Date: May 25, 2023
To: Participants and COBRA Beneficiaries in the Union Roofers Health and Welfare Fund
Re: Kaiser and HealthNet Extend Certain COVID-19 services and tests through Nov. 11,2023; and Normal Plan Rules Resume July 11, 2023
This notice advises you of certain material modifications (plan changes) that have been made to the Union Roofers Health and Welfare Fund (the Plan). This information is very important for you and your eligible dependents. Please take the time to read this notice carefully. Also, please keep it along with your Summary Plan Description (SPD) dated January 1, 2020 and other Summaries of Material Modifications (SMMs).
Aviso a los participantes que hablan español: Si tiene alguna pregunta referente a este aviso o requiere alguna otra información referente a su cobertura de salud, por favor de comunicarse con la oficina administrativa al (562-927-1434) donde habrá varios representantes bilingües que le ayudarán.
COVID-19 Tests (Over the Counter (OTC) and PCR), Vaccines and Therapeutic Treatment
The California Department of Managed Health Care is requiring HMOs to extend certain COVID-19 services and tests through November 11, 2023. Below is a summary of Kaiser and HealthNet’s extensions of certain COVID-19 services and tests.
Kaiser will continue COVID-19 testing (OTC and PCR), vaccines and boosters, and therapeutic treatment (such as Paxlovid) at $0 cost-share through November 11, 2023, whether in or outside the Kaiser network. Typically, OTC tests are performed at home, while PCR tests are handled by a laboratory. After November 11, 2023, you must remain within the Kaiser network to receive these tests and services at $0 cost share; and any COVID-19 related out-of-network services (e.g., testing, vaccines, and treatment) are only covered for emergency/urgent care situations, if medically necessary and when legally required. You can visit kp.org to learn more about the extension of COVID-19 services that are being extended. You can also call Kaiser’s 24/7 KP COVID Info Line at 1-888-550-0951 (available in English and Spanish) for regular recorded updates.
HealthNet will continue COVID-19 testing (OTC and PCR), vaccines and boosters, and therapeutic treatment (such as Paxlovid) at $0 cost-share through November 11, 2023, whether in or outside the HealthNet network. After November 11, 2023, you must remain within the HealthNet network to receive these tests and services at $0 cost share; and any COVID-19 related out-of-network services (e.g., testing, vaccines, and treatment) are only covered for emergency/urgent care situations, if medically necessary and when legally required. You can visit healthnet.com to learn more about the extension of COVID-19 services that are being extended. You can also call HealthNet at 1-800-522-0088.
You can contact the Department of Managed Health Care Help Center at www.HealthHelp.ca.gov or call 1-888-466-2219.
The Indemnity Plan is not extending these COVID-19 services and tests at $0 cost share past May 11, 2023. For example, the Indemnity Plan will no longer cover OTC tests. The Indemnity Plan provides COVID-19 services and tests, but with applicable member co-payments, co-insurance, and deductibles after May 11, 2023.
You can also visit the website at https://www.unionroofers.org to download the links for additional information.
Normal Plan Rules Resume July 11, 2023 (and End of Extension of Certain Plan Deadlines)
With the extensions issued under the COVID-19 National Emergency expiring on July 10, 2023, the suspension of the Plan’s deadlines for COBRA election and payment, HIPAA special enrollment, filing claims and appeals, and requests for external review will also come to an end. During the National Emergency, plans were required to disregard the “Outbreak Period” for up to one year when calculating certain plan deadlines. The Outbreak Period will also end on July 10, 2023. Timing for submitting the following documents will revert back to regular Plan timelines starting on July 11, 2023, as follows:
Please note that you may not get the full one-year Outbreak Period extension if your original deadline to submit documents is within a year before July 10, 2023. If you believe this may apply to you or if you have any questions, please call the Fund Office at (562) 927-1434. You may also review the normal Plan rules in your Summary Plan Description.
In accordance with ERISA reporting requirements, this document serves as your Summary of Material Modifications (SMM) to the Plan and we are advising you of these Plan changes within 60 days of the adoption of the Plan changes. Receipt of this notice does not constitute a determination of your eligibility. If you wish to verify eligibility, or if you have any questions regarding these Plan changes, contact the Administrative Office.