• How do I submit a claim?

  When you receive services from a participating provider (Blue Cross Blue Shield or Delta Dental) the provider will submit your claim to the Plan. If you receive services from a non-participating provider you may have to submit the claim to the Plan. If you need to submit a claim, request an itemized bill from the provider and complete a claim form found in Quick Links under Medical and select Initial Claim Form. Forward the bill and completed form to the address as it appears on the claim form.

• Is there an office co-pay?

  Yes. The office co-pay is $25 per visit at a participating provider.
  
  If you receive care at a non-participating provider, benefits are paid at 70% after the deductible has been satisfied.
  
  

• Is there an office co-pay? (West River Participants)

  Yes. The office co-pay is $15 per visit at a participating provider.
  
  If you receive care at a non-participating provider, benefits are paid at 70% after the deductible has been satisfied.
  
  

• What is the deductible?

  $500 per person (effective January 1, 2018)
  
  $1,000 per family (effective January 1, 2018)
  
  

• What is the deductible? (West River Participants)

  $800 per person
  
  $1,600 per family
  
  

• Is there coverage for chiropractic and acupuncture treatment?

  Yes. The Plan pays 100% based on Reasonable and Customary charges to a combined maximum of 19 visits per year per person. No benefits are payable for services that are work related, auto related, or involve third party liability.
  

• Are there vision benefits?

  Yes. Active employees, pre-Medicare retirees, Medicare retirees and their adult dependents are entitled to reimbursement up to $500 per 2 calendar years. The 2 calendar years begin on the first day of every even year. The $500 may be used for eye examinations, prescription lenses (including contacts) and frames.
  
  For dependent children under the age of 19, the Plan allows 100% coverage for any eye examination, with no maximum. Children under age 19 have $500 per 2 calendar years for prescription lenses (including contacts) and frames.
  
  Claim forms are found in Quick Links under Vision. Select your appropriate Vision Claim Form:
  Vision Claim Form for Bloomington.
  Vision Claim Form for Duluth.
  
  Medicare Retirees - Click the "How does a Medicare Retiree file a claim for vision/hearing?" FAQ for details on filing a claim.
  

• How can I locate a participating provider?

  Click on the BlueCross Blue Shield link. Click on Find a doctor found under Resources. You may also call the number found on the reverse side of your Identification Card under Find a Provider, 1-800-810-2583. Or, contact Medical Advocacy Program (MAP) toll free at 1-866-573-5745.

• What is an HRA?

  An HRA is a Health Reimbursement Arrangement funded as an employer-provided medical reimbursement as defined under IRS Notice 2002-45. You may receive reimbursements for certain Qualified Medical Care Expenses through your HRA.

• How do I receive reimbursement from the HRA?

  Wilson-McShane will use your HRA account to pay for deductibles and coinsurance automatically. Other Qualified Medical Care Expenses must be submitted for reimbursement with an HRA Claim Form. Expenses will be reimbursed once the total is $25 or more and there is sufficient money in the HRA account.
  
  If you do not want to receive automatic reimbursement, you should complete an election form to terminate the automatic feature. This form can be found under HRA Election Change Form (Off). If automatic reimbursement is terminated, you must submit all Qualified Medical Care Expenses with an HRA Claim form.

• What do I need to do if I do not want to receive automatic reimbursement from my HRA account?

  If you do not want to receive automatic reimbursement, you should complete an election form to terminate the automatic feature. This form can be found under HRA Election Change Form (Off). If automatic reimbursement is terminated, you must submit all Qualified Medical Care Expenses with an HRA Claim form.

• What is a Health Dynamics Physical?

  A Health Dynamics Physical is a preventive care examination including laboratory tests. The Plan pays 100% of the Health Dynamics Physical when services are provided at a Health Dynamics Location.

• What are the benefits of receiving a Health Dynamics Physical?

  The Health Dynamics Preventive Care Program is a package of health screening tools designed to thoroughly assess an individual’s health status and health risks. Additionally, for those individuals that have a Health Dynamics Physical, they may receive EITHER a $20 per month gym/health club membership reimbursement for up to 12 months or receive $240 for reimbursement of coinsurance and/or copayments.
  
  In addition, the Health Dynamics physical wellness incentive benefit has improved to allow a waiver of the Calendar Year Deductible for the employee and/or spouse who participates in a Health Dynamics physical. The Calendar Year Deductible of $500 (effective January 1, 2018) will be waived in the calendar year following the 12-month period (December – November) in which a Health Dynamics physical is completed. For example, the employee and/or spouse who participates in a Health Dynamics physical between December 2017 and November 2018 will have their individual 2019 Calendar Year Deductible waived.
  
