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Fill Out Your Painters Trust Health Plan Form

The Painters Trust Health Plan form is a key document that outlines the benefits available to eligible employees under the Employee Painters’ Trust Health and Welfare Plan. This form provides essential information regarding how to obtain benefits, file claims, and access customer service resources. Understanding this form is crucial for ensuring you and your family receive the benefits you deserve, so be sure to fill it out correctly by clicking the button below.

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Fill Out Your Painters Trust Health Plan Form

Article Structure

The Painters Trust Health Plan form serves as a crucial guide for employees covered under the Employee Painters' Trust Health and Welfare Plan. This document outlines essential contact information, ensuring that members know where to send claims and requests for assistance. Central to the operation of this form is Zenith Administrators, which handles claims and customer service. The form also provides details on eligibility and patient assistance programs, which include pre-certification for hospital stays and access to home health care. Additionally, it highlights the importance of using Preferred Providers to minimize out-of-pocket expenses. With clear instructions on how to navigate the claims process, the form emphasizes the necessity of pre-certification for certain procedures to prevent unnecessary costs. Furthermore, it informs members of the plan’s flexibility, noting that the Board of Trustees may amend or terminate the plan as needed. All these elements reinforce the relevance of the Painters Trust Health Plan form in helping employees understand and access their health benefits effectively.

Painters Trust Health Plan Example

The Employee

Painters’ Trust

Health and

Welfare Plan

Actives

Summary Plan

Description

January 2007

TRUST FUND

CONTACT INFORMATION

TRUST OFFICE

Zenith Administrators, Inc.

104 S. Freya Suite 220

Spokane, WA 99202

Submit all claims to:

PO Box 2523

Spokane, WA 99220

Submit all correspondence and payments to: 104 S. Freya Suite 220

Spokane, WA 99202

The Employee Painters’ Trust Health & Welfare Plan Claims Customer Service

Telephone	(509) 534-0265
Toll-Free	(800) 566-4455
Fax	(509) 534-5910
The Employee Painters’ Trust Health & Welfare Plan Eligibility Customer Service
Telephone	(509) 534-5625
Toll-Free	(800) 522-2403
Patient Assistance Program: Hospital Pre-Certiﬁcation; Home Health Care, Hospice (CareAllies)
Telephone	(800) 932-7766

WEBSITE

www.zenithadmin.com

This website contains:

•Helpful information about your Plan

•Notices about Plan changes

•Printable versions of claims forms, change of address forms and enrollment forms

•Links to Preferred Providers

•Summary Annual Report

•Claims History

•Eligibility

Please contact the Trust Ofice Claims Customer Service if you need a password.

Medco by Mail – Mail Order Pharmacy
Telephone	(800) 711-0917
First Choice Health Network (FCHN)
To ind a Preferred Provider near you	(800) 231-6935
Website	www.fchn.com
Managed Healthcare Northwest (MHN)
For Preferred Providers in SW Washington and Oregon	(503) 413-5800
Website	www.mhninc.com
Sierra Healthcare Options (SHO)
For Preferred Providers in Nevada	(800) 573-1124

YOUR GROUP INSURANCE BENEFITS

THE EMPLOYEE PAINTERS’ TRUST

HEALTH AND WELFARE PLAN

Actives

HOW TO OBTAIN PLAN BENEFITS

To obtain beneits see the Payment of Claims provision.

Forward your completed claim form to:

The Employee Painters’ Trust c/o Zenith Administrators, Inc.

P.O. Box 2523

Spokane, Washington 99220

Phone: 1-509-534-0265 or 1-800-566-4455

Fax: 1-509-534-5910

CLAIM ASSISTANCE

If you need assistance with iling your claim or an explanation of how

your claim was paid, contact:

The Employee Painters’ Trust c/o Zenith Administrators, Inc.

