Navigating Your Healthcare Benefits with Confidence and Ease

Both Delta Dental and VSP Vision Care use the policyholder’s Social Security number as the ID number.  The dental group number is 23179. Vision does not require a group number.  There are no cards required for dental or vision benefits.

Verify the correct RX bin, RX group number, and RX ID are being used; not the medical ID or group number. The RX numbers are on the bottom left of your medical ID card.

Pregnancy is not covered for dependent children. Pregnancy and pregnancy-related conditions are only covered for female employees or spouses of employees.

Complete an updated Enrollment Form. This form can be found under the Member Forms section below.

The form should be submitted to the FMCP Benefit Office by:

Email – fmcp_customer_service@nifmcp.com
Fax – 1-706-841-7020
Mail – 410 Chickamauga Avenue, Suite 301, Rossville, GA 30741

Many services and treatments require pre-certification to be covered by the Plan. It is your responsibility to ensure that your provider has received pre-certification before you receive services. You or your provider should call Anthem BCBS at the number provided on the back of your ID card, 1-855-343-4851, for pre-certification.

All inpatient treatment requires pre-certification. Partial inpatient and intensive outpatient treatment for mental health and/or substance use requires pre-certification. Durable medical equipment and home healthcare may also require pre-certification.

You must also obtain pre-certification for various surgeries and specialized cardiovascular treatments in order for these benefits to be covered by the Plan. Additional treatments and services, such as genetic testing, may also require pre-certification.

Additionally, after visit limitations have been met, physical therapy, occupational therapy, and cardiovascular therapy may require pre-certification. Applied Behavioral Analysis (ABA) therapy also requires pre-certification.

The hospital or physician will usually make the call for you, but it is your responsibility to ensure that your provider has received pre-certification before you receive services. In case of an emergency admission, Anthem should be contacted within 48 hours of the admission.

Pre-certification is a requirement for both in-network and out-of-network hospitalization benefits, including inpatient treatment for mental health and/or substance abuse benefits.

Please note that pre-certification is NOT a guarantee of payment. Services are approved based on medical necessity and appropriateness. Actual payment is dependent upon that person meeting the Plan’s eligibility rules and other provisions.

You or your provider should call Anthem BCBS at the number provided on the back of your ID card, 1-855-343-4851, to check the status of a pre-certification.

Yes, the Fund will provide you with an Explanation of Benefits (EOB).

Copies of your EOB can be found on the Participant Portal.

You can find your deductible balance by visiting the Anthem website at www.anthem.com or by downloading Anthem’s app, called Sydney Health, to your computer, tablet, or mobile device.

Deductibles, coinsurance, and co-pays (if applicable to your plan) are applied to meeting your Plan’s out-of-pocket amount for each calendar year.

In-network providers throughout the country will file your claims for you. When visiting a Blue Card PPO provider, all you need to do is show your medical ID card. If you choose to use an out-of-network provider, you may need to file your claims yourself; however, some out-of-network providers may file your claims with the local plan on your behalf.

The Blue Card PPO provider network is extensive including more than 97 percent of hospitals and nearly 90 percent of physicians in the United States. You are encouraged to use an in-network provider so that you aren’t required to pay for medical services up front, and so that you can take advantage of the Blue Cross and Blue Shield negotiated provider discounts. Claims must be filed to the local Blue Cross Blue Shield plan regardless of the provider’s participation status. If an out-of-network provider won’t file the claim for you, you will be responsible for filing the claim yourself. Please refer to your Summary Plan Description (SPD) for more detailed instructions.

Bariatric surgery and weight loss medications are not covered, even if deemed medically necessary by your doctor. The Plan specifically excludes coverage for obesity, morbid obesity, or any overweight condition, including bariatric surgery or complications resulting from bariatric surgery.

You can find a participating provider by visiting www.anthem.com or by calling 1-800-810-BLUE (2583). The Anthem website and phone number are also located on the back of your medical ID card. Additionally, you can call your provider directly and ask if they participate in the Blue Card PPO network. Contact the FMCP Benefit Office at 1-877-937-9602 if additional assistance is required.

