FAQs

These FAQs are only an overview of your Teamsters Security Fund for Southern Nevada—Hotel & Casino Workers benefits. Refer to the applicable Summary Plan Description or plan contract/certificate for a full description of benefits. In the event of a discrepancy between these FAQs and the official plan documents, the information provided in the plan documents will govern.

Eligibility

You are eligible for Teamsters Security Fund for Southern Nevada—Hotel & Casino Workers health & welfare benefits if you are:

  • An active employee of a participating employer, you have met the initial eligibility requirements (first day of the month after the receipt of three consecutive months’ contributions), and you have maintained continuous eligibility, or
  • A retiree of a participating employer who is receiving a pension from the Teamsters Western Conference or another collectively bargained pension plan, has maintained continuous eligibility, and is not yet eligible for Medicare. You must have been eligible as an active employee, or through COBRA, for 96 of the 120 months immediately before retirement.

Your eligible dependents include:

  • Your legal spouse (including same-gender spouse)
  • Your children up to age 26, including:
    • Natural children
    • Stepchildren
    • Legally adopted children
    • Children placed for adoption
    • Children for whom you are the court-appointed guardian.
  • Your unmarried disabled adult child

Login at https://www.zenith-american.com/ and click on Health Eligibility in the left menu.

Enrollment

To enroll for health and welfare benefits, complete and return an Enrollment Form to Zenith-American Solutions or your employer’s Human Resources office. Complete all sections of the form and enclose any required documents for your dependents.

You can change your benefit elections once every 12 months. To make changes, complete and return an Enrollment Form to Zenith-American Solutions or your employer’s Human Resources office. Complete all sections of the form and enclose any required documents for your dependents. To drop a dependent from coverage, send a request to the Trustees with an explanation of why the change is justified.

You can also make enrollment changes due to certain qualifying life events, such as getting married or divorced, having a baby, or your spouse losing coverage under his or her own plan. You must make these changes within 60 days after the life event. See the Summary Plan Description for more information.

To enroll dependents, send copies of the following documents along with your completed Enrollment Form:

  • Spouse: Certified Marriage Certificate
  • Children/stepchildren: Certified Birth Certificate or court-appointed guardianship certificate; divorce decree for stepchildren, if applicable

If your dependents lose eligibility for coverage due to divorce, legal separation or death, you must notify the Fund by sending a copy of one of the following documents along with an updated Enrollment Form:

  • Divorce decree
  • Legal separation papers, or
  • Death certificate

Note that you must list the Social Security number for all dependents on your Enrollment Form.

Claim Status

When you receive care from either an in-network or non-network provider, show your Medical ID Card to your provider, who will submit the claim for you. Note that out-of-network benefits will apply for non-network providers.

If your claim involves an accident or injury, the PPO Plan administrator needs additional information before it can process the claim, such as how and where the accident or injury occurred and whether anyone else was involved. This can affect who pays the claim. Medical providers do not include this information when they submit their claims, so the administrator will contact you to obtain it.

Login at https://www.zenith-american.com/ and click on Claim Status in the left menu.

Plan Benefits

If you visit the emergency room for non-life-threatening treatment, the PPO Plan pays $75 of emergency room charges and you pay the balance; the HMO Plan pays nothing in this case.

Under the PPO Plan, you can use BlueCard® to access benefits and receive healthcare services while traveling or living outside the PPO Plan service area. BlueCard links participating providers and BlueCross BlueShield Association Plans across the United States through a single electronic network for claims processing and reimbursement. For more information, call (702) 734-8601.

Under the HMO Plan, you have coverage while traveling if you visit a Health Plan of Nevada contracted urgent care facility listed at www.myhpnonline.com. You also have emergency room coverage, but keep in mind that the HMO Plan pays nothing if your visit is for a non-life-threatening emergency.

We encourage all members to get preventive care services. Early detection is often key to treatment of many diseases and conditions that cause serious illness or even death. Spending a relatively small amount of time now can save you a lot of time, money, and discomfort in the future. Both the PPO and HMO Plans cover preventive care for you and your family at no charge to you, as long as you see in-network providers. This includes services such as physical exams, certain immunizations, and preventive screenings and services based on your age and risk factors—such as a flu shot, colonoscopy, PSA test for men, or mammogram or pap smear for women. For a list of covered preventive care services, visit anthem.com for the PPO Plan or www.myhpnonline.com for the HMO Plan.

