Alaska Teamster-Employer Welfare and Pension Trusts

Coordination Where Medicare Benefits are “Primary.” When Medicare benefits are primary to any benefits under the Plan, Medicare benefits are paid first, and payment of Plan benefits, if any, occurs second based on what Medicare has paid and other rules. For example, Medicare is primary to Plan benefits if you are eligible for Medicare benefits based on age or disability and your coverage under the Plan is not based on current employment (as in the case of coverage for Retired Participants and their Dependents and certain “COBRA” coverage). Coordination Where Medicare Benefits are “Secondary.” Medicare benefits are sometimes “secondary” to those under the Plan, meaning that Plan benefits are paid first and Medicare benefits, if any, are paid second. Further Discussion of Coordination of Plan Benefits with Medicare. For the full explanation of the rules on coordination of Plan benefits with Medicare, see your TEAMStar Retiree booklet (if receiving benefits through TEAMStar) or Section 15.10 through 15.12 of the SPD.

Your medical and dental benefit coverage is provided through the Alaska Teamster-Employer Welfare Trust, which is a multi-employer employee benefit plan governed by a federal law called ERISA, the Employee Retirement Income Security Act. Medical and dental benefits (other than Retiree benefits obtained through TEAMStar) are not paid by an insurance company; they are paid directly by the Plan.

The Board of Trustees has designed a comprehensive program of Health Plan benefits for you and your eligible dependents. However, not all services you receive are covered by the Plan. For covered services, you will be responsible for deductibles, co-payments and co-insurance amounts. The Plan will not pay charges above the “Usual, Customary and Reasonable” rate for medical services or supplies. A charge that does not meet all three of those requirements – by being “usual,” “customary,” and “reasonable” – will be adjusted by the Plan or eliminated. A charge is “usual” if it is no more than the charge that the medical provider most frequently makes to its patients for that service or supply. A charge is “customary” if it is equal to or less than the 85th percentile rate established for the geographic area by the Plan’s third party service, which analyzes appropriate health care charges, and does not exceed Medicare’s allowed amount for end-stage renal disease charges. A charge is “reasonable” if the service or supply is justified by the circumstances, and is not performed too frequently or at an unreasonable time.

An Active Employee who has met the initial eligibility requirements will be automatically enrolled in Employee-Only coverage. Enrollment of a spouse and/or children under the Employee-Plus or Family coverage levels requires a timely and properly-completed enrollment form. Otherwise, the Eligible Employee will remain enrolled in Employee-Only coverage until a change at the Plan’s next Open Enrollment or (if available) a change at Special Enrollment. Enrollment forms are available online and from the Trust Customer Service Office.