FREQUENTLY ASKED QUESTIONS

How do I submit a claim?

If health care services are provided through the Preferred Provider Organization (PPO), the PPO Health Care Provider will usually submit the written proof of claim directly to the Appropriate Claims Administrator.

If you pay for non-PPO health care services at the time services are provided, you may later submit the bill to the Appropriate Claims Administrator. At the time you submit your claim you must furnish evidence acceptable to the Appropriate Claims Administrator that you or your covered Dependent paid some or all of those charges. Plan benefits will be paid to you up to the amount allowed by the Plan for those eligible expenses. The Appropriate Claims Administrator will not accept a balance due statement, cash register receipts, photocopy, canceled checks or credit card receipts as proof of claim.

Occasionally a Health Care Provider will send a claim directly to you. In this case you should contact the Appropriate Claims Administrator to find out if they require you to complete a claim form. If a claim form is required, it may be obtained from the Appropriate Claims Administrator whose name and address are listed in the Summary Plan Description.

Click here to access the Initial Report of Claims Form.

Is there an office co-pay?

Yes, for In-Network Providers.
In-Network Providers: The office co-pay is $20 per primary care physician or specialist visit. For all other services performed and billed during an office visit, the Plan pays 80% after the Deductible is met. For all other professional fees, the Plan pays 80% after the Deductible is met.

Non-Network Providers: The Plan pays 50% after the Deductible is met for professional fees.

What is the deductible?

$400 per person per calendar year
$1,200 per family per calendar year

What is the medical coinsurance payable by the Plan?

80% after satisfaction of the Deductible for In-Network Providers
50% after satisfaction of the Deductible for Non-Network Providers

What is the Out-of-Pocket Limit?

In-Network Providers - Medical Plan: $5,000 per person, $10,000 per family
In-Network Providers - Medical Outpatient Retail and Mail Order Drugs: $1,600 per person, $3,200 per family
Non-Network Providers: Unlimited

Is there coverage for chiropractic care?

Yes.
In-Network Providers: There is a $20 co-pay per office visit. For all other services performed and billed during an office visit, the Plan pays 80% after the Deductible is met. Maximum benefit is 12 visits per person per calendar year.
Non-Network Providers: Professional fees paid at 50% after the deductible is met. Maximum benefit is 12 visits per person per calendar year.

Which pharmacies can I use?

You can go to any retail pharmacy to have your prescription filled; however, if you use a Cigna retail pharmacy or the mail-order program, you will save money. To find a Cigna pharmacy near you, or to access the mail-order program, call the Customer Service Number: (800) 244-6224 (Customer service is available 24 hours a day, 7 days a week for precertification, ordering mail order drugs, questions, etc.).

How can I locate an In-Network Provider?

Visit www.cignasharedadministration.com or call CIGNA at (800) 768-4695. When accessing the online directory for the Open Access Plus (OAP) network:

Go to this website: www.cignasharedadministration.com
Click on the “Find a Doctor” button
Select the option for “Shared Administration OAP Provider Directory”
Enter your search location, e.g. Salt Lake City, UT
Select “medical” plans and then choose “OAP” from the drop down menu

I’ve misplaced a letter sent to me regarding a pending claim potentially related to an accident. 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 print a Replacement Accident Letter and mail it to the Fund office, Wilson-McShane Corporation.

When do I receive my medical ID cards?

You will receive your medical cards 7-10 business days from the end of the month in which the Fund office receives the required contributions to be eligible for benefits.

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

You can review the Summary Plan Description electronically or you can call Wilson-McShane Corporation at (800) 622-8780 to request a physical SPD Booklet.

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

You or your spouse must notify the Plan and mail a fully executed copy of your divorce decree to Wilson-McShane Corporation. Once the Plan receives the divorce decree, your former spouse’s coverage will be terminated back to the date of your divorce.

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

You or your spouse must 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 be eligible for 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 Benefits..

I’m a Jobsite Employee, how much do I pay for my insurance?

Jobsite Employees pay nothing. Your insurance is employer paid.

I do not know if I am currently eligible, how do I find out?

Contact Wilson-McShane Corporation at (800) 622-8780 and ask to speak with an AR Specialist.

How do I verify if my spouse and dependents are active under my insurance?

Contact Wilson-McShane Corporation at (800) 622-8780 and ask to speak with a Claims Representative.

I have not received my ID card yet or I have misplaced it. How do I request a new card?

Contact Wilson-McShane Corporation at (800) 622-8780 and ask to speak with a Claims Representative. They will verify eligibility and request that a new card be mailed to you. Your new card will arrive within 7-10 business days from the date you first notify the Fund office that you need a new card.

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