Generic drugs are free under the PPO Plan and half the cost of preferred brand drugs under the HMO Plan. Since generic drugs use the same active ingredients and are proven to work the same way as their brand-name counterparts, they have the same risks and benefits. However, doctors don’t always automatically prescribe generic drugs. Be sure to ask whether a generic is available.

If you take medications on a regular basis for chronic conditions such as high blood pressure, arthritis, diabetes, and asthma, use the mail order service to save money on prescriptions. Depending on which plan you’re in and the type of drug, your copays for a 90-day supply may be lower than the same supply from a retail pharmacy, plus you get the convenience of home delivery.

Here’s how to get started with mail order:

This plan is a preferred provider organization (PPO). It gives you the flexibility to see any medical provider. However, you save money when you use in-network providers. Refer to your Summary Plan Description for details on this plan. This plan is self-funded, which means the Fund is responsible for claims costs for participants’ eligible health care services, not Anthem or Zenith American Solutions.

This plan is a health maintenance organization (HMO). You must always see Health Plan of Nevada providers in order to receive coverage, except for life-threatening emergencies. If you see an out-of-network provider, you will pay all costs for those services. The HMO Plan is fully insured, which means Health Plan of Nevada pays the claims for participants’ eligible health care services.

Precertification assures that your health care services meet or exceed accepted standards of care and that the admission and length of stay in a hospital or health care facility, surgery, drug, dental service or other health care services are medically necessary. If you’re in the PPO Plan, you will need to precertify certain medical services; see the Summary Plan Description for a complete list. To start the precertification process, contact Innovative Care Management (ICM) at:

P.O. Box 22386
Portland, OR 97269
Phone: 1-800-862-3338
Website:  www.innovativecare.com

How to Locate In-Network Providers

Keep in mind that we have different provider networks for hospital, mental health/substance abuse, prescription drugs, and other types of medical care. When you need services, choose the right network:

  • Southern Nevada Hospitals: Choose Hospital Coalition providers from the list at lvhsc.org.
  • Mental health/substance abuse treatment: Call Harmony Healthcare at (702) 251-8000 or visit harmonyhc.com for an online provider directory.
  • Prescription drugs: Access the EnvisionRx Pharmacy Locator at envisionrx.com or call 1-800-361-4542.
  • All other providers: Visit anthem.com and click “Find a Doctor” under “Menu.” Under “Search as a Member,” enter “TDG” below “Identification number or alpha prefix,” then click “Continue” and follow the instructions.

If you’re in the PPO Plan:

  • See the list of urgent care centers in your enrollment packet, or use the Anthem mobile app or visit anthem.com to find a facility near you.
  • Or consider using LiveHealth Online to connect with a doctor 24/7 via two-way video on your smartphone, tablet or computer. You’ll only have a $10 copay for this service. Visit livehealthonline.com or download the LiveHealth Online mobile app for free from the App Store or Google Play.
  • Or request urgent care services where you need them — at your office, home, or anywhere else. You’ll have only a $15 copay for this service. Visit dispatchhealth.com, call (702) 848-4443, or download the Dispatch Health app for free from the App Store or Google Play.

If you’re in the HMO Plan:

  • Visit a Health Plan of Nevada contracted urgent care facility listed at myhpnonline.com.
  • Or, consider using telemedicine. Visit myhpnonline.com and follow the instructions under NowClinic® Virtual Visits.

To find a VSP doctor near you, visit www.vsp.com and click on “Find a VSP doctor” or call 1-800-877-7195.

To find an in-network dental provider,

  • Diversified Dental PPO Plan: Visit ddsppo.com, click “Find a Dentist,” and follow the instructions.
  • LIBERTY Dental Plan DHMO-EPO (Benefit Plan NV-400): See the provider list in your enrollment packet, or visit libertydentalplan.com and click the “Find a Dentist” tab and select NV-100 through NV-700 from the Benefit Plan drop-down menu, then follow the instructions. You may also call LIBERTY Dental Plan at 1-888-401-1128.

