Iron Workers District Council of Philadelphia and Vicinity

HRA Health Benefit Plan Changes

We’re making some important changes to the Iron Workers District Council of Philadelphia and Vicinity Health Benefit Plan:

  • We’re changing the eligibility rules to make it easier for you to maintain coverage.
  • We’re starting a Health Reimbursement Arrangement (HRA) Program. Credits will go into your HRA Account for each hour you work. You’ll be able to use those Credits to be eligible for coverage and/or to pay for eligible health care expenses. The more you work, the easier it will be to maintain your eligibility—and the more Credits you’ll have to cover health care expenses.
  • You’ll be able to choose from different levels of coverage and how many people you want to cover. This will allow you to find a health plan option that meets your needs and budget. And it will put our Health Benefit Plan on stronger financial ground going forward. This will help current and future participants, our contributing employers and the Plan.

You’ll be able to make your choices during the enrollment period, which ends on January 15, 2021. We held meetings, sent out mailings and are continuing to post information on this website to explain the changes and guide you through the process.

Watch the Recording

Watch the Recording

We held meetings to explain the Plan changes, why we made them, what they mean for you, and what you’ll need to do. You can also review the presentation on this site. There is a PDF as well as a video.

 

The HRA Program At-A-Glance

The Trustees know how vital the Plan is to you and your family. We want to make sure you can count on your health benefits now and for years to come. To do that, the Trustees have decided to make some significant changes to the Plan for active members in 2021.

Currently, we offer only one health plan. It’s a good plan, but expensive and not flexible enough for many members and your families. Beginning March 1, 2021, the Plan will offer three health plan options, including the one available now, to active members and their dependents. Each plan option provides you with the health coverage you need to care for yourself and your family. Based on the hours you work, you’ll accumulate “Credits,” which you can then use to be eligible for coverage or to pay for eligible health care expenses. For example, the plan option that’s the same as what you have now offers the highest level of coverage, but it requires the most Credits for eligibility. If you don’t have enough Credits for the health plan you want, you can pay the difference out of pocket.

There will be an enrollment period from December 1, 2020 through January 15, 2021. During this period, all eligible participants will have a chance to select your coverage option. You will receive an enrollment guide in the mail that will explain the program in detail and the enrollment process. All eligible participants will also receive a personalized statement that shows what your initial HRA Program account balance will be to help you select the plan option and coverage tier that make sense for you and your dependents.

FAQs

Why are the Trustees making changes to our benefits?

The Trustees have tried to address rising health care costs in recent years by increasing employer contributions and making small benefit changes. We can’t continue to provide reliable, high-quality medical coverage, that is still affordable, without a bigger change. With the new HRA Program and medical plan options, we can continue offering comprehensive coverage to you and your dependents, while keeping costs in check for you, the Plan, and our contributing employers.

What are the medical plan options?

Plan A is identical to the plan we offer now, and t requires the most Credits for eligibility. Plan B has a higher deductible and higher cost-sharing than Plan A, and it requires fewer Credits for eligibility than Plan A. Plan C has the highest deductible and cost-sharing, and it requires the fewest Credits for eligibility.

How do I become eligible for a medical plan option?

You can elect coverage during open enrollment only if your HRA Account Credit balance is equal to or greater than three months of the cost of coverage for the plan option you elect. If you do not have enough Credits to enroll in a plan, or choose to wait until you have enough Credits for the plan you prefer, you can request to enroll in coverage at any point during the year once you’ve met the Account Balance requirement.

How do I remain eligible for medical coverage?

You remain eligible for coverage each month when you have enough Credits in your HRA Account to pay for the health plan you have selected. If you don’t have enough Credits in your HRA Account in a month for the plan option you elected, you may self-pay the difference for that month. You may also elect COBRA coverage (if you’re eligible), purchase other coverage under a public health exchange at healthcare.gov, or waive coverage. When your HRA Account Credit balance is once again equal to or greater than three months of the cost of coverage for the plan option you previously selected, you can request to re-enroll in coverage under that plan.

What is a Health Reimbursement Arrangement (HRA)?

An HRA is an account you can use to be reimbursed for eligible health care expenses on a pretax basis. Beginning March 1, 2021, the Plan will create an account for all eligible participants. That account will receive Credits on your behalf for each hour of covered employment that you work. You’ll use those Credits to determine if you’re eligible for coverage and to maintain your coverage, and/or to be reimbursed for eligible health care expenses.

What can I use my HRA for?

You’ll receive Credits in your HRA Account based on employer contributions received on your behalf for each hour you work in covered employment. You’ll then use those Credits to be eligible for coverage and/or to be reimbursed for eligible health care expenses.

Can I enroll during the year?

If you don’t have enough Credits to be eligible to enroll in a medical plan option during open enrollment, but you accrue enough during the year, you can request to enroll during the year by contacting the Plan Office.

What happens if I don’t enroll during open enrollment?

If you don’t enroll during Open enrollment, you will not have medical coverage beginning March 1, 2021.

What are Credits?

Credits are the contributions to the Plan your employer makes for every hour you work in covered employment, less $1.10 for General Account Expenses. You’ll use Credits to determine if you’re eligible for a medical plan option or to be reimbursed for qualified health care expenses.

What if I become disabled?

If you are unable to work because of a disability and you are receiving Workers’ Compensation benefits or Weekly Disability benefits from the Health Benefits Plan, you will be granted HRA Credits based on 21 hours per week at the hourly employer contribution rate less $1.10 for General Account Expenses.

What are qualified health care expenses?

Qualified health care expenses include amounts paid by you or your covered dependents for deductibles, copayments and coinsurance under this Plan or any other qualified group health plan in which you’re enrolled.