  Health Dynamics physicals are available to eligible employees and spouses only. Medicare Retirees are eligible to undergo an examination through Health Dynamics, but are not eligible for the Health Dynamics physical incentives.

• I’ve misplaced a letter sent to me regarding a pending accident claim. How can I get a replacement letter?

  You may contact Wilson-McShane Corporation and request that another letter be sent to you, or you may click on Quick Links under Medical and select Replacement Accident Letter. Print and complete the form and return it to Wilson-McShane Corporation.

• When do I receive my medical cards?

  7-10 business days from when you first become eligible.

• How do I get the Summary Plan Description Booklet (SPD)?

  You can access the Summary Plan Description Booklet on this website. The SPD can be found under the Documents section of the website. You can also call Wilson-McShane Corporation at 952-854-0795 or 1-800-535-6373 and request a Summary Plan Description Booklet.

• If I get divorced, what happens with my former spouse’s coverage?

  The Plan retroactively terminates your former spouse’s coverage back to the date of your divorce.

• How do I remove my former spouse from coverage through the Plan?

  You or your spouse need to mail a fully executed copy of your divorce decree to Wilson-McShane Corporation within 60 days of the divorce or legal separation date for your spouse to receive COBRA Continuation Coverage. If you have children for whom you do not have custody, a copy of any QMCSO is also required. At this time, you may also want to review your beneficiary designation for your Life and AD&D Insurance, if eligible.

• I’m an active member, how much do I pay for my insurance?

  Members with active coverage pay nothing. Your insurance is employer paid.

• How many hours can I bank?

  The maximum hours you can bank is 600 hours.

• What can I use my HRA money for?

  You may obtain reimbursement for certain Qualified Medical Care Expenses incurred on a non-taxable basis. For detail of what qualifies as a Qualified Medical Care Expense, visit the HRA section of this site under Quick Links. HRA may also be used to pay COBRA, self-pay and retiree premium amounts. You will be automatically reimbursed for deductible and coinsurance amounts from your HRA unless you complete an election form requesting otherwise.
  This form can be found under HRA Election Change Form (Off).

• Can I use the money in my HRA if I am not currently eligible?

  Yes. You can still access your HRA money even if you are not currently eligible for coverage.

• How much money is in my HRA?

  Please contact Wilson-McShane Corporation at 952-854-0795 or 1-800-535-6373 and ask to speak to your Claims Examiner. He or she will be able to tell you how much money is in your HRA. In addition, your quarterly statement from the Fund will provide you with your HRA balance and activity. Your HRA balance is also included on each HRA reimbursement.

• Working outside of Local 49's jurisdiction and need your Health and Pension hours sent back to Local 49?

  If you are working in an area other than Local 49’s jurisdiction and need to have your contributions transferred back, you need to fill out a Request and Authorization for Transfer of Contributions form, also known as a reciprocity form. Below are steps on how to get your contributions sent to the appropriate Fund.
  
  If you’re transferring Pipeline hours worked:
  

  1. Please call the Pipeline Health & Welfare Fund, Zenith American Solutions at (888) 255-3863.
  2. For Pension transfers and information please contact the Central Pension Fund office at 202-362-1000 ext. 521 or online at www.cpfiuoe.org.
  3. Ask them to send you a transfer form to your current residence and make sure they have the correct address.
  4. This will ensure that your hours get transferred back to your home local.
  5. Call the office you submitted the forms to ensure they received the transfer request.
  6. Call the benefit office that will be receiving the contributions 30 days after filling out the forms to ensure that the hours have been received.

  Make sure to document all hours worked to ensure that the correct amount of hours have been appropriately transferred.
  (*Make sure to keep a written document of your hours on paper. Many members like to keep track of their hours on a cell phone, however we have had cases where a phone crashes and all of information is lost.)
  
  
  If you’re a member of Local 49 who is working outside of Local 49’s jurisdiction:

  1. Contact the Local who’s jurisdiction you’re working in to confirm you are cleared in to work in their area.
  2. For Health plan contributions transferring back to Local 49’s health plan, request the Reciprocity forms from the Local you're in to have them sent back to your home local.
  3. For Pension transfers and information please contact the Central Pension Fund office at 202-362-1000 ext. 521 or online at www.cpfiuoe.org.
  4. Ask them to send you a Request and Authorization for Transfer of Contributions Form to your current address.
  5. This will ensure that your hours get transferred back to your home local.
  6. Call 30 days after filling out the forms to ensure that the hours have been received.

