WELCOME TO THE KENTUCKY LABORERS
DISTRICT COUNCIL HEALTH AND WELFARE FUND
The Kentucky Laborers District Council Health & Welfare Fund provides eligible Active Participants and their Eligible Dependents and Eligible Retired Participants and their Eligible Spouses with a wide range of benefits including Medical, Prescription Drug, Dental and Vision benefits for Active Participants and Dependents and Retired Participants and Retired Participants’ Spouses as well as Loss of Time Weekly Disability, Death and Accidental Death & Dismemberment benefits for Active Participants only and Death Benefits for Retired Participants only.
This website contains important information about your benefits and provides access to documents and forms that you may need.
- Anthem (Medical PPO Network)
- Delta Dental (Dental PPO Network)
- Elixir (Prescription Benefit Manager)
- LiveHealth Online (Telemedicine)
The above links are provided for quick access to your benefit pages.
NOTE: The links to Anthem, Delta Dental and Elixir will have Provider Directories and other information.
NOTE: In accordance with government regulations under the Consolidated Appropriations Act regarding transparency in coverage, the above-referenced link will allow you to search several files, including applicable In-Network Negotiated Rate files, Out-of-Network Allowed Amount files and Out-of-Area Rates (applicable when members use providers in non-Anthem states.) You will need to enter the Fund’s Employer Identification Number (EIN) to activate your search. The Fund’s EIN is 23-7017526.
INFORMATION REGARDING FORM 1095-B
On December 2, 2019, the IRS issued Notice 2019-63, relieving reporting entities of the requirement to furnish a copy of Form 1095-B to all covered individuals. However, you may still request to receive a copy of your 1095-B. You can send your request for Form 1095-B by email to email@example.com or by mail to the Kentucky Laborers District Council Health and Welfare Fund at 1996 By Pass South, Lawrenceburg, KY 40342. The Kentucky Laborers Health and Welfare Fund will furnish you with a Form 1095-B within 30 days of your request. You may contact the Kentucky Laborers District Council Health and Welfare Fund at (502) 839-8166 with any questions related to receiving a copy of Form 1095-B.
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)? When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for: Emergency services: If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center: When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
- You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact the federal agencies at 1-800-985-3059.
Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.