administration Office. To verify your Plan address, contact the TBT Plan Administration Office.
Change of Address Card: Participant (PDF) | Retiree (PDF)
Remember, you are responsible for notifying TBT about changes to your mailing address so you will receive important information about your Plan benefits. TBT keeps one address for each participant. If your covered spouse or dependents do not live with you, make sure they know that all TBT mail is sent to your address.
It’s also a good idea to send address changes to your Teamsters Local Union and Contributing Employer. Please be aware that your Local Union and the Teamsters Benefit Trust are administered separately. Changing your address with your Employer or Local Union will not update the address the TBT Plan Administration Office has on file for you.
Changes in Family Status
Q. How do I notify TBT about changes that affect my eligibility or that of my covered dependents?
A. It is extremely important that you notify the TBT Plan Administration Office in writing within 30 days when a change occurs that affects your eligibility or that of your dependents (including your covered spouse) or when you need to add or remove an eligible dependent. You will be required to submit an updated enrollment form with the change in family status.
You must notify the TBT Plan Administration Office within 30 days if:
- You get married or divorced.
- You establish a domestic partnership.
- A covered family member dies.
If your Plan provides coverage for dependent children, you must notify the TBT Plan Administration Office within 30 days if:
- You have a newborn child.
- You adopt or become the legal guardian of a child.
- Due to marriage, you acquire stepchildren that you want to cover as dependent children.
- Due to divorce, your stepchildren are no longer eligible for coverage.
- Your covered child loses coverage due to age (see next question).
- A covered family member dies.
With your notice, send The TBT Plan Administration Office a copy of your:
- Marriage certificate
- Certification of domestic partnership
- Divorce decree
- Birth certificate (if a child is added after one year following birth)
- Adoption or legal guardianship documents (as requested)
Note: Evidence of a child’s status as an eligible dependent (including a court order of adoption or an order appointing you as the child’s legal guardian) is required.
See the Summary Plan Description (including the Guide to Your Benefits) for your TBT Plan to learn more about your Plan’s eligibility requirements and coverage.
Claim Filing Process
Q. How are my Indemnity Medical claims paid when I use the PPO network?
A. Generally, if you use the PPO providers, there are no forms required to fill out and submit because providers bill the Plan directly. Present your Anthem Blue Cross PPO identification card each time you receive medical services because instructions for billing are on the back of the ID card.
Participating providers agree to handle the claims for PPO participants and bill the Plan directly. After the Plan pays, you are billed for your portion (if any). You are responsible only for your deductibles and share-of-cost amounts when they are required by your Plan.
Q. How do I know whether a claim will be paid?
A. Each TBT Plan has unique limitations and exclusions and claims review and denial procedures that are described in the Guide to Your Benefits for your TBT Plan.
HMO limitations are described in the Evidence of Coverage brochures provided by each HMO. Copies of these materials are available through the TBT Plan Administration Office. If you have questions about your coverage or the claim filing process and deadlines, contact the TBT Plan Administration Office.
Q. How will I know if my Indemnity Medical claim has been paid?
A. Once your Indemnity Medical claim has been received and processed for payment, you will receive an Explanation of Benefits (EOB), a statement explaining what portion of your bill was paid under the Plan and what portion is your deductible or share-of-cost.
Q. What should I do if I have a question about a claim?
A. If you have a question about your claim, call the TBT Plan Administration Office and ask for the Claims Customer Service Desk.
TBT Dental Plan Options
Q. How do I enroll for dental coverage?
A. The TBT Plan Administration Office automatically mails your enrollment materials to the address provided by your Employer as soon as you become eligible. If your Plan provides dental coverage, your package will contain a Dental Option Form that lists your TBT Dental Plan options. The Comparison of Dental Benefits for your TBT Plan helps you compare your Plan’s choice of dental options. Contact the TBT Plan Administration Office if you are a newly hired employee (with a currently participating Employer) and need more information. Read about TBT Dental Plan resources.
Disability Extension of Benefits
Q. How do I apply for an extension of TBT benefits if I become totally disabled and cannot work?
A. If you are eligible for TBT benefits but cannot work because you become totally disabled as a result of an illness or injury, coverage for you and your covered dependents may continue for up to three months. See What is Total Disability? (defined in your Plan’s Guide to Your Benefits for your TBT Plan).