104 S. Freya, Suite 220

Spokane, Washington 99202

Phone: 1-509-534-0265 or 1-800-566-4455

Fax: 1-509-534-5910

A Plan Document required by law is available upon request from the Plan Administrator at the Painters’ Trust Administration Ofice. This booklet is a Summary Plan Description and is not the contract. In the event of a conlict the Plan Document will prevail.

When you utilize a Preferred Provider Hospital or Physician, the costs to the Trust are reduced. This also reduces your out-of-pocket costs. The Trust strongly urges you to utilize Preferred Provider services whenever possible. A directory of Preferred Providers may be obtained from the Union Ofice, Plan Administrator, First Choice at www.fchn.com 800-231-6935, Managed Healthcare NW at www.mhninc.com 503-413-5800 or Sierra Healthcare at 800-573-1124. Members in Anchorage have two Preferred Provider Hospitals to use. If these hospitals are not utilized, beneits are reduced. Please refer to the schedule.

Utilization Review (hospital pre-certiication) and Case Management for inpatient hospital services provide support so the patient can receive necessary, appropriate care while avoiding unnecessary expenses. To beneit from these programs, pre-certiication from CareAllies must be received before you receive medical and/or surgical services. Call CareAllies at (800) 932-7766.

To All Eligible Employees:

Please note that there is a separate booklet for Retirees. Please contact the Trust Ofice if you need a Retiree Booklet.

The Board of Trustees is pleased to present you with this new Summary Plan Description describing the medical, disability and accidental death and dismemberment beneits available to you and your family from the Painters’ Trust.

Please read this booklet carefully so you understand your beneits. Only the Trust Ofice represents the Board of Trustees in administering the Plan and providing information relating to the amount of beneits, eligibility and other Plan provisions. No participating employer, employer association, labor organization or any individual employed thereby, has any authority in this regard.

If you have any questions about your beneits, please contact the Trust Ofice for assistance.

Sincerely,
Board of Trustees
Mike Ball	Tim Bendokas
Tim Carrier	Nancy Gudmundson
John Smirk	Mike Guza
Steve Bloom	Gary Liles
	Bob Puzas

“NOTICE - Trustees Discretion Retained. The Board of Trustees reserves the maximum legal discretionary authority to construe, interpret and apply the terms, rules and provisions of the Beneit Plan covered in this Descriptive Booklet. The Trustees retain full discretionary authority to make determinations on matters relating to eligibility for beneits, on matters relating to what services, supplies, care, drug therapy and treatments are Experimental, and on matters which pertain to Participant’s rights. The decisions of the claims adjusters, Administrator, and Board of Trustees as to the facts related to any claim for beneits and the meaning and intent of any provision of the Beneit Plan, or application of such to any claim for beneits, shall receive the maximum deference provided by law and will be inal and binding on all interested parties.”

“Amendment and Termination of Beneit Plan. The Board of Trustees expects to maintain this Beneit Plan indeinitely, however, the Trustees may, in their sole discretion, at any time, amend, suspend or terminate the Beneit Plan in whole or in part. This includes amending the beneits covered by the Beneit Plan and/or the governing Trust Agreement and Policies of Administration. If the Plan is terminated, the rights of the Participants are limited to beneits incurred before termination. All amendments to this Plan shall become effective as of a date established by the Board of Trustees.”

SCHEDULE OF BENEFITS

MEDICAL BENEFITS

All beneits described in this Schedule are subject to the exclusions and limitations described more fully under the General Exclusions and Limitations in this booklet. This includes, but is not limited to, the Plan Administrator’s determination that: care and treatment is Medically Necessary; that charges are Usual and Customary; that services, supplies and care are not Experimental and/or Investigational. The meanings of these capitalized terms are in the Deinitions section of this document.

The Plan is a plan that contains Preferred Provider Organizations.

This Plan has entered into an agreement with certain Hospitals, Physicians and other health care providers, which are called Preferred Providers. These Preferred Providers have agreed to charge reduced fees to persons covered under the Plan.

Therefore, when an Insured Person uses a Preferred Provider, that Insured Person will owe a lesser amount than when a Non-participating Provider is used. It is the Insured Person’s choice as to which Provider to use.

