About My
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The Greater Metropolitan Employer-Employee Health & Welfare Fund is a self-funded, multi-employer Health Plan with approximately 800 eligible individuals working in union hotels across the Twin Cities area. This Fund is overseen by a Board of Trustees made up of both Labor and Management. The Trustees are committed to providing you and your family with the tools, information, and programs you need to take control of your health.
The Trustees of the Greater Metropolitan Hotel Employers-Employees Health and Welfare Fund hired Wilson-McShane Corporation to perform various functions associated with administration of the Fund. This includes, but is not limited to, processing medical claims, dental claims, vision claims, weekly disability benefit payments, eligibility administration, and employer contribution processing. The Plan also contracts with a variety of other Service Providers, as stated below.
United Healthcare (UHC) Choice Plus is the Plan’s Medical Preferred Provider Organization Network (“PPO”). The Plan contracts with United Medical Resources (UMR), a subsidiary of UHC, to utilize UHC’s network of providers and doctors. Using the United Healthcare Choice Plus network, the Plan gets significant discounts on the allowed charges of claims through UMR. For questions related to your healthcare network, please contact the Plan Administrator.
Delta Dental is the Plan’s Dental Preferred Provider Organization (“PPO”). The Plan contracts with Delta Dental to utilize their network of providers and dentists. Using the Delta Dental network, the Plan get significant discounts on the allowed charges of claims.
CVS/Caremark and CVS/Specialty are the Plan’s Pharmacy Benefit Managers (“PBM”).
If you have questions, please contact the Plan Administrator (Fund Office) Wilson McShane Corporation:
Helpful
Change of Name Form
Complete this form to change or correct your name and return it to the Fund Office.
Change of Address Form
Complete this form to change or correct your mailing address and return it to the Fund Office.
Authorization for Release of PHI Form
If you want the Plan to disclose your protected health information to another person or organization (for example, your spouse), you must fill out this form and return it to the Fund Office.; your spouse or dependent child over the age of 17 must also fill out this form to disclose their protected health information to you.
Beneficiary Designation Form
To designate a beneficiary for the Death Benefit, you must fill out this form and return it to the Fund Office.
What happens if I don’t work 255 hours per Qualifying Period? Am I still covered?
After you have satisfied initial eligibility if you fail to meet the set number of hours (255) to continue eligibility, but have worked in covered employment during the Qualifying Period, you will be allowed to self-pay for the difference between the hours worked and hours required.
How do I get a Summary Plan Description booklet (SPD)?
You can review the Summary Plan Description electronically or you can call the Fund Office to request a hardcopy of the SPD booklet.
Who do I inform and how do I inform if I have a child, adopt a child, or get married?
You may want to designate your significant other or child as your beneficiary. You may designate anyone as a beneficiary for the Death Benefit ($6,000.00) which is payable in a lump sum (after a death certificate or a certified copy of a death certificate is submitted to the Plan within one year after death or the Plan will not be liable for payment of the benefit). You may submit the Beneficiary Designation Form to the Fund Office.
Lastly, it is also recommended that you complete an Authorization for Release of PHI Form. This form will allow the Plan to disclose your protected health information to another person or organization. You must fill out this form and return it to the Fund Office.
Lastly, it is also recommended that you complete an Authorization for Release of PHI Form. This form will allow the Plan to disclose your protected health information to another person or organization. You must fill out this form and return it to the Fund Office.
When do I receive my ID cards?
You will receive your ID cards 10-15 business days after you become eligible. Contact the Fund Office if you do not receive the cards or need a replacement card.
How do I locate a network provider?
You can contact the Fund Office (952) 854-0795, or you can access UMR’s Find a Provider document.
How do I add a dependent to my health insurance?
