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Welfare

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Welfare Documents

Welfare

Medicare and You 2019
Private Health Information Authorization Form
Active City Carpenters Reimbursement Claim Form 2018
Active City Carpenters Reimbursement Claim Form 2019
Retired City Carpenters Reimbursement Claim Form 2018
Retired City Carpenters Reimbursement Claim Form 2019
ASO/SIDS Dental Claim Form
Paid Family Leave- Bonding Application
Paid Family Leave- Care for Family Member Application
Paid Family Leave- Military Application
Health Insurance Claim Form- Empire
Health Plan Enrollment Form
Required Documents for Eligible Dependents
Prescription Mail Order Form- English
Prescription Mail Order Form- Spanish
Short-Term Disability Form
Short-Term Disability Form- City Carpenters
SBC Uniform Glossary

Other

Change of Address Form
NYCDCC Beneficiary Designation Form

To request any forms or documents that you do not see available on the website, please call the Benefit Funds Call Center at (800) 529-FUND (3863) or (212) 366-7373.

FAQs

I moved. How can I change my address?
Show Answer
You can change your address by filling out a Change of Address form and following the instructions located on the form. You can find the Change of Address form here: Change of Address Form
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What happens to my Life Insurance money if I die without a Beneficiary?
Show Answer
If you are eligible for Welfare Benefits at the time of your death and do not have a Beneficiary on file, payments will be made in the following order:

• your surviving spouse or, if none

• your children in equal shares, or, if none,

• your parents in equal shares or, if none,

• your brothers and sisters in equal shares, or, if none,

• your estate.

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What are the guidelines to retire with medical benefits?
Show Answer
To be eligible for Welfare coverage as a Retiree, you must satisfy one of the three requirements below:

• You have reached the age of 55 and earned a minimum of 30 Vesting Credits with the New York City District Council of Carpenters Pension Fund (“Pension Fund”).

• You have reached the age of 55, earned at least 20 Vesting Credits under the Pension Fund and, during the 60-month period immediately preceding the effective date of your pension, you are eligible as an Active Employee for at least 24 months; or

• You have reached the age of 55, have 25 years with at least 250 hours worked in Covered Employment, have earned at least 15 Vesting Credits under the Pension Fund and during the 60-month period immediately preceding the effective date of your pension, you are eligible as an Active Employee for at least 24 months.

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How can I add my spouse and/or children to my coverage?
Show Answer
You can add your dependents by filling out a Health Plan Enrollment Form and submitting the required documents.  
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What should I do about unpaid medical bills?
Show Answer
If you are a non-Medicare eligible member, contact Empire Blue Cross Blue Shield. You can log onto www.empireblue.com and register to view your claims that have been processed. If a claim was denied by Empire Blue Cross Blue Shield, contact Empire for appeal instructions. If you are Medicare-eligible, contact UnitedHealthcare directly at www.UHCretiree.com or by calling (888) 736-7441.
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How do I obtain my Empire BlueCross BlueShield or UnitedHealthcare card?
Show Answer
If you are a non-Medicare eligible member, you can request a card by calling Empire directly (800) 553-9603 or via internet @ www.empireblue.com. If you are Medicare-eligible, you can contact UnitedHealthcare by calling (888) 736-7441 or via internet @ www.UHCretiree.com.
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Does the Welfare Fund provide any help with prescription drug copayments?
Show Answer
Express Scripts is your pharmacy benefit manager. Retail co-payments are $15 for generic, $25 for preferred, and $40 for non-preferred prescriptions. Additionally, mail order co-payments are $25 for generic, $45 for preferred, and $75 for non-preferred prescriptions. *Note that mail-order co-payments represent a three month supply.
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What are the prescription drug copayments?
Show Answer
Express Scripts is your pharmacy benefit manager. Retail co-payments are $15 for generic, $25 for preferred, and $40 for non-preferred prescriptions. Additionally, mail order co-payments are $25 for generic, $45 for preferred, and $75 for non-preferred prescriptions. *Note that mail-order co-payments represent a three month supply.
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*Disclaimer: The Funds have prepared these informal answers to frequently asked questions for the convenience of our participants and contributing employers.  The Funds have made every effort to provide accurate answers, but they are not legally binding and do not address every possible situation.  The Collection Policy, Trust Agreements, and Collective Bargaining Agreements are official legal documents and supersede any inconsistent statements herein.