Additional information about this option, as well as a list of Preferred Providers will be given to covered Employees and updated as needed.

DEDUCTIBLES

Deductibles are dollar amounts that the Insured Person must pay before the Plan pays.

A deductible is an amount of money that is paid once a Calendar Year per Insured Person. Typically, there is one deductible amount per person and it must be paid before any money is paid by the Plan for any covered services. Each January 1st, a new deductible amount is required unless otherwise speciied.

Any amount applied to the deductible in the last three months of a Calendar Year will be carried over and applied to the deductible amount for the next Calendar Year.

SERVICES	BENEFITS	MATERIAL HANDLERS
MAXIMUM BENEFIT AMOUNT	$1,000,000	$1,000,000

DEDUCTIBLE, PER CALENDAR
YEAR
Per Covered Person	$300	$450
Per Family Unit	$900	$1350

MAXIMUM OUT-OF-POCKET,
PER CALENDAR YEAR	$1300 Per Person	$3450

The Plan will pay the designated percentage of covered charges until the above listed amount of out-of-pocket payments is reached, at which time the Plan will pay 100% of the remainder of covered charges for the rest of that Calendar Year unless stated otherwise.

Hospital Services

		PPO	NON-PPO
		PROVIDERS	PROVIDERS
Room and Board	80% of the semiprivate room rate	80%	60%
Intensive Care Unit	80% of the Hospital’s ICU charge	80%	60%
Emergency Room	80% after $100 co-pay	80% after $100	60% after $100
		co-pay	co-pay
Outpatient Services	80%	80%	60%

Skilled Nursing Facility	80%	60%
Refer to page 35 for limitations

Physicians Services (NOTE: ALL PHYSICIANS’ SERVICES ARE SUBJECT TO THE USUAL AND
CUSTOMARY CLAUSE EXCEPT WHEN PERFORMED BY PPO PROVIDERS

Ofﬁce Visits	80%	80%	60%
Inpatient Visits	80%	80%	60%
Surgery	80%	80%	60%

Home Health Care	100% not to exceed 130 visits in any calendar year
(must meet plan requirements,
refer to page 35)

Neurological and Initial	80%	80%	60%
Psycholgical Tests and Evaluations

Hospice Care	100% not to exceed 180 days of inpatient and out-patient services in any
(must meet Plan requirements.	covered person’s lifetime
Refer to page 36)

Ambulance	80%	80%	60%
(to the nearest hospital equipped to	Commercial airline transportation
furnish the services)	may be covered if medically
	necessary.
Physical/Occupational Therapy	80%	80%	60%
Limited to 60 visits per year (must be
prescribed by physician)
Neurodevelopmental Disorders	80%	80%	60%
$2000 Lifetime Maximum (limited to
Dependents age 6 and under)

SERVICES	BENEFITS	MATERIAL HANDLERS
		PPO	NON-PPO
		PROVIDERS	PROVIDERS

Speech Therapy	80%	80%	60%
Limited to 30 visits per year (must be
for restoration of lost speech due to
diagnosed illness or Injury)

Durable Medical and	80%	80%	60%
Respiratory Equipment

Prosthetics	80%	80%	60%

Orthotics	80%	80%	60%
Not Covered except for diabetics

Spinal Manipulation/Chiropractic	80%	80%	60%
Services % up to $20 maximum per
visit. 24 visits per calendar year

Temporomandibular Joint Disorder	80%	80%	60%
(TMJ) $5,000 Lifetime Maximum
Regular Plan beneits for jaw surgery
if treatment started within 12 months
from date of injury.

Note: The above charges for TMJ will not be counted in accumulating covered charges toward the 100% payment percentage of other charges, nor will these charges be subject to the 100% payment.