• Eligible Employees may enroll their Dependent Child(ren) when first eligible for coverage under the Plan. If for any reason, the Eligible Employee does not enroll their Dependent Child(ren) at when they (employee) first becomes eligible, the Eligible Employee may only enroll their Dependent Children should they be legally entitled to do so under the HIPAA Special Enrollment Requirements within 30 days of qualifying event.
o HIPPA SPECIAL ENROLLMENT REQUIREMENTS
• The cost for Dependent Child(ren) coverage will be the responsibility of the Eligible Employee.
- Marriage
- Birth
- Adoption
- Placement for adoption
What if my dependent already has coverage?
The Fund will reimburse an eligible employee up to $225 per month for the cost of obtaining dependent medical care insurance. The employee must submit proof of payment along with a claim form to the Fund for each reimbursement.
Who is eligible as a Dependent under the Dependent Care Reimbursement Benefit?
- Your spouse from whom you are not divorced or legally separated.
- Each unmarried child who has not yet reached 26.
- Domestic Partner; anyone who has a currently registered domestic partnership with a governmental body pursuant to state, local, or other law authorization.
What should I have in place in the event of my death?
- You may designate anyone as a beneficiary for the Death Benefit ($6,000.00) which is payable in a lump sum (after a death certificate or a certified copy of a death certificate is submitted to the Plan within one year after death or the Plan will not be liable for payment of the benefit). You may submit the Beneficiary Designation Form to the Fund Office.
- Dependents covered under the Plan may elect to make self-contributions for COBRA Continuation Coverage for 36 months maximum.
How do I designate a beneficiary for the Death Benefit?
Request a Beneficiary Designation Form and mail it to the Fund Office.
If I am injured and cannot work and the injury is not employment related, what support do I have?
If you are injured or have a sickness that is not employment-related, you are eligible for the Weekly Accident and Sickness Benefit. You must be unable to perform the duties of your occupation and you must not be engaged in any other occupation for wage or profit. You will receive the amount of the Weekly Rate of $250.00 for a maximum of 13 weeks. This benefit will begin on the first day of disability due to injury and on the eighth day of a disability due to a sickness. Sickness includes: Physical illness, including pregnancy, and mental or nervous disorders.
When I retire, what are my options for continuing health coverage?
You may continue eligibility through self-contributions under COBRA for up to 18 months.
If electing COBRA coverage through self-contribution, you have 60 days after you have been sent the election notice or 60 days after coverage would terminate. However, you should turn it in as soon as possible.
If you are 65 years of age or older, and enrolled in Medicare, the Plan will be primary over Medicare if you maintain your eligibility under the Plan.
If electing COBRA coverage through self-contribution, you have 60 days after you have been sent the election notice or 60 days after coverage would terminate. However, you should turn it in as soon as possible.
If you are 65 years of age or older, and enrolled in Medicare, the Plan will be primary over Medicare if you maintain your eligibility under the Plan.
Should I enroll in Medicare Part B?
Yes, you should enroll for Medicare Part B when you are first eligible to do so.
Medicare Part B is “supplementary medical insurance, primarily covering physician services, although it also covers a number of other items and services such as:
- Medically Necessary Services
- Preventative Services
- Clinical Research
- Ambulance Services
- Durable Medical Equipment
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Mental Health
- Inpatient
- Outpatient
- Partial Hospitalization
- Intensive Outpatient Program services
- Limited Outpatient Drugs
Who do I contact with questions?
If you have any questions about your eligibility, benefits, or claims, contact the Fund Office at (952) 854-0795 or (800) 535-6373.
Notice regarding Change Healthcare
This notice alerts participants to the cyberattack attack against Change Healthcare, details the Fund’s connection to Change Healthcare, and offers/directs them to resources for free support (including two years of free credit monitoring) for those concerned about their personal data.
Need Help?
Give us a call at:
Phone: (952) 854-0795
Toll Free: (800) 535-6373
Fax: (952) 854-1632
Mailing Address:
3001 Metro Drive, Suite 500, Bloomington, MN 55425
Greater Metropolitan Hotel Employers-Employees Health and Welfare Fund