In-network providers cannot bill you for the difference between what the Plan reimburses and what the provider charges for covered health services. You are only responsible for the plan co-payments, deductibles, and coinsurance.

If you seek services from an in-network provider, you are typically required to pay your office visit co-pay. You may also be required to pay for coinsurance and deductibles.

Services or supplies required by an employer as a condition of employment, or which an employer is required to provide under a labor agreement, or which are required by law, are excluded from coverage. This also applies to physicals for sports.

You can call the “coverage while traveling” number on the back of your medical ID card, 1-800-810-2583, or visit www.bcbsglobalcore.com.

Please note this does not apply to travel by cruise. Any claims for medical service received while on a cruise will need to be submitted to the FMCP Benefit Office, and the provider will be considered out-of-network.

Complete an updated Loss of Time Benefit Statement of Claim form (participant portion and physician statement). This form can be found under the Member Forms section below.

The form should be submitted to the FMCP Benefit Office by:

Email – fmcp_customer_service@nifmcp.com
Fax – 1-706-841-7020
Mail – 410 Chickamauga Avenue, Suite 301, Rossville, GA 30741

You can verify eligibility through the Participant Portal.

Contact the FMCP Benefit Office. The customer service phone number, 1-877-937-9602, is listed on the back of your medical ID card. You can also contact the Benefit Office by emailing fmcp_customer_service@nifmcp.com, by sending a message through the Participant Portal, or by clicking the Contact the Benefit Office button at the top of this page.

You can view this information by logging in to your Participant Portal account. Click on Work History to view hours received. Click on Eligibility to view your eligible months of coverage.

If you are a construction participant, you must provide a completed Enrollment Form – Construction listing the dependents you wish to add. When adding a spouse, you must also provide a certified copy of a marriage certificate. When adding children, you must also provide a certified copy of the child’s birth certificate and/or any court documents that may apply regarding custody, guardianship, adoption, or a Qualified Medical Child Support Order (QMCSO). The above-mentioned form can be found under the Member Forms section below.

All documents should be submitted to the FMCP Benefit Office by:

Email – fmcp_customer_service@nifmcp.com
Fax – 1-706-841-7020
Mail – 410 Chickamauga Avenue, Suite 301, Rossville, GA 30741

If you are a non-construction participant, please contact your employer for details.

A dependent is one of the following:

1. Your legal spouse (from whom you are not divorced).
2. Your child who is less than 26 years old. (Your child will remain eligible through the end of the calendar month in which their 26^th birthday occurs.)
3. Your unmarried child who is age 26 or older and who is permanently and totally disabled because of intellectual disability, mental incapacity, or physical disability, as certified by a doctor. The child must have become disabled before becoming age 26; must remain disabled, be incapable of self-sustaining employment, must be dependent upon you for the major portion of their financial support and maintenance, and specifically not provide more than 50% of their own support during any calendar year. Within 31 days after the child’s 26^th birthday, you must furnish, at your own expense, initial proof of the child’s disability and that they became disabled before they became age 26. Subsequent proof of the child’s continued disability may be required by the Trustees, but not more often than once a year.

A “child” means any of the following:

1. A child born of a valid marriage of yours, including a child legally adopted by you or placed in your home for adoption.
2. A child not born of a valid marriage of yours, of whom you have been determined to be the legal parent. Legal guardianship must be finalized and signed by a court of competent jurisdiction prior to the child’s 18^th birthday.
3. A stepchild of yours, meaning any child of your spouse who was born to your spouse or who was legally adopted by your spouse before your marriage to them.
4. A foster child, meaning an individual who is placed with you by an authorized placement agency or by judgment, decree, or other order of any court of competent jurisdiction.
5. A child who is determined to be an “alternate recipient” under the terms of a court order which the Trustees determine to be a Qualified Medical Child Support Order (QMCSO). The Trustees, in consultation with the Fund legal counsel, have adopted procedures for determining whether a particular court order qualifies as a QMCSO. If you would like a copy of the Plan’s QMCSO procedures, please call or write the Benefit Office. If you are a responsible party in a court action involving a child, you should request a copy of the Plan’s procedures BEFORE the final order is entered.