Mental Disorders

Inpatient	80%	80%	60%
10 Inpatient Hospital days
Calendar Year maximum
Outpatient	80%	80%	60%
Limited to 20 visits per Calendar Year
maximum

Substance Abuse/Chemical	80%
Dependency	to a maximum of the greater
Inpatient and Outpatient	of $13,000 or $13,000 plus
	any adjustment based on the
	Consumer Price Index during a
	24 month period which increases
	$500 each year. (Detoxiication is
	not subject to $13,000 maximum)

Pregnancy	80%	80%	60%
(Employee and Spouse only)
Newborn Care	80%	80%	60%
(limited to bassinet, nursery, and
Physician charges while baby and
mother are inpatient)

SERVICES	BENEFITS		MATERIAL HANDLERS

Preventive Care Beneﬁts

Routine Physican Exams	100%		100%
(age 24 months or older)
Includes physician’s routine ofice
visits, lab and x-ray services, routine
cancer screening, smoking cessation
treatment (ofice visit and prescribed
medications)
% (not subject to deductible) $300
annual maximum

(Dependent Children under the age	100% to $2500 maximum		100% to $2500 maximum
of 24 months) Includes physician’s
preventative health care services,
inoculations as recommended by the
ACIP, oral polio vaccine and tests for
tuberculosis.
(not subject to deductible)

			PPO	NON-PPO
			PROVIDER	PROVIDERS

Preventative Care Female Employee	80%		80%	60%
or Spouse
One routine pap smear including
physician’s charges. Routine
mammograms (not subject to
deductible)

Hearing Aids	80%		80%	60%
$350 per ear each 36 months (does
not include battery or other ancillary
equipment replacement)

Acupuncture, Massage Therapy and	80%		80%	60%
Naturopathic Care
Up to 24 visits per year for each
service

PRESCRIPTION DRUGS	Reimbursement Plan; OR
You have three choices as to how you
would like to obtain your prescription
drugs.
Co-payments for mail order and retail	Medco by Mail, or;	20% for Generic Drugs
plans are:	ExpressScripts	25% for Brand Drugs when Generic is not available
		50% for Brand Drugs when Generic is available
		$5000 maximum out of pocket

TABLE OF CONTENTS
The key sections of your booklet
appear in the following order.
	Page
DEFINITIONS	1
HOURLY EMPLOYEE ELIGIBILITY	12
FLAT RATE EMPLOYEE ELIGIBILITY	16
DEPENDENTS ELIGIBILITY	18
SCHEDULE	21
UTILIZATION MANAGEMENT	22
ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS	28
WEEKLY DISABILITY BENEFITS	30
MAJOR MEDICAL BENEFITS	31
PREFERRED PRESCRIPTION DRUG PROVIDER OPTION	43
MAIL ORDER PRESCRIPTION DRUG BENEFIT	45
FAMILY AND MEDICAL LEAVE
as Federally Mandated	47
UNIFORMED SERVICES EMPLOYMENT AND
REEMPLOYMENT RIGHTS	58
COORDINATION OF BENEFITS (COB)	51
THIRD PARTY REIMBURSEMENT AND/OR SUBROGATION	55
HEALTH CONTINUATION/CONVERSION	57
MEDICAL CONVERSION
For You and Your Dependents	57
COBRA GROUP HEALTH INSURANCE CONTINUATION
as Federally Mandated	59
EXTENSION OF BENEFITS	63
GENERAL EXCLUSIONS AND LIMITATIONS	64
PAYMENT OF CLAIMS	67
APPEAL OF ADVERSE BENEFIT CLAIM DECISIONS	68
PRIVACY NOTICE	77
SUMMARY PLAN DESCRIPTION	83

Get Painters Trust Health Plan PDF Form

Form Characteristics

Fact Name	Details
Contact Information	The Trust Office for the Employee Painters’ Trust Health and Welfare Plan is operated by Zenith Administrators, Inc., located at 104 S. Freya Suite 220, Spokane, WA 99202. Claims can be sent to PO Box 2523, Spokane, WA 99220.
Eligibility and Claims Assistance	For questions regarding eligibility or claims, members may contact the Customer Service at (509) 534-0265 or toll-free at (800) 566-4455.
Utilization Review Requirement	Pre-certification from CareAllies is mandatory before receiving medical or surgical services to ensure necessary support and avoid unnecessary expenses.
State Governing Laws	This plan is governed by the Employee Retirement Income Security Act (ERISA) among other applicable state laws, primarily enforced at the state level where the Trust operates.
Discretionary Authority Clause	The Board of Trustees holds discretionary authority to interpret and apply the terms of the Benefits Plan, ensuring that decisions made by claims adjusters and administrators are final and binding.