What are General Account Expenses?

General Account Expenses include administrative costs, stop-loss insurance, long-term disability, life insurance, waiver of premium, and fees that may be associated with the Affordable Care Act.

What if I don’t have enough Credits in my HRA Account to enroll in a medical plan option during open enrollment?

You can enroll in COBRA coverage (if you’re eligible), purchase coverage under a public health exchange at healthcare.gov, or waive coverage. When your HRA Account Credit balance is once again equal to or greater than three months of the cost of coverage for the plan option you previously selected, you can request to re-enroll in coverage based on that plan option.

Can I choose a more expensive medical plan option once I’ve accrued enough Credits?

It depends. You can switch medical plan options in the middle of the year only if you experience a qualifying event, such as marriage, divorce, or the birth of your child. Otherwise, the coverage option you choose—and the dependents you cover—will remain in effect through December 31, 2021. You’ll be able to choose a different medical plan option during the next open enrollment period in the fall of 2021, for coverage effective January 1, 2022.

What is open enrollment?

Open enrollment is your once-per-year opportunity to change your medical plan and add or drop coverage for your dependents. Outside of experiencing a qualifying event, it’s the only time you can make coverage changes.

When is open enrollment?

This year, open enrollment will be held December 1, 2020–January 15, 2021, for coverage effective March 1, 2021. In future years, open enrollment will be held October 15–November 30, for coverage effective January 1–December 31 of the following year.

How do I enroll in coverage?

Fill out the enrollment form included with your Enrollment Guide, and submit it to the Plan Office by January 15, 2021.

Why can’t I withdraw Credits from my HRA?

You accrue Credits separately from your wages for each hour you work in covered employment. It’s a notional account, which means you accrue Credits—not money. Although you can use HRA Credits for your own health care expenses, those Credits belong to the Plan. For instance, if you lose eligibility for coverage, you will not receive any money from the account.

Can I keep the same coverage I had before?

It depends. If you have enough Credits to elect Plan A, you can elect to keep the same coverage as before. If you don’t have enough Credits for Plan A, you can select another coverage option or you can wait until you save up enough Credits for Plan A coverage.

Why didn’t I receive a personal statement?

Active members who were covered for at least one coverage quarter between September 1, 2019, and August 31, 2020, received an initial allocation of HRA Credits to use during open enrollment. If you did not receive a personal statement, you were not eligible for an initial allocation of Credits. If you think that you should have received a personalized statement, but did not, please call the Plan Office immediately.

What should I do if there’s an error on my personal statement?

Contact the Plan Office immediately.

What happens to my HRA Account balance if I stop working?

Credits in your HRA Account are forfeited if you’re an active member and no employer contributions are received on your behalf, or no HRA Credits are grated to you due to disability, for a period of 12 consecutive months.

What happens to my HRA Account balance when I retire?

When you retire, you’ll keep your HRA Account balance. Although you won’t receive additional Credit contributions to your HRA Account, you can use any remaining Credits to be reimbursed for eligible health care expenses.* If you retired on or before August 31, 2020, you are not eligible to participate in the HRA. If you retire and then return to covered employment, you will accrue Credits in your HRA when you begin working again.

* The $100 that is deducted from retirees’ monthly pension benefit for Plan Coverage is not an eligible health care expense.

Terms & Definitions

 

Terms & Definitions

Annual Out-of-Pocket Maximum: The maximum amount you will pay for covered services during a calendar year. Once you reach the maximum, the Plan pays 100% of the cost of covered services for the rest of the year.

COBRA Continuation Coverage: If you lose eligibility for coverage, you can elect to continue group health coverage for up to 18 months by self-paying via COBRA, if you are eligible. Contact the Fund Office for help with COBRA continuation coverage.

Coinsurance: The share you pay for covered services after meeting your deductible. It is generally shown as a percentage.

Copayment: A fixed amount that you pay for a covered health care service. If you have a $20 payment for seeing your primary care provider, this is a copayment.

Coverage Tier: When you enroll in a medical plan, you’ll pick a coverage tier depending on the dependents you wish to cover. There are three coverage tiers:

  • Single (covers only you)
  • Member + 1 (covers you and one dependent)
  • Family (covers you and all of your dependents)

Credits: For each hour of employer contributions received for your work in covered employment, you’ll receive Credits in your HRA Account. You can use Credits to establish or continue eligibility for medical plan coverage and/or to be reimbursed for eligible health care expenses.

Deductible: The amount you must pay out of pocket for covered services before the Plan starts paying for benefits. There are different deductible levels for the different coverage tiers for each medical plan option.

General Account Expenses: The General Account Expenses include administrative costs, stop-loss insurance, long-term disability, life insurance, waiver of premium, and fees that may be associated with the Affordable Care Act. To pay for these expenses, $1.10 will be deducted from each hourly contribution your employer makes on your behalf, so the Plan can continue providing valuable, affordable benefits.

Health Reimbursement Arrangement (HRA): A notional account in which you accrue Credits for hours paid through employer contributions for your work in covered employment. You can use the Credits in your account to establish or continue eligibility for coverage and/or to be reimbursed on a pretax basis for eligible health care expenses.

Initial Credit Allocation: The starting balance of Credits in your HRA provided by the Fund Office to all active members who were covered under the Health Plan for at least one quarter between September 1, 2019 and August 31, 2020.

Notional Account: A type of account that exists for administrative purposes, but does not accrue money. Your HRA is a notional account because you accrue Credits—not money—to establish your eligibility for a medical plan option. In addition, you can use Credits to be reimbursed for eligible health care expenses.

Questions? Contact Us.

Please check this site regularly as we will be posting news and updates. You can also call the Plan Office at 215-537-0900 or 800-473-5005.