Health & Welfare Fund Plan
The U.A. Local 447 Pipe Trades Health and Welfare Plan provides Health and Welfare benefits for Active and Retired participants and their eligible dependents. The Health and Welfare Plan provides medical, prescription drug, dental, hearing aid, and vision benefits.
Health & Welfare Plan Notifications (Sent Via Mail)
Summary Plan Description
-
Click Here to download the Active Health & Welfare Fund Summary Plan Description. Printed 2014.
- Click Here to download the Retiree Health & Welfare Fund Summary Plan Description. Printed 2013.
Summary of Material Modification Letters
Summary of Benefits and Coverage
Active
Provisional
Retiree
Supplemental Insurance
We are happy to provide Aflac as a supplemental insurance to our members, at an additional cost. For more information and to sign up please contact the number on the Aflac flyer. Do not contact the Trust Office. Unfortunately, this supplemental insurance is not available to our retirees.
Forms & Instructions
-
Change of Address Form
- Beneficiary Designation Form You can fill out the form online, but MUST print the form to sign. We can not accept digital signatures at this time.
- Enrollment Form- You can fill out the form online, but MUST print to sign and return. We can not accept digital signatures at this time.
- Kaiser Application- You can fill out the form online, but MUST print to sign and return. We can not accept digital signatures at this time. If you have more dependents than the original form will hold, please use this page also.
- PHI Authorization for Release of Medical Records Form - You can fill out the form online, but you MUST print to sign and return. We can not accept digital signatures at this time.
Over-the-Counter COVID-19 Test Reimbursement
- If you have the Blue Shield PPO Plan you can receive at home FDA approved COVID tests (up to 8 per month per eligible participant) with no up front costs at the Pharmacy counter at participating pharmacies using your WellDyne Pharmacy card. If the pharmacy will not run the COVID tests under your WellDyne card, you can purchase the at home FDA approved tests and submit the below reimbursement form directly to WellDyne to receive reimbursement (up to $12/test) for the tests.
- Over-the-Counter COVID Test Reimbursement Form- Complete this form and send it along with your purchase receipt to
WellDyne to request reimbursement for over-the-counter COVID-19 tests
you have paid for out-of-pocket.
- Alternatively, you may also order COVID tests directly from Welldyne. You will need to create an account using your member number on your ID card.
- If you have Kaiser, you can also purchase at home FDA approved COVID tests (up to 8 per month per eligible participant) at participating retailers, and submit your receipt to Kaiser for reimbursement. Reimbursement (up to $12/test) can be done using the below reimbursement form, or submitting online in your Kaiser account. Alternatively you can go to a Kaiser pharmacy and receive, with no up front costs, the at home FDA approved COVID tests.
Service Providers
Blue Shield of California - Active and Retired participants of the U.A. Local 447 Health & Welfare Plan may choose to have medical benefits provided by the Self-Funded Indemnity Plan, which utilizes the Blue Shield of California PPO Network.
Website: www.BlueShieldCA.com
Kaiser Permanente - Active and Retired participants of the U.A. Local 447 Health & Welfare Plan may choose to have medical benefits provided by Kaiser Permanente.
Website: www.kaiserpermanente.org
Phone: 800-464-4000
EyeMed - The U.A. Local 447 Health & Welfare Plan utilizes EyeMed to provide vision care services to all active participants/dependents covered under the Plan.
Website: https://www.eyemed.com/en-us
United Concordia - Dental benefits for all Active participants covered under the U.A. Local 447 Health & Welfare Plan are provided through United Concordia. Participants are covered under the Elite Plus Network.
Website: www.unitedconcordia.com
Phone: 800-332-0366
Delta Dental
- Retired Participants of the U.A. Local 447 Health & Welfare Plan
may choose to purchase dental benefits through Delta Dental of
California. Participants can choose between Delta Dental PPO Plan and
the Delta Care USA Plan
Website: www.deltadentalca.com
