HB Bulletin #37-14
September 4, 2014
HEALTH BENEFITS BULLETIN
WORKSHOPS
To update and inform the membership we have conducted Town Hall meetings and educational workshops regarding:
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The next scheduled workshop is:
“WHAT TO DO IF INJURED ON THE JOB WORKSHOP”
Friday, October 3, 2014, 11:00 a.m. – 1:30 p.m. at the Memorial Association, 231 West C Street, Wilmington, CA 90744.
The workshop will cover Pacific Marine Safety Code – 2008 Revision – Section 6 Rule 602 and U.S. Department of Labor Employment Standards Administration Office of Workers’ Compensation Programs under the LONGSHORE ACT.
Speakers scheduled to appear: Mr. Marco A. Adame II, District Director, 18th Compensation District, Local 13 Officials and Southern California Area Welfare Director.
COASTWISE-ZENITH
Claims from “in network” providers have the least difficulty getting processed and paid, DO NOT assume that your “in network” provider will refer you to “in network” providers for other services. If they refer you for anything outside their office; such as blood work, diagnostic testing (MRI’s, CT Scans, X-rays, etc.), to see a specialist, or for other treatment such as; surgery, physical therapy etc. your very first question to them should be: “Is that provider in network?” If they are not, you may request a referral that is “in network” or use that provider knowing that it will be paid at the 80/20 of Maximum Allowable Charges (MAC) rate.
If your claim(s) has (have) been denied and Zenith is informing you that your only option is to ask for an appeal you (not your provider) must request in writing the first step of the appeal process for a Full and Fair Review and mail to the ILWU/PMA Benefit Plans Office, 1188 Franklin Street, Ste. 300, San Francisco, CA 94109. You should address your letter to the Trustees of the plan, attention: Mario Perez, Welfare Manager.
Important note: If you need assistance regarding your unpaid medical bills, the Coastwise Zenith representative is available to assist you at ILWU Local 13 – Monday through Friday, 8:30 a.m. to 4:30 p.m. Please make sure to bring your EOB(s) and unpaid medical bills.
(Over)
YOUR PATIENCE IS APPRECIATED
Due to the following, we are experiencing more than average daily phone calls and foot traffic:
▪ Retirement Applicants & Evaluations ▪ Deceased Notifications ▪ Loss of Welfare Coverage ▪
▪ Supplement Claims (follow-up & re-submission) ▪ Problematic Claims ▪
▪ Light Duty ▪ Open Enrollment ▪ Medical/Dental Change Over ▪ Job related injuries ▪
OFFICE VISIT TO ILWU LOCAL 13
As you arrive to ILWU Local 13, please state your business with the Receptionist, sign in, and patiently take a seat until your name is called. If you have any issues or concerns, please make sure to speak with an Official at the time of your visit. If an Official is not available, please leave a message with detailed information and they will contact you as soon as possible. We ask for your patience. If you don’t receive an immediate response, please DO NOT RUSH TO POST ANY UNPROFESSIONAL AND DISRESPECTFUL COMMENTS WITH INACCURATE INFORMATION ON YOUR SOCIAL MEDIA, for such will only hurt our Union and show the employer the disrespect we have for each other.
We are here to service the membership and your patience is greatly appreciated. Please remember free public parking is available through the 7th street entrance.
UPDATING PERSONAL INFORMATION
REMINDER: It is your responsibility to update your personal information i.e. address, phone number, e-mail, beneficiary form(s), dependent add/delete or important notice regarding taxation, etc.
Important Note: All Updated Personal Information must be submitted by the Participant(s) only. (You become a Participant in the ILWU-PMA when you become registered.) You must notify PMA Payroll Office in person separately.
ADA
(American Disability Act)
ADA JPLRC meeting is scheduled 1st and 3rd Tuesday of each month at 9:00 a.m. at Pacific Maritime Association, 300 Oceangate, 12th Floor, Long Beach, CA 90802 (no parking validation).
SAFETY TIP
Section 6 – Rule 602: An injury of any kind, irrespective of its severity, shall be reported immediately to the foreman, walking boss, or man in charge of operations, by the injured person, if they are physically able to do so. If not, the injury shall be reported by any other person in possession of the facts.
APPOINTMENT WITH THE HEALTH BENEFITS OFFICER
The Health Benefits Officer maintains an open door policy, however, if you need special assistance, (i.e. retirement, disability or personal matter) we recommend that you schedule an appointment with Jerry Avila at (310) 830-6116.
In Solidarity,
Jerry Avila
Health Benefits Officer
ILWU Local 13
OPEIU #537/mv
HB Bulletin #37-14
