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Hourly Contributions Generally, to be initially eligible, you need 360 hours reported within 3 or fewer consecutive months. You are then eligible the first of the following month and also the month after, with the balance of your hours in the bank. Example: Member has a total of 360 hours reported January, February and March. These hours will provide eligibility for April and May with 120 hours in the bank. After initial eligibility requirements are satisfied, eligibility is on a 'skip' month basis. 120 hours reported for a particular month gives eligibility for the skip month (work a month, skip a month, eligible a month). Example: 140 hours reported for April work will give June eligibility with 20 hours going to the bank. Flat Rate Contributions Employees of contributing employers reported at a flat rate, including non-bargained office employees and company officers, normally establish initial eligibility the first day of the month following three consecutive months for which contributions were received. Each flat rate contribution will provide a single month of eligibility. Note: Flat rate contributions do not normally provide an hour bank accumulation. Owner-Operators Contributions An Owner-Operator, signed to an approved Owner-Operator agreement, who is not eligible, based on payroll hours from an employer is eligible on the first day of the second month (skip month) following receipt of each payment to the Trust Fund Office. Note: Owner-Operator contributions do not provide an hour bank accumulation. Bank Hours Members establishing or reestablishing initial eligibility on or after July 1992 may bank up to 990 hours. Members with eligibility effective dates prior to July 1992 may continue to bank up to 1320 hours.

Yes, your covered dependents are your lawful spouse and dependent children. Dependent children are covered until age 26.

There is no specific open enrollment period. Eligible participants have the opportunity to change health plans anytime during the year. However, you must remain in the plan you select for a minimum of 12 months unless you move out of the HMO's service area. Any change in plans will be effective on the first day of the second month following the date the completed enrollment form is received by the Fund Office.

If you are on the Comprehensive Plan you may use any doctor you choose. However, if you choose to use a non-contracting doctor, your out-of-pocket expense may be significantly higher. To maximize your benefits and reduce your out-of-pocket expense. Use contracting doctors.

Unless it's an emergency or you live outside the contracting area, the Fund will only pay what they would have paid to a contracting hospital. Your out-of-pocket expense will be substantial. Use contracting hospitals.

Vision care benefits are provided by Vision Service Plan (VSP) and include coverage for an annual eye examination and glasses. Examinations and lenses are available once in a 12 month period. Frames are available once in a 24 month period.

If you don't use a VSP doctor, you will be subject to the same time limits and $7.50 deductible as described for VSP panel doctors and you will be reimbursed in accordance with a schedule. There is no assurance that this payment will be sufficient to cover your charges. Contact VSP for assistance in filing your claim.

No, you may use any dentist you choose. However, by using a Delta Dental PPO dentist your benefits will be maximized.

Yes, you can get a predetermination from Delta Dental. Use the dental claim form for this purpose. A predetermination allows you and your dentist to know ahead of time whether the procedure(s) will be covered and, if so, the amount payable. Predetermination is recommended for procedures such as dentures, bridges, partials, crowns and implants.

Yes, the maximum amount payable in each calendar year is $2,500 per person. The maximum amount payable for orthodontic work is $2,500 a lifetime per person.

Each participant is responsible for tracking his or her eligibility. The participant can verify eligibility by calling the District Office, Fringe Benefits, or the Eligibility Department at the Trust Fund Office. The participant should always call the appropriate Trust Fund contact, as soon as possible, with questions regarding coverage or eligibility.

As soon as the Trust Fund posts the hours establishing initial eligibility, a complete packet is sent to the participant and ID cards are ordered. The packet includes the enrollment form, H&W booklet (Summary Plan Description), a Preferred Provider Organization (PPO) book of contracting providers, and claim forms. ID cards are mailed separately and should be received within two weeks after receiving the packet. Note: The ID cards are not always mailed in an Operating Engineer envelope. When the packet is received, the participant should immediately complete the enclosed enrollment form and return it to the Trust Fund Office. If a participant lives in the Kaiser service area and wants Kaiser coverage, the participant must contact the Trust Fund Office for the enrollment packet.

Complete a new dependent enrollment form, available on the Member Dashboard, and return it to the Trust Fund Office along with the appropriate documentation (marriage, birth or death certificate or divorce decree). Forms are available at the District Office, Fringe Benefits, or the Trust Fund Office.

Present your OptumRx Identification Card at any participating drugstore, or use the mail order program. Review the Prescription Drug section for current benefits and copayments. If you have not received your ID cards or need additional cards, information, or forms, call the Trust Fund Office, or Fringe Benefits. (If you are covered by Kaiser, refer to the Kaiser section for more information on your prescription drug benefits).

Call any VSP doctor for an appointment and identify yourself as a VSP member. If you need help in locating a VSP panel doctor, call VSP at (800) 877-7195 or visit them on the Internet at www.vsp.com. When you call, VSP will need to know the covered employee's social security number and the name of the group plan - Operating Engineers Health & Welfare Trust Fund. You no longer need to obtain a benefit form from VSP before receiving services - just call a VSP doctor for an appointment. After you have scheduled an appointment, the VSP doctor will contact VSP to verify your eligibility and Plan coverage and obtain the proper authorization. You will pay the VSP doctor $7.50 for all covered charges and VSP will pay its portion directly to the doctor. You will be responsible for additional services and materials not covered by this Plan.

The Delta Dental PPO program allows you the freedom to visit any licensed dentist, including a dentist from the Delta Dental Premier network. However, there are advantages to visiting a Delta Dental PPO dentist instead of a Premier or non-Delta Dental dentist. Your dentist may call Delta Dental to verify your eligibility. After the work is completed, the dentist will submit completed claim forms to Delta Dental for processing. You will be responsible for any deductible or coinsurance amounts. Refer to the Dental section for more information.