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Form 1095-B Information

Click here to view/download important information about Form 1095-B


How are my benefits funded?
The primary source of financing for the benefits provided under the Health Plan and for the expenses of Fund operations is employer contributions.
What are the Fund’s eligibility requirements?
Initial eligibility requires 135 hours within one month. There is one bookkeeping month in which the participant is not eligible. For example, 135 hours in April will provide eligible for the month of June.

Continuing eligibility requires 135 hours of employer contributions per month. The participant is then eligible the first day of the second month. For example, 135 hours worked in September make the participant eligible in November.
What do I do if my employer does not remit my fringes?
First, call your employer. There may be a very good reason why the fringes have not been remitted. If your employer cannot explain the reason to your satisfaction, you should contact the Local Union.
What do I do when I get divorced?
You must notify us immediately as coverage for an ex-spouse is not permitted under this plan. Send a complete copy of your divorce decree otherwise coverage will be maintained for your ex-spouse. If the Fund pays for benefits that should not be paid because your spouse no longer meets the definition of a dependent, you will be held responsible.
When does coverage stop for my dependent children?
The Health Care and Education Affordability Reconciliation Act of 2010 requires the Fund to extend Adult child coverage up to age 26. Coverage may continue until the last day of the month in which that adult child turns 26 years old or earlier if you do not maintain your eligibility under the Plan.
Can I continue coverage when I retire?
Yes, provided you meet the retiree requirements for maintaining coverage. Refer to Page 27 of the Summary Plan Description.
What do I do if I am injured or ill and cannot work?
The Fund provides disability benefits which may continue your coverage for health care benefits. You should complete a disability form.
What are the self-payment rates?
The self-payment rates for the Active and CE/CW classifications are based on the contribution rate multiplied by the actual hours short of the 135 hours required for eligibility and then divided by 50% and rounded up to the nearest dollar. Cable Pullers/Residential and Motor Shop Trainees must pay at 100% of the hours short of the 135 hours required for eligibility rounded up to the nearest dollar.

The current hourly contribution rate varies based on your job classification and location. Contact our office or your local union for specific information regarding your contribution rates.
What is COBRA?
COBRA is the Consolidate Omnibus Budget Reconciliation Act of 1986. COBRA requires that the Fund provide coverage for participants and their dependents that may not otherwise be offered. COBRA is available for dependents who no longer meet the definition of a dependent as defined by the Plan. Please contact the Fund office for the current COBRA rates.
What is Coordination of Benefits?
Coordination of Benefits (COB) coordinates benefits with other health benefits you may have such as coverage through your spouses’ employer.
What are the Health Plan Benefits?
The Plan has contracted with BCBSM to provide participants and the Fund with discounts on medical services. If a BCBSM participating provider is utilized the participant has a $750 deductible per person and $1,500 deductible per family. Benefits are then paid at 80%. The maximum out of pocket expense is $2,000 per person and $4,000 per family. Preventative services are generally paid at 100%. For further details regarding the medical benefits available, please refer to the Summary Plan Description (SPD).

To find a participating doctor, click here to visit that topic on the Blue Cross Blue Shield of Michigan website.
What are the prescription drug benefits?
The Plan provides for a $20 co-payment for Generic Prescriptions, a $35 co-payment for Tier 2 or Preferred Brand Name Drugs, and a $50 co-payment for Tier 3 or Non-Preferred Brand Name Drugs.
What vision benefits are available?
The Plan has an agreement with Vision Service Plan (VSP) to provide a 25% discount on selected frames with purchase of complete pair of prescription glasses.
How do I order a new health & welfare ID card?
You can order a new Medical ID card on the BlueCross BlueShield of Michigan website and you also have access to print off a temporary card under your account. You may also call the Fund Office and a claims specialist can order one for you. Your new ID card will arrive within 7-10 business days from the date of your request.
How do I view my Explanation of Benefits (EOB)?
Please visit the BlueCross BlueShield of Michigan website. Once you are on the BCBSM website, you will need to login to your account to access your EOBs.

Due to privacy laws anyone in the household under the insurance that is over the age of 18 will need to set up their own username and password to access their EOB’s on the BlueCross BlueShield of Michigan website.

Any member between the ages of 12-17, will need to set up their own username and password in order to re-print the EOB’s. Claims for this age group can be viewed under the subscriber’s account but due to privacy laws you will not be able to view and re-print the EOB’s.
How do I file an out-of-network health claim?
If you receive services from a non-participating provider you may have to submit the claim to BCBSM, please contact the number on your ID Card for additional information.
How do I designate a beneficiary?
Complete a Beneficiary Designation Form and mail to the Fund Office.
How do I change my address?
In order to change your mailing address, you must complete a Change of Address Form. You may print and complete the form, or you may contact the Fund Office and a form will be mailed to you.
How do I add a dependent to my health insurance?
To enroll your spouse for coverage under the Plan, submit a completed Family Update Form along with a copy of the certified marriage certificate to the Fund Office.

To enroll your dependent child for coverage under the Plan, submit a completed Family Update Form along with a copy of the birth certificate or adoption papers to the Fund Office.
How do I file for disability benefits?
Submit a completed Disability Claim Form to the Fund Office.
How do I get the health & welfare Summary Plan Description Booklet (SPD)?
You can review the SPD electronically or you can call the Fund Office to request a hardcopy of the SPD Booklet.
Who do I contact with questions?
If you have any questions about your eligibility or benefits, contact the Fund Office at (855) 633-4584. For questions related to medical claims contact BCBSM or visit


Change of Address

Change of Name

Apprentice Eligibility Notice and Form

Authorization for Release of PHI Form

Beneficiary Designation Form

Participant Data Form

Direct Deposit Form

Retiree Program Enrollment Form

Retiree Program Opt Out Form

Self-Payment Transfer from Fund Form

Special Fund Payment Request Form

Special Fund Verification Form

Spouse Employment Data Form

Vacation Payee Deposit Agreement

Waiver of Participation

Weekly Disability Application

Widow Enrollment Form

Working Owner Participation Form


Summary Plan Description (SPD) 202005

SMM 202201 OTC Covid Tests

SMM 202005 Automobile Accidents Exclusion

Local Union Directory

SBC 20240831

WEX Health Fact Sheet

Change in Administrator