H&W: Eligibility & Enrollment Information

Professional Musicians, Local 47 and Employers’ Health & Welfare Fund

The Fund mailed Eligibility and Enrollment information to all eligible participants in mid-November. The enrollment materials advise each participant of the level at which they qualified (A, B or C).

The qualifying levels are as follows:

Level             Employer Contribution Amount
A                    $1,500 plus
B                    $1,200 to $1,499
C                    $800 to $1,199

In order to be covered by one of the Fund’s benefit plans, for the coverage year beginning January 1, 2018, you must (A) have accumulated a minimum of $800 in employer contributions, for covered work performed between October 3, 2016 through October 2, 2017, and (B) remit, to the Fund’s Administrative Office, a completed enrollment form along with the proper co-premium, no later than December 20, 2017.

Information about the Benefit plans, including Summaries of Benefits and Coverages, is posted on the Fund’s website:

www.pacfed-musicians.com

The Professional Musicians, Local 47 and Employers’ Health and Welfare Fund ‘s website contains information, documents and forms that are helpful to Fund participants. Most of the information is provided in PDF format to allow for easy download, to save or print, etc.

What Benefit Levels are Available?

The Welcome page on the Fund’s website shows the various benefit levels that a musician may obtain based upon proper contributions from a Participating Employer. A Participating Employer is one that has signed a valid AFM agreement that calls for benefits to come to the Professional Musicians, Local 47 and Employers’ Health and Welfare Fund: proper contributions are those that are remitted for actual work that was performed under the applicable AFM or Local 47 collective bargaining agreement.

What Benefits Does the Fund Offer?

The Fund offers a variety of benefits and benefit options. To view these benefits – when at the Fund’s website – select the Benefits link associated with each benefit level; here you may view the array of benefits offered to musicians who qualify for coverage under the Fund’s rules and regulations, for level of qualification (e.g., $800-$1,999; $1,200-$1,499; $1,500 and above). The Summary of Benefits is a brief summary of the various benefits sponsored by the Fund. The Explanation of Coverage (EOC) is a larger booklet, issued by the insurance companies which actually provide and administer the benefits, with detailed coverage information regarding the precise benefits they provide. You are entitled to receive the EOC for the coverage you enroll in.

How Do I Enroll?

The Fund will send you a notice in the mail advising you of your eligibility level. If you receive a notice of eligibility, log onto the Fund’s website to view the benefits for which you may be eligible. Select the benefit that best suits your situation and applies to your qualification level, compete the enrollment form that is included in with our eligibility notice and return the completed enrollment application, along with the proper co-premium to the Fund office at:

Professional Musicians, Local 47 and Employers’ Health & Welfare Fund
c/o PacFed Benefit Administrators
1000 N. Central Ave., Ste. 400
Glendale, CA 91202

What Does It Cost?

Select the Rates link to view the monthly premium rates for the eligible participants and dependents for all levels of coverage. As many of you are aware, in addition to qualifying for and enrolling in the benefit plan, you must pay a portion of the premium (called the “participant co-premium”).

How Can I Contact a Fund Representative?

Select the Contact link to obtain information about how to contact the Fund. The Fund is administered by PacFed Benefit Administrators and on the Contact page you will find the Administrator’s location, telephone numbers, fax number and email address.

How Do I Find an in-Network Doctor or Dentist?

Select Providers on the menu to find a provider affiliated with one of the Blue Shield, Kaiser or Delta Dental plans. The Providers page has instructions on how to find a provider for the benefit plan in which you are enrolled.

Frequently Asked Questions (FAQs)

The FAQ page has information on how to use your HMO or PPO health plan. The FAQ page also has information on Family and Medical Leave Act (FMLA), Health Insurance Portability and Accountability Act (HIPAA) and Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA).

What Happens if You Do Not Receive a Notice of Eligibility

If you believe that you performed enough covered work to have sufficient employer contributions to make you eligible for benefits, but you did not receive an eligibility notice, you may file an appeal with the Fund’s Board of Trustees. For more information on how to file and when to file an eligibility appeal, please check the Appeals page on the Fund’s website.

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