  Make sure to document all hours worked to ensure that the correct amount of hours have been appropriately transferred.
  (*Make sure to keep a written document of your hours on paper. Many members like to keep track of their hours on a cell phone, however we have had cases where a phone crashes and all of information is lost.)

• What happens with my coverage through the Operating Engineers Local 49 Health & Welfare Fund once I become a Medicare Retiree?

  All Medicare retirees making retiree self payments have insurance through a Medicare Advantage Plan offered by Humana.

• How do I enroll in the Medicare Advantage Plan?

  Three months before you turn 65, an enrollment packet will be mailed to you from Humana with your application. You should complete the application and return it in the enclosed envelope as soon as you receive the form. Your premiums will continue to be billed directly by Wilson-McShane. If you become Medicare-eligible before your 65th birthday, you will need to contact the Fund office and inform them of your Medicare eligibility and they will have an enrollment packet mailed to your address.

• Do I need Medicare Part B in order to go on the Medicare coverage?

  YES. In order to be eligible to go on the Medicare coverage you must have both Medicare Part A and Part B. If you do not have Medicare Part B it is crucial that you enroll in Medicare Part B as soon as possible.

• Who do I contact if I have questions about my Medicare coverage?

  You should contact Humana customer service at 1-800-733-9064.

• How does a Medicare Retiree file a claim for vision?

  Vision Benefit: Humana may have discounts available for prescription eyewear. Be sure to show your Humana insurance card at the provider location to access these discounts.
  
  In addition to the discounts from Humana, the Operating Engineers Local 49 Health & Welfare Fund also has an available reimbursement of up to $500 per person every other calendar year (replenished every even year) for vision expenses.
  
  Reimbursement from the Operating Engineers Local 49 Health & Welfare Fund is done through a separate application to Wilson-McShane Corporation on a Vision and Hearing Reimbursement Claim Form for Medicare Retirees.

• How does a Medicare Retiree file a claim for hearing?

  Hearing Benefit: Humana have discounts available for hearing aids. Be sure to show your Humana card at the provider location to access these discounts.
  
  In addition to the discounts from Humana, the Operating Engineers Local 49 Health & Welfare Fund also has an available reimbursement of $2000 once in 5 calendar years for hearing aids.
  
  Reimbursement from the Operating Engineers Local 49 Health & Welfare Fund is done through a separate application to Wilson-McShane Corporation on a Vision and Hearing Reimbursement Claim Form for Medicare Retirees.

How do I...?

• Request a Beneficiary Designation Form?

  Click here to submit a Request for a Beneficiary Designation Form. This will be sent to the Fund Office so they can mail you a Beneficiary Designation Form.
  
  

• Add a dependent?

  When adding a spouse you must notify the Fund Office within 90 days of the date of your marriage to cover your spouse under the Plan. Please complete a family update form and include a copy of your marriage certificate. If this information is received within 90 days of the date of your marriage, your spouse’s effective date will be the date of the marriage.
  
  Adding a child will also require that you complete a family update form and provide a copy of the birth certificate, adoption papers, or court order. If you are requesting to add a step-child you will need to provide a copy of your marriage certificate and a copy of your spouse’s divorce decree or other court order showing the responsibility of the natural parents of the step-child. Stepchildren are eligible from the date of your marriage, provided they are living in your home and are dependent on your for support.

• Change my address?

  In order to change your mailing address you must complete a Change of Address form. The form is available on this site on the Forms page or you may contact the Fund office, Wilson-McShane Corporation, at 952-854-0795 or 1-800-535-6373 and they will mail you the form to complete.

• File a claim for vision or hearing benefits?

  If you are actively covered by the Plan and you are receiving services by a Blue Cross provider, the provider will submit a claim directly to the Plan. If you are not using a Blue Cross provider or you have purchased prescription glasses or contacts, the provider may require you to submit your claim to the Plan. You may forward a copy of the itemized bill to the Plan by completing a claim form.
  
  Claim forms are found in Quick Links under Vision. Select your appropriate Vision Claim Form:
  Vision Claim Form for Bloomington.
  Vision Claim Form for Duluth.
  
  For Hearing benefit use an Initial Report of Claims form in Quick Links, under Medical.
  
  Medicare Retirees - Click the "How does a Medicare Retiree file a claim for vision/hearing?" FAQ for details on filing a claim.

• Access my HRA?

  Wilson-McShane will use your HRA account to pay for deductibles and coinsurance automatically. Other Qualified Medical Care Expenses must be submitted for reimbursement with an HRA Claim Form. Expenses will be reimbursed once the total is $25 or more and there is sufficient money in the HRA account.
  