If you’re in the PPO Plan, use LiveHealth Online to connect with a doctor 24/7 via two-way video on your smartphone, tablet or computer. You’ll only have a $10 copay for this service with no deductible. Visit www.livehealthonline.com or download the LiveHealth Online mobile app for free from the App Store or Google Play.

If you’re in the HMO Plan, visit  www.myhpnonline.com and follow the instructions under NowClinic® Virtual Visits.

Employee Assistance Program

The EAP, offered through Harmony Healthcare for all members and their immediate families includes:

  • Mental health and substance abuse treatment authorization
  • Free, confidential counseling for personal and family concerns: up to four free visits

To schedule an appointment, call Harmony Healthcare at 1-800-363-4874 or (702) 251-8000, 24 hours a day, seven days a week.

Accident/Disability Benefits

You are eligible for this benefit if you are an active employee. This benefit is not offered to your dependents.

If you think you are eligible for an accident and disability benefit, contact Zenith-American Solutions by phone at (702) 734-8601 or in person, or by completing and submitting the Disability Claim Form. If your claim for a Plan benefit is denied, you have the right to appeal the decision.

You’re covered if you become wholly and continuously disabled due to illness or injury and this disability prevents you from working. The benefit is $250 per week for up to 26 weeks for any one period of disability.

Disability benefits begin when the claim for disability has been determined to meet the definition of total disability under this plan and it is determined that plan disability exclusions do not apply to the claim. Disability claims will be determined no later than 45 calendar days after receipt of the claim unless additional information is required. You must provide proof of disability no later than 90 calendar days after the end of the period for which disability benefits are payable.

Life and AD&D Benefits

Teamsters Security Fund for Southern Nevada—Hotel & Casino Workers provides the following life and accidental death & dismemberment insurance (AD&D) coverage through Ullico:

  • Active employees: $25,000
  • Dependents of active employees (must be listed on the policy): $10,000
  • Retirees who have maintained continuous eligibility and are not yet eligible for Medicare: $10,000.

Note that dismemberment coverage may be different than life insurance coverage. Contact Zenith American Solutions for details.

You can apply for life and/or AD&D benefits by contacting Zenith-American Solutions by phone at (702) 734-8601 or in person.

Retiree Medical Coverage

The Teamsters Security Fund for Southern Nevada—Hotel & Casino Workers provides retiree coverage to eligible non-Medicare participants and their dependents. If you live in the Health Plan of Nevada (HPN) area, you may only enroll in the HMO Medical Plan. If you live outside the HPN area, you may only enroll in the Indemnity (PPO) Medical Plan.

Retiree coverage includes medical, pharmacy, dental, and vision benefits. Life and AD&D insurance coverage of $10,000 is included for members only.

Once you are eligible for Medicare, Via Benefits (One Exchange) is available to assist you in locating medical, prescription drug, dental, and supplemental life and accident insurance plans. Contact them by calling 1-888-825-2645 or visiting My.ViaBenefits.com/lasvegasteamsters.

Complete the Retiree Enrollment Form, which you should have received in your Retirement Packet. Confirm the premium you will pay for your medical and dental plan choices on the Retiree Enrollment Acknowledgement Form. Return the Enrollment Form, the Enrollment Acknowledgement Form and a copy of your Pension Benefit Award Letter to Zenith American Solutions.

ID Cards

If you are enrolled in the PPO Plan and have not received your ID Card and sleeve in the mail, contact Zenith-American Solutions at (702) 734-8601 to request them. If you are enrolled in the HMO Plan and have not received an ID Card in the mail, contact Zenith-American Solutions or Health Plan of Nevada at 1-800-777-1840.

Appeals

For claims administration and appeals related to the PPO Plan (including prescription drug and behavioral health claims), the Diversified Dental PPO Plan, vision care benefits, and the disability benefit, refer to Claim Filing and Appeal Information in the Summary Plan Description. If you receive an Adverse Benefit Determination for one of these claims, you may appeal it to the Board of Trustees.

For claims administration and appeals under the Health Plan of Nevada HMO Plan, the Liberty Dental Plan DHMO-EPO, and the Ullico Life and Accident Insurance Plan, refer to the official documents of these insurance companies.

Please keep in mind that you must file appeals within certain time limits. See the documents referenced above for more information.