Extension of benefits coverage is not automatic. You must apply for the extension of benefits by filling out and submitting the required forms to the TBT Plan Administration Office. Contact the Administration office at (800) 533-0119 and ask for the disability department as soon as your physician has determined you will be out on disability. If you feel entitled to an extension of benefits, you should send a claim and evidence of your disability to the TBT Plan Administration Office as soon as possible. You will receive an initial decision on whether you qualify for a disability extension within 45 days. Download the Proof of Disability Form (PDF).
Emergency Care
Q. Must the Indemnity Medical option’s hospital pre-authorization and utilization review requirements be followed in an emergency?
A. Under the TBT Indemnity Medical option, Anthem Blue Cross Life and Health must be notified as soon as possible following an emergency hospital admission (and no later than 72 hours after admission). The doctor’s office must call Anthem Blue Cross toll-free at (800) 274-7767. Once notified, the registered nurse coordinators and doctors at Anthem Blue Cross Life and Health conduct the certification and communicate their decisions to the doctor’s office, often during the same phone call. Read Indemnity Medical option’s Hospital Requirements for more information.
Hospital Prior Authorization (Medical Review)
Q. When must hospital coverage be pre-certified?
A. Under the TBT Indemnity Medical option, Pre-admission Certification is required before you are covered for any non-emergency hospitalization. (See the next question for emergency hospital requirements.) Call Anthem Blue Cross life and Health at (800) 274-7767 (or make sure your doctor calls them) before a hospital stay is scheduled. Failure to obtain Pre-admission Certification will result in a reduction or loss of benefits. Charges for non-certified hospital days are not covered under the Plan. Read about Hospital Requirements for more details.
For alcohol or chemical dependency treatment, different Pre-admission Certification procedures are required before an in-hospital stay. The Teamsters Assistance Program (TAP) must pre-certify and oversee hospitalization due to alcohol or chemical dependency treatment. Phone TAP at (800) 253-TEAM or (510) 562-3600 for Pre-admission Certification. See the Summary of Coverage for limitations related to this treatment under your TBT Plan. Note: If you are a member of Teamsters Locals 94, 137, 150, 386, 431, 439 or 533, the Joint Council 38 Teamsters Alcohol/Drug Rehabilitation Program (TARP), rather than TAP, oversees hospitalization due to alcohol or chemical dependency treatment. Phone TARP at (800) 522-8277 or (209) 572-6966.
How to Enroll
Q. How do I apply for enrollment in a TBT Plan?
A. Once you are eligible for coverage, you must enroll within 30 days to have the medical and dental options you want. You enroll yourself and your eligible dependents by completing the forms (that are automatically mailed to you by the TBT Plan Administration Office when you become eligible). These forms are available on this website.
Remember, TBT Plan representatives must first verify your eligibility before sending you the enrollment materials that apply to your Plan coverage. Contact the TBT Plan Administration Office if you need enrollment materials or have questions about eligibility.
Q. Are there enrollment deadlines?
A. Yes. Coverage is not automatic. If you don’t send in the required enrollment forms within 30 days after you and your covered dependents become eligible, the coverage may be delayed—or even denied if you choose an HMO. You may also lose the opportunity to enroll in the TBT medical and dental options of your choice. See How to Enroll in your Plan’s Guide to Your Benefits for your TBT Plan for more details about how to enroll. Your Plan’s Guide, Summary of Coverage and other materials are posted under your TBT Plan.
Open Enrollment
Q. How do I change my TBT medical and/or dental options?
A. After your initial election of medical and dental options, your Open Enrollment program allows you to change your medical and/or dental options once every 12 months between January 1 and December 31.
Your new 12-month Open Enrollment period begins each time you change medical and/or dental options. You and your eligible dependents must be covered under the same medical and dental options. Read more about Open Enrollment. Note: There are no annual mailings. You will not be sent medical or dental option change forms unless you request them from the TBT Plan Administration Office.
Q. What if I don’t make changes? Must I renew my medical and dental options each year?
A. If you do not request changes, your current medical and dental options will stay in effect as long as they are offered by TBT and you remain eligible under your Plan. From time to time, TBT may change the available options. If this occurs, you will be notified and may then choose any of the currently available options. See Plan Updates to view or print recent Plan notices or Summaries of Material Modification (SMMs).
Q. May I change my TBT medical or dental option when I move out of the service area for the HMO or prepaid dental plan I chose?
A. Yes. You may change your TBT medical or dental option when you move out of the service area for an HMO or prepaid dental option you chose. The TBT Indemnity Medical and Indemnity Dental options are not limited to specific service areas. Contact the TBT Plan Administration Office for details that apply to you and your coverage.