Guidelines on Utilizing Painters Trust Health Plan

To ensure that you complete the Painters Trust Health Plan form accurately and efficiently, follow the steps outlined below. Missing information or errors may lead to delays in processing your claims, so it's essential to pay attention to each detail. After submitting your form, it will undergo review by the Trust Office, which will then determine your claim eligibility and benefits.

Begin by carefully reading the entire form to familiarize yourself with sections and requirements.
Provide your personal information at the top of the form, including your name, address, and contact details.
In the section for patient information, list the names of any dependents, their relationship to you, and relevant details as required.
Next, complete the sections related to your medical condition or services received. Include dates, diagnosis, and description of the treatment.
Attach any necessary supporting documentation, such as medical records or receipts from your healthcare providers.
Sign and date the form at the bottom to certify that all information provided is accurate and complete.
Make a copy of the completed form and all attachments for your own records.
Submit the original form and attached documents to the Trust Office by mailing it to: The Employee Painters’ Trust c/o Zenith Administrators, Inc. P.O. Box 2523 Spokane, Washington 99220.
If you prefer, you can also fax the documents to (509) 534-5910.

Once your claim is submitted, monitor your mailbox for communication from the Trust Office regarding your claim's status. Should you need assistance at any point, do not hesitate to reach out to the customer service numbers provided in your plan documentation.

What You Should Know About This Form

What should I do if I need to submit a claim?

To submit a claim for benefits under the Employee Painters’ Trust Health Plan, complete the claim form and mail it to the following address: The Employee Painters’ Trust, c/o Zenith Administrators, Inc., P.O. Box 2523, Spokane, Washington 99220. If you have any questions or need assistance while filing your claim, you can call the Claims Customer Service at (509) 534-0265 or toll-free at (800) 566-4455.

How can I find a Preferred Provider?

Finding a Preferred Provider near you is easy. You can contact First Choice Health Network at (800) 231-6935 or visit their website at www.fchn.com. Additionally, Managed Healthcare Northwest (MHN) serves areas in SW Washington and Oregon, and you can reach them at (503) 413-5800. For Preferred Providers in Nevada, Sierra Healthcare Options (SHO) can be contacted at (800) 573-1124.

What is the Patient Assistance Program?

The Patient Assistance Program offers support for services like hospital pre-certification, home health care, and hospice services. To access this program, you need to call CareAllies at (800) 932-7766 before receiving medical or surgical services, so you can ensure that your services will be covered.

What should I know about my benefits eligibility?

To confirm your eligibility for benefits under the Painters’ Trust Health Plan, contact the Eligibility Customer Service at (509) 534-5625 or toll-free at (800) 522-2403. Understanding your eligibility is crucial for accessing the medical, disability, and accidental death and dismemberment benefits provided by the plan.

How can I obtain a Plan Document?

If you're interested in obtaining a Plan Document, which outlines all the specifics of your benefits, you can request it from the Plan Administrator at the Painters’ Trust Administration Office. Keep in mind that this booklet is a Summary Plan Description and not the actual contract. If there are any conflicts between the two, the Plan Document will take precedence.

Common mistakes

Filling out the Painters Trust Health Plan form can be a straightforward process, but many individuals make common mistakes that can lead to delays or complications. One frequent error involves improperly completing personal information. Ensure that all fields are filled with accurate information, including your name, address, and contact details. Errors or omissions can result in processing delays.