A completed Disenrollment Form and proof of other insurance is required. Please contact the FMCP Benefit Office at 1-877-937-9602 to obtain a copy of this form.

All documents should be submitted to the FMCP Benefit Office by:

Email – fmcp_customer_service@nifmcp.com
Fax – 1-706-841-7020
Mail – 410 Chickamauga Avenue, Suite 301, Rossville, GA 30741

A completed Re-Enrollment Form and proof of loss of other insurance (creditable coverage letter) is required. Please contact the FMCP Benefit Office at 1-877-937-9602 to obtain a copy of this form.

All documents should be submitted to the FMCP Benefit Office by:

Email – fmcp_customer_service@nifmcp.com
Fax – 1-706-841-7020
Mail – 410 Chickamauga Avenue, Suite 301, Rossville, GA 30741

A totally disabled child over the age of 26 has no age maximum as long as they continue to be totally disabled and you, the policy holder, is eligible.

A child who is less than 26 years old will be eligible. Your child will remain eligible through the end of the calendar month in which their 26th birthday occurs.

If awarded Supplemental Security Income (SSI):

• A copy of an award of disability benefits from the Social Security Administration.
• Proof the child dependent relies upon you for the major portion of their financial support and maintenance, and specifically cannot provide more than 50% of their own support during any calendar year (i.e., copy of tax return). This will be required only once.

If not awarded Supplemental Security Income (SSI):

• A yearly letter from the doctor stating child dependent is totally disabled.
• Proof the child dependent relies upon you for the major portion of their financial support and maintenance, and specifically cannot provide more than 50% of their own support during any calendar year (i.e., copy of tax return). This must be provided annually.

If your spouse is enrolled with insurance through their employer, please provide a copy of their insurance card and the effective date of the other insurance. If your spouse changes from one insurance plan to another, a creditable coverage letter from the previous insurance will be required indicating the termination date of the previous plan.

All documents should be submitted to the FMCP Benefit Office by:

Email – fmcp_customer_service@nifmcp.com
Fax – 1-706-841-7020
Mail – 410 Chickamauga Avenue, Suite 301, Rossville, GA 30741

A copy of your Supplemental Security Income (SSI) award letter (if applicable), a copy of the front and back of your Medicare card (if applicable), a copy of your pension letter, a completed election form (if Medicare eligible), and an Authorization for Automatic Electronic Transfer form (if applicable) are required. The Authorization for Automatic Electronic Transfer form can be found under the Member Forms section below. For a copy of the appropriate election form, please contact the FMCP Benefit Office at 1-877-937-9602.

All documents should be submitted to the FMCP Benefit Office by:

Email – fmcp_customer_service@nifmcp.com
Fax – 1-706-841-7020
Mail – 410 Chickamauga Avenue, Suite 301, Rossville, GA 30741.

If your local has elected to include retirement benefits in your collective bargaining agreement, you must meet the following requirements:

• If you have been awarded disability Supplemental Security Income (SSI), no other requirements are necessary.
• If you have not been awarded disability Supplemental Security Income (SSI):
  • You must be eligible for 48 out of the last 60 months.
  • You must be drawing an industry pension.
  • You must be at least 55 years of age.

Note: Retirement benefits are not available for participants currently on COBRA. Participants that have exhausted the 12 month short-term disability benefit, and fulfill all of the above requirements, are eligible for retirement benefits.

You can verify your Special Fund Account balance by visiting Wex Healthcard.

This is an Internal Revenue Service (IRS) requirement. Your Special Fund Account (SFA) is a health reimbursement account for you and your eligible dependents. There is no other way to substantiate and validate your purchases through your SFA. In order for reimbursement to occur, valid and itemized receipts or correlating Explanation of Benefits (EOB) must be received.

Click here to view a handy FAQ document featuring common questions and helpful tips for managing your SFA.

For additional non-urgent inquiries or support, contact SFASupport@nifmcp.com.