Medical Plan FAQs

What is the Annual Medical Dental Update Form and why do I need to fill it out each year?

An Annual Medical/Dental Update Form for each participant (and reflecting such participant’s eligible dependents) must be on file at the Administrative Office for any claims to be processed. 

The Plan requires that an Annual Medical/Dental Update Form be updated once every twelve months or whenever the patient’s information changes.  For example, the form should be updated when a spouse’s medical insurance changes through his or her employer.

How do I add a dependent?

Simply update your Enrollment Form and submit copies of the following documents, as appropriate:

  • State-issued Marriage certificate
  • State-issued Birth certificate
  • Adoption papers signed by a judge
  • Certificate of creditable coverage from your dependent’s prior insurance coverage
  • Court orders in case of divorce decree and/or any other legal documents specifying the order to provide medical support for a dependent child. 

For an overview on who your eligible dependents are, please visit the Eligibility & Reciprocity page.

Note: You should submit a new enrollment form to the Administrative Office as soon as possible if you gain a new eligible dependent (for example through birth or adoption of a child).

How long do I have to file a claim?

The Plan accepts claims for medical services for twelve months from the date of service. A preferred provider will automatically submit a claim on your behalf.

What is pre-authorization and why does my procedure need to be pre-authorized?

The Plan only covers procedures and treatments that are medically necessary.  The Plan has contracted with Aetna to perform this function. 

To obtain pre-authorization of your procedure, have your physician or health care provider call Aetna at 1-888-632-3862 option 3. Preferred providers are contractually obligated to obtain preauthorization when it is required by the Plan.

Does my prescription co-pay apply toward my medical deductible?

No. The Plan has separate deductibles for medical and prescriptions. Your prescriptions DO NOT apply to your medical deductible.

Are travel expenses covered?

Travel to the nearest facility will be reimbursed by the Plan if treatment is unavailable locally.  If the member traveling is a minor, the Plan will reimburse travel for one parent or guardian to accompany the minor.  The Plan will also reimburse travel for one companion to assist an adult member if the member is incapacitated due to a medical condition and will need assistance.  

Use this Travel Reimbursement Checklist when requesting reimbursement for travel expenses.

For additional information on what is covered, and how to submit for reimbursement, see the Health & Welfare Summary Plan Description (H&W-SPD).

May I use the Wellness and Minor Care program for treatment of a long-term condition?

Treatment of chronic or long-term conditions such as diabetes or asthma is not covered under the Plan’s Wellness and Minor care program.  However, many of the providers that participate in the Wellness and Minor Care program also provide treatment of chronic conditions. Claims for such treatment are processed under the Plan’s major medical benefit, subject to deductibles, coinsurance and copayments, as applicable.

What area does the Municipality of Anchorage Include?

The Municipality of Anchorage is comprised of the area from Girdwood to the Knik River Bridge including the Anchorage bowl area.

Who are my preferred providers in the Municipality of Anchorage?

Visit the Find a Provider page for a list of preferred providers for inside and outside the Municipality of Anchorage.

What is the penalty for using a non-preferred provider (within the Municipality of Anchorage)?

If you use a health care provider within the Municipality of Anchorage that is not a preferred provider, the Plan will base your reimbursement on the preferred provider rate and will then reduce your regular reimbursement percentage by 20% for the first $50,000 in covered charges.  In addition to these reductions, a $1,000 copayment penalty will be imposed to each inpatient admission to a non-preferred provider. See the Preferred Provider Provisions section of the Health & Welfare Summary Plan Description (H&W-SPD) for more information.

Prescription Plan FAQs

Does the Plan coordinate prescription drug benefits with other health plans?

No. The Plan does not coordinate prescription drug benefits with other coverage.

What do I do if my prescription was denied at the pharmacy?

When the Caremark system rejects a prescription, the reason for the denial is transmitted to the pharmacist.  The pharmacist may call the Caremark Pharmacist Hotline at 1-877-478-1246, option 4, to resolve the problem.  If the problem cannot be resolved by the pharmacist, please contact the Administrative Office for assistance.

Why is my co-payment so much more for a brand name drug than a generic drug?

Co-payments for brand name drugs are higher than co-payments for generic drugs primarily because brand name drugs cost more than generic drugs.

The Plan uses a four-tier formulary-based prescription plan administered by CVS/Caremark. The cost you pay is determined by which tier your medication falls under. See the Health & Welfare Summary Plan Description (H&W-SPD) for co-payment schedules.

How soon can I refill my prescription?

The Plan allows you to refill your prescription after 2/3 of the prescribed dosage has been used.

Dental Plan FAQs

How long do I have to file a claim?

The Plan accepts claims for dental services for twelve months from the date of service.

Is there a Preferred Provider (PPO) for dental services?

The Plan has no preferred providers for dental services, nor does it maintain a referral list of dentists.

Is fluoride treatment a covered expense for adults?

Yes, all participants and dependents are allowed one fluoride treatment per year.

Will the Plan pay for a cosmetic treatment I need for my teeth?

No, the Plan will not pay for treatments or services which are primarily for cosmetic purposes.

Do I need pre-authorization for dental treatments or procedures?

No, pre-authorization is not required for any dental services.  However, intravenous sedation is covered only when treatment warrants the sedation.  If you are unsure whether your treatment warrants sedation, you or dentist may call (800) 478-1246 or email the Administrative Office to confirm.

I need to travel to another town to have some dental work done. Will the Plan pay for my travel expenses?

No, the Plan does not cover travel expenses for dental services.

What types of sedation are covered under the dental plans?

Nitrous oxide is covered for dependent children age 12 and under.  Intravenous sedation is covered only if treatment warrants that type of sedation.  As a rule, general anesthesia is not a covered expense.  Contact the Administrative Office if you have questions regarding sedation and anesthesia coverage.

Weekly Disability Benefit FAQs

How much income will I receive each week from my disability plan?

Gross disability income varies from plan to plan, ranging from $75 per week to $375 per week.  Your benefit will be determined by which plan your employer is contributing under and whether you qualify for monetary benefits.  Some plans do not provide weekly income (monetary benefits) for occupational disabilities.

How long may I receive disability income?

The maximum time you may receive disability income varies from plan to plan, ranging from 3 months to 24 months, or the day you return to work, whichever is sooner.

Why didn't I receive my check this week?

Most often, payment of weekly disability income is interrupted for lack of a current physician’s statement.  Every 30 days your doctor must fill out the “Statement of Attending Physician” located on the bottom half of the Supplementary Disability Claim Form.  If you do not receive your payment, please contact the Administrative Office.

Why is my medical coverage paid, but I do not receive disability income?

Some of the disability plans offered by the Trust Funds include disability income benefits for both occupational and non-occupational disabilities.  For plans that only cover non-occupational disabilities, there is no disability income for an occupational disability; however, your medical plan will provide continued medical coverage for up to six (6) months.