Question 1

What is a qualifying life event?

Accepted Answer

A Qualifying Life Event (QLE) is a specific life change that allows you to make changes to your health insurance and other benefits outside of the annual Open Enrollment period. These changes are permitted because the event significantly impacts your coverage needs. Common QLEs include:
 • Marriage, divorce, or legal separation
 • Birth or adoption of a child
 • Death of a dependent
 • Loss or gain of other coverage (e.g., through a spouse's job)
 • A significant change in employment status (e.g., starting or leaving a job, changing from full-time to part-time, or retiring)
 • A change in residence that affects your coverage area (e.g., moving to a different state)
When a QLE occurs, you have a limited window of 30 days from the date of the event to make adjustments to your benefits. This could include enrolling in, changing, or canceling coverage. It's essential to act quickly and provide any necessary documentation to avoid missing this opportunity.

If documentation is received after 30 days, your coverage will begin on the first of the month following when documentation is submitted

Here's an overview (https://www.healthcare.gov/glossary/qualifying-life-event/)of qualifying life events from Healthcare.gov.

If you have a QLE, contact Zenith American Solutions at 1-302-761-1080.

Question 2

What services and screenings are covered as preventive care?

Accepted Answer

Preventive screenings can help you take better control of your health. They are an important foundation of early detection and prevention of disease.

Preventive care services are NOT subject to a copayment or deductible when using in-network providers and must be billed to insurance with proper preventive coding.

Take a look at this flyer (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_8b2b1786c12e4189a3f15ab0f6824e86.pdf)to learn about the services and screenings that are covered as preventive care.

Please note: Coverage for these services is subject to certain conditions, age and time limits.

Question 3

How can I save money on prescriptions with GoodRx?

Accepted Answer

https://youtu.be/9qkXs768JKY
    
Here's how you get started:
 • Visit ww(http://www.goodrx.com)w.goodrx.com (http://www.goodrx.com)to search a prescription.
 • Locate the pharmacy that is most convenient to you, offering the lowest price for your prescription.
 • If a coupon is available, you can print it out and take it with you when you pick up your prescription to receive an immediate discount. NOTE: if you use a coupon, the total charge will not apply to your deductible.
 • For even easier access, download the app!(https://www.goodrx.com/mobile)

Question 4

Where should I go for medical care?

Accepted Answer

Take a look at this flyer (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_f5fbe910404d487b8d5f6059db07f5a8.pdf)t(https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_f5fbe910404d487b8d5f6059db07f5a8.pdf)o learn about your choices when it comes to where you should receive care.
 
High level overview:
 
Primary Care Physician - This is your home base. Your doctor knows your history and is a good place to start.
 • Cost to you: $10 copay per visit.

Emergency Room - Go to an ER when you have a life-threatening issue.
 • Cost to you: $10 copay per visit if admitted. $100 copay if not admitted.

Urgent Care - Consider an urgent care center for non-life threatening condition. You'll save time and money over the ER.
 • Cost to you: $10 copay per visit.

Telemedicine - Consider using Teladoc for non-life threatening conditions, and when you need 24/7 care.
 • Cost to you: $0

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Question 5

Where can I read information about Medicare?

Accepted Answer

Visit www.medicare.gov (http://www.medicare.gov/)for information.
 
Take this short survey (https://www.medicare.gov/basics/get-started-with-medicare/sign-up/how-do-i-sign-up-for-medicare)to determine if you will automatically receive Medicare or if you will need to sign up.
 
You can also click here (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_fa400095f8924c488d855ff433164310.pdf)to read a comprehensive overview of Medicare and its various parts.

Question 6

Where do I get an Explanation of Benefits (EOB)?

Accepted Answer

For Medical: For copies of EOBs from Aetna for the Health and Welfare Fund, you can contact Zenith American Solutions at 1-302-761-1080.
 
For Dental: Members can register online and print an EOB at www.deltadental.com (https://www.deltadental.com/)or call customer service at 1-800-932-0783.

Question 7

Do I need a referral to see a specialist?

Accepted Answer

No. But keep in mind that the Plan offers in-network coverage only.

Question 8

Should I go to Quest or LabCorp?

Accepted Answer

You may go to either Quest or LabCorp. Both options are available and are in-network.

Question 9

Why did I get billed for my preventive care visit?

Accepted Answer

While regular medical care focuses on treating illness, preventive care aims to keep you from getting sick in the first place by focusing on helping you maintain good health.

When you visit your doctor for a preventive care service - like a physical exam or a health screening - you should not be billed.

However, if you ask your doctor about a specific health concern while you are at your preventive care visit, it may be billed as an office visit, and not a preventive care visit.

Here’s how to be sure your preventive care visit is free for you:
1. Mention prevention upfront - When scheduling your appointment, confirm that you are scheduling a preventive care visit.
2. Know what to discuss with your doctor during the visit - During your visit, keep the conversation focused on how you can maintain a healthy lifestyle.
3. Ask your doctor - If you do ask questions about a specific health concern while at your visit, ask your doctor if that will be treated as an office visit or as a preventive visit. Let your doctor know you are expecting this visit to be of no charge to you.

For more information about preventive care, contact your Lacher benefits advocate.

Question 10

What events enable me to make benefit changes in the middle of the year?

Accepted Answer

These events are called Qualified Life Events (QLE) and include things like a birth of child/adoption, marriage, loss of coverage elsewhere, and more. Click here (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_ecd041045b154b9d9044a400e0f40c6a.pdf)to read about QLEs.

Question 11

How do I get a new ID Card?

Accepted Answer

Contact Zenith Welfare Eligibility at 302-761-1080 ext. 556513, or email LRutter@zenith-american.com,(mailto:LRutter@zenith-american.com) to request an ID card.

Question 12

Where can I find information for Retirees or Medicare?

Accepted Answer

Click here.(https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_53424f81a45f4f81a2372d369b4029a5.pdf)

Question 13

How do I file an out-of-network vision claim?

Accepted Answer

Please follow the instructions on this form.(https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_c26d4e05f6d048eda3c58aacfae7da0d.pdf)

Frequently Asked Questions