Another mistake is neglecting to sign and date the form. A lack of signature indicates that the form isn’t officially submitted, causing unnecessary back and forth with the Trust Office. Always double-check your signatures before sending in your claim.

Many applicants also fail to review the instructions thoroughly. Each section of the form has specific requirements. Skipping over these instructions can result in incomplete submissions, which can lead to the rejection of your claim. Take the time to read every detail carefully.

Inaccuracies in reportable expenses represent another significant pitfall. When detailing medical costs, ensure that all expenses are documented comprehensively. Provide itemized invoices and any additional information requested. The failure to present detailed expense reports can lead to disputes or denials.

Individuals often overlook the importance of keeping copies of submitted claims. Providing a system for tracking submissions is essential. If issues arise, having a copy can expedite communication with the Trust Office, ensuring quicker resolution.

It’s crucial not to ignore deadlines. Missing a submission deadline can disqualify you from receiving benefits. Mark your calendar, set reminders, and ensure that you submit the form and any necessary documentation on time.

Lastly, failing to reach out for help can be detrimental. Many individuals get overwhelmed and submit forms without seeking clarification. Whenever in doubt about instructions or requirements, contact the Claims Customer Service for assistance. This simple step can prevent future headaches and ensure your claims process runs smoothly.

Documents used along the form

The Painters Trust Health Plan form is an essential document for employees involved in the Painters’ Trust program. However, several accompanying documents enhance the understanding and functionality of the plan. Each plays a critical role in ensuring employees have access to the benefits and information they need.

Claims Form: This document allows members to submit requests for reimbursement for medical expenses. Completing the claims form accurately is crucial, as it outlines all necessary details about the service rendered, ensuring prompt processing of funds.
Change of Address Form: Members are required to notify the Trust of any changes to their address. This form is essential for maintaining accurate records and ensuring that all communications and benefits reach the right person.
Enrollment Form: New employees or those wishing to sign up for additional coverage must complete this form. It collects vital personal information and designates the benefits applicants wish to enroll in, ensuring that the necessary coverage is effectively initiated.
Summary Annual Report: This document provides an overview of the plan's financial performance and the benefits provided over the previous year. It is designed to keep members informed about the plan’s status and any changes in coverage or benefits.

Having these documents readily available can streamline the process of managing benefits for employees. Each form contributes to a better understanding of the Painters Trust Health Plan, enhancing the experience of all members involved.

Similar forms

Health Insurance Policy Document: This document outlines the terms and coverage of health insurance plans, similar to how the Painters Trust Health Plan describes benefits, eligibility, and claims processes.
Employee Benefits Handbook: Like the Painters Trust form, this handbook provides a summary of employee benefits, including health, dental, and retirement plans, ensuring employees understand their entitlements.
Summary Plan Description (SPD): Similar to the Painters Trust form, an SPD explains benefits, eligibility, and how to file claims, ensuring compliance with legal requirements under ERISA.
Claims Form: This is used to submit medical expenses for reimbursement, akin to the claims process mentioned in the Painters Trust document.
COBRA Notification: This document informs employees of their rights to continue health coverage after leaving employment, much like the Painters Trust provides information about maintaining benefits.
Preferred Provider Network (PPN) Directory: Similar to the Painters Trust's emphasis on using preferred providers, this directory lists providers within an insurance plan, reducing costs for members.
Medicare Summary Notice: This notice details health care services billed to Medicare, akin to how the Painters Trust outlines benefits and payment of claims for its members.
Accident and Health Insurance Policy: Like the Painters Trust document, this policy provides detailed coverage information related to medical expenses arising from accidents or illnesses.
Flexible Spending Account (FSA) Plan Document: This outlines how employees can use pre-tax dollars for eligible medical expenses, similar to how the Painters Trust explains benefit eligibility.
Dependent Care Assistance Program Document: This provides guidelines for tax-free reimbursement for dependent care, paralleling the support offered by the Painters Trust for family health benefits.

Dos and Don'ts

When filling out the Painters Trust Health Plan form, it is important to follow certain guidelines to ensure the process goes smoothly. Below is a list of things to do and to avoid.