Contact TBT a few months before you move so the change will take affect when needed. All required enrollment forms—including the TBT Enrollment Form, Medical Option Form, Dental Option Form (and an HMO application if you choose an HMO) must be received by the TBT Plan Administration Office before the changes may be effective. See How to Enroll in your Plan’s Guide to Your Benefits. Read more about TBT Health Maintenance Organization (HMO) Resources.
Plan Eligibility
Q. How do I confirm eligibility status for me and my dependents?
A. To verify eligibility status and Plan details, contact the TBT Plan Administration Office. Only the TBT Plan Administration Office represents the Trustees in verifying eligibility, administering benefits and providing information. Plan representatives may give you information in person, on the phone or in writing. Keep in mind that only written communications from the TBT Plan Administration Office are binding upon the Board of Trustees.
Preferred Provider Organization (PPO)
Q. What is a PPO?
A. Under the TBT Indemnity Medical option, a Preferred Provider Organization (PPO) is a network of hospitals, doctors, x-ray centers, clinical laboratories, physical therapy centers, chiropractors, mental health providers and other medical facilities or providers that have agreed to accept pre-negotiated rates for services covered by your Plan.
Q. Which PPO network is available under the TBT Indemnity Medical Option?
A. If you have selected the TBT Indemnity Plan medical option and live in California, your PPO network is the Anthem Blue Cross PPO. If you live outside of California and have elected the TBT Indemnity Plan medical option, your PPO network is the Blue Cross Blue Shield National PPO. Note: If you live in California, you can use the Blue Cross Blue Shield National PPO network when you travel out-of-state.
Q. How do I save money (for me and the Plan) when I choose a PPO network provider?
A. PPO providers bill TBT at pre-negotiated rates that are lower than rates charged by non-PPO providers. Therefore, your share of the bill with a PPO provider will be lower because the amount billed by the provider is lower.
For some claims, the copayment percentage TBT pays is higher if you use a PPO provider than if you use a non-PPO provider. For example, an inpatient hospital stay at a PPO hospital is generally covered at 100% of the PPO rate and 50% of “usual and customary” rates if you use a non-PPO hospital.
You are responsible for paying any charges above Usual, Customary and Reasonable (UCR) if you use a non-PPO provider. Any amount that you are required to pay due to use of a non-PPO hospital does not apply towards your out-of-pocket maximum. See the Guide to Your Benefits and Summary of Coverage for your TBT Plan for more details.
Q. How do I use the PPO network?
A. Before making an appointment, call the Provider Access phone number on the back of your Anthem Blue Cross ID card and find out if your doctor, hospital, lab or other provider is in the PPO network.
Once you have confirmed that your provider is in the PPO network, schedule your appointment and identify yourself as an Anthem Blue Cross PPO participant (Blue Cross Blue Shield National PPO if you live outside of California).
Present your Anthem Blue Cross ID card at the doctor’s office. If you need medical care and have not received your ID card, ask the provider to contact the TBT Plan Administration Office to verify eligibility and for billing instructions.
Prescription Drug Coverage
Q. Is there a list of prescription drugs that are covered under the Indemnity Medical option?
A. Under the TBT Indemnity Medical option, there is not currently a drug “formulary” or list of covered or excluded drugs. (However, the TBT Board of Trustees reserves the right to adopt a formulary if necessary in the future.)
The Indemnity Medical option covers most medicines and drugs that are: (1) prescribed under federal and state laws by a licensed doctor or dentist, (2) medically necessary for the patient’s illness or injury, (3) fully approved by the U.S. Food and Drug Administration (FDA), (4) not excluded under the heading What is Not Covered in the Prescription Drugs section of the Guide to Your Benefits (found under your Plan’s name to the left). Also refer to What is Covered in your Guide’s prescription drug section to find out about the most common drugs and medicines that are covered and limitations or restrictions that apply. If you are not sure whether an item is covered, call Prescription Solutions/Optum Rx at (800) 797-9791.
Q. How do I file prescription drug claims?
A. You rarely need to file a claim when you use Anthem CarelonRx participating pharmacies or the mail order service. However, some TBT Plans require that Kaiser enrollees use a Kaiser pharmacy only. See your Summary of Coverage for details.
TBT Vision Coverage
Q. Must I enroll for vision coverage?
A. No. You are automatically enrolled in your Plan’s vision coverage when you enroll for your TBT Medical Plan option. Check the Guide to Your Benefits, Summary of Coverage and Comparison of Medical Benefits for your TBT Plan for details about your vision and other benefits.