  If you do not want to receive automatic reimbursement, you should complete an election form to terminate the automatic feature. This form can be found under HRA Election Change Form (Off). If automatic reimbursement is terminated, you must submit all Qualified Medical Care Expenses with an HRA Claim form.

• Get reimbursed for my gym/health club membership or copayments and/or coinsurance after I have a Health Dynamics physical?

  To submit a claim for gym/health club membership or copayments and/or coinsurance reimbursement you and/or your spouse must have had a Health Dynamics Physical. Complete a Health Dynamics claim form and attach copies of your health club membership fees or copies of Explanation of Benefits for copayments and coinsurance. Return the completed reimbursement form to the address listed on the form. The Health Dynamics claim form is found in Quick Links under Medical.

• File for Disability Benefits?

  If you become totally disabled and unable to work and your disability is not job related, auto related or third party liability related, you should complete the front side of the Initial Report of Claims form in full. Your attending physician should complete the reverse side of the form paying particular attention to respond to questions 1, 2, 4, 5, 7, 8, and 9. Your physician should date and sign the form. The completed form should be returned to the address found on the top of the Initial Report of Claims form. The form is found in Quick Links under Medical.

• Find a network provider?

  In the helpful links section of this website you will find links to BCBS of MN and Delta Dental. You can log on to the BCBS of MN or Delta Dental websites and search for in network providers.

• How does a Medicare Retiree file a claim for vision?

  Vision Benefit: Humana may have discounts available for prescription eyewear. Be sure to show your Humana insurance card at the provider location to access these discounts.
  
  In addition to the discounts from Humana, the Operating Engineers Local 49 Health & Welfare Fund also has an available reimbursement of up to $500 per person every other calendar year (replenished every even year) for vision expenses.
  
  Reimbursement from the Operating Engineers Local 49 Health & Welfare Fund is done through a separate application to Wilson-McShane Corporation on a Vision and Hearing Reimbursement Claim Form for Medicare Retirees.

• How does a Medicare Retiree file a claim for hearing?

  Hearing Benefit: Humana may have discounts available for hearing aids. Be sure to show your Humana insurance card at the provider location to access these discounts.
  
  In addition to the discounts from Humana, the Operating Engineers Local 49 Health & Welfare Fund also has an available reimbursement of $2000 once in 5 calendar years for hearing aids.
  
  Reimbursement from the Operating Engineers Local 49 Health & Welfare Fund is done through a separate application to Wilson-McShane Corporation on a Vision and Hearing Reimbursement Claim Form for Medicare Retirees.

• Working outside of Local 49's jurisdiction and need your Health and Pension hours sent back to Local 49?

  If you are working in an area other than Local 49’s jurisdiction and need to have your contributions transferred back, you need to fill out a Request and Authorization for Transfer of Contributions form, also known as a reciprocity form. Below are steps on how to get your contributions sent to the appropriate Fund.
  
  If you’re transferring Pipeline hours worked:
  

  1. Please call the Pipeline Health & Welfare Fund, Zenith American Solutions at (888) 255-3863.
  2. For Pension transfers and information please contact the Central Pension Fund office at 202-362-1000 ext. 521 or online at www.cpfiuoe.org.
  3. Ask them to send you a transfer form to your current residence and make sure they have the correct address.
  4. This will ensure that your hours get transferred back to your home local.
  5. Call the office you submitted the forms to ensure they received the transfer request.
  6. Call the benefit office that will be receiving the contributions 30 days after filling out the forms to ensure that the hours have been received.

  Make sure to document all hours worked to ensure that the correct amount of hours have been appropriately transferred.
  (*Make sure to keep a written document of your hours on paper. Many members like to keep track of their hours on a cell phone, however we have had cases where a phone crashes and all of information is lost.)
  
  
  If you’re a member of Local 49 who is working outside of Local 49’s jurisdiction:

  1. Contact the Local who’s jurisdiction you’re working in to confirm you are cleared in to work in their area.
  2. For Health plan contributions transferring back to Local 49’s health plan, request the Reciprocity forms from the Local you're in to have them sent back to your home local.
  3. For Pension transfers and information please contact the Central Pension Fund office at 202-362-1000 ext. 521 or online at www.cpfiuoe.org.
  4. Ask them to send you a Request and Authorization for Transfer of Contributions Form to your current address.
  5. This will ensure that your hours get transferred back to your home local.
  6. Call 30 days after filling out the forms to ensure that the hours have been received.

  Make sure to document all hours worked to ensure that the correct amount of hours have been appropriately transferred.
  (*Make sure to keep a written document of your hours on paper. Many members like to keep track of their hours on a cell phone, however we have had cases where a phone crashes and all of information is lost.)