Do: Carefully read all instructions provided with the form before starting.
Do: Provide accurate and complete information to avoid delays.
Do: Double-check all details for correctness before submitting.
Do: Keep a copy of the completed form for your records.
Do: Submit the form to the correct address as indicated in the instructions.

Don't: Submit the form without signing it, as this may lead to rejection.
Don't: Give incomplete information or leave any sections blank.
Don't: Forget to attach all necessary supporting documents as required.
Don't: Use outdated forms; always use the most current version available.

Misconceptions

Misconception 1: The Painters Trust Health Plan form is a contract.

Many people mistakenly believe the form serves as a binding contract between the employee and the Trust. In reality, the form is a Summary Plan Description (SPD). It outlines available benefits and provisions, but it is not the contract itself. The official Plan Document, which holds legal authority, should be referenced for any disputes or clarifications.

Misconception 2: All claims must be submitted in person at the Trust office.

Another common misconception is that claims must be physically brought to the Trust office. There are actually multiple convenient options for submitting claims. Employees can send completed claims via mail, fax, or even contact customer service for assistance. Utilizing these methods can save time and streamline the process.

Misconception 3: Preferred Providers are not available outside the local area.

Some employees worry that seeking care outside their area is not an option. However, the Trust has agreements with Preferred Providers in various regions. Resources such as the First Choice Health Network and Managed Healthcare Northwest can help find providers regardless of location. This expands the options for employees in need of medical services.

Misconception 4: The Trust Office handles all inquiries related to benefits.

While the Trust Office is the primary contact for questions, misunderstandings arise when employees expect them to provide all answers related to eligibility and benefits. It's important to note that claims adjusters and the Board of Trustees also play key roles in administering and interpreting the plan. Employees should reach out to the appropriate contacts for their specific questions.

Misconception 5: Pre-certification is optional for all services.

Some individuals believe that obtaining pre-certification for hospital services is merely a suggestion. In fact, it is a requirement for certain types of care. Engaging with CareAllies before receiving services can prevent unexpected expenses and ensure coverage. Skipping this step could lead to a reduction in benefits.

Misconception 6: The Board of Trustees cannot change the Plan once it is established.

A common myth is that once the Plan is created, it remains unchanged. The Board of Trustees retains the authority to amend, suspend, or terminate the Plan at their discretion. They can adjust both the benefits and the terms of the Plan as needed. Employees should stay informed of any updates regarding their coverage.

Misconception 7: Only employees can use the Painters Trust Health Plan.

Employees might assume the benefits are exclusively for themselves. However, the Plan also extends coverage to eligible family members. Understanding this can be crucial for planning health care needs and utilizing available resources effectively.

Key takeaways

Understanding how to fill out and effectively use the Painters Trust Health Plan form is crucial for maximizing your health benefits. Here are key takeaways to keep in mind:

Complete Claims Form: Fill out the claims form accurately and completely. Missing information can lead to delays in processing claims.
Submit to Correct Address: Always send your completed claims form to the right address, which is The Employee Painters’ Trust c/o Zenith Administrators, P.O. Box 2523, Spokane, Washington 99220.
Contact Information: If you need assistance with your claim, contact the Claims Customer Service at (509) 534-0265 or toll-free at (800) 566-4455.
Use Preferred Providers: Utilize Preferred Provider services whenever possible. This practice reduces costs for both you and the Trust.
Pre-Certification Requirement: Before receiving medical services, ensure you obtain pre-certification from CareAllies to avoid unnecessary expenses.
Review Summary Plan Description: Carefully read the Summary Plan Description. It contains valuable details regarding your benefits and the claims process.
Inquire for Updates: Keep in touch with the Trust Office for updates or changes to the Plan. This helps to stay informed about your eligibility and other provisions.

By adhering to these guidelines, you can streamline your experience with the Painters Trust Health Plan and ensure that your claims are handled promptly and effectively.

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