Your questions answered (2023)

Table of Contents
Eligibility and Enrollment What are my benefits? When will my dependents and I getbenefits? Can I put my niece, nephew or parents on mycoverage? I got divorced. What should Ido? Culinary Health FundCustomer Service I just had a baby. Is my baby automaticallycovered? I didn’t get my ID card. What should Ido? My employer didn’t report all of my work hours. What should Ido? I went on vacation, but my vacation hours weren’t reported for the work period I was gone. What should Ido? What’s Self-Pay? How do I know how much my self-payment is? Benefits and claims I got an “Explanation of Benefits” in the mail. What is this and do I need to doanything? My doctor sent in a claim and I got a letter asking questions about an accident. What should Ido? I was in an accident and I got paperwork about my accident. What is it and what should Ido? My doctor is sending me bills for services that I thought were covered by my benefits. What should Ido? I got a letter saying that more information is needed before my claim can be paid. What should Ido? My claim was denied. I think it should have been paid. What can Ido? How much is my copay for a doctor’svisit? Is my doctor a PPO doctor? Pharmacies Can I get medicine at the Culinary Pharmacies forfree? What other pharmacies can Iuse? How much will my medicine cost at a retailpharmacy? What’s the difference between getting my medicine by mail and picking up mymedicine? What’s a generic medicine? Why do generic medicines costless? Taxes What is a 1095-B form? Why didn’t I get a 1095-B form in the mail? How can I get a copy of my 1095-B form?

We get it. It’s natural for you to have questions. There’s a lot of information on this website and in our other materials. Sometimes it’s hard to understand it all. If you’re not sure about something, please askus.

We’re happy to answer your questions. It’s important for you get the answers you need. It can help you make the right choices for you and yourhealth.

The number for our Customer Service Office is 702-733-9938.

Here are the answers to some of the questions we get asked alot:

Eligibility and Enrollment

What are my benefits?

The Culinary Health Fund offers the best health plan in Nevada. We offer medical, dental, vision and pharmacy benefits. Hospital stays, home health, and life insurance are also part of your benefits. To learn how your benefits work, read the Summary Plan Description. Log in to this website to viewit.

When will my dependents and I getbenefits?

After you work 360 hours within 3 months you are eligible for benefits. You then have to wait one month before you can use your benefits, and they start the 1st day of the next month. Be sure to enroll your dependents before your benefits start. Learn morehere.

Can I put my niece, nephew or parents on mycoverage?

No. The only people you can add to your coverage are your spouse (if you’re legally married) and yourchildren.

I got divorced. What should Ido?

If you get divorced, you have to let us know. You can do that by calling our Customer Service office at 702-733-9938.

Culinary Health Fund
Customer Service

1901 Las Vegas Boulevard South
Suite 107
Las Vegas, Nevada 89104

Phone: 702-733-9938
Fax: 702-733-0989

Your questions answered (1)

I just had a baby. Is my baby automaticallycovered?

Yes. We cover your baby for the first 30 days. But you still have to enroll your baby. Bring your baby’s birth certificate to our Customer Service office to enroll them. Your baby will not have benefits if you don’t enroll them within 30days.

I didn’t get my ID card. What should Ido?

Call our Customer Service office at 702-733-9938. We’ll make sure you getone.

My employer didn’t report all of my work hours. What should Ido?

Call Customer Service at 702-733-9938. Ask how many work hours your employer reported for you. Let us know if all of your hours weren’t reported. We’ll contact your employer to get the right number ofhours.

I went on vacation, but my vacation hours weren’t reported for the work period I was gone. What should Ido?

Call our Customer Service office right away at 702-733-9938. Tell us when you went on vacation. Your employer may have put in your vacation hours wrong. We’ll contact your employer tocheck.

Your job usually pays you before you go on vacation. Sometimes the hours when your job paid you and when you were on vacation get mixed up. This can give you too many hours in one work period and not enough in the next. If so, your employer will move your vacation hours to the right period. It’s important to get this done right away so it doesn’t disrupt yourbenefits.

What’s Self-Pay?

Self-Pay is an option to pay us to keep your benefits when you don’t work enough hours. Once you have benefits, you need to work 240 hours every 2 months to keep them. If you work less than that you can pay us for the hours you’re short. Learn more aboutself-pay.

How do I know how much my self-payment is?

You’ll get a notice in the mail. The notice will tell you how much you owe and when you have to pay by. Call our Customer Service office at 702-733-9938 if you don’t get a notice but think you’re shorthours.

We only send self-pay notices by mail. If your address is not in our system you won’t get it. It’s important for you to tell us if your addresschanges.

Benefits and claims

I got an “Explanation of Benefits” in the mail. What is this and do I need to doanything?

An Explanation of Benefits is not a bill.

It tells you what the doctor charged and what we paid. It may also tell you if we didn’t pay for a service, and why. If you have any questions about your Explanation of Benefits, call our Customer Service office at702-733-9938.

My doctor sent in a claim and I got a letter asking questions about an accident. What should Ido?

We ask for information if it looks like you were hurt in an accident or if someone else might have caused your injury. Please answer the questions in the forms that came with the letter and send them back to us. You will get a bill from your doctor if you don’t send the completed forms back. We can’t pay your medical bill until we get the forms back fromyou.

I was in an accident and I got paperwork about my accident. What is it and what should Ido?

Please complete the paperwork and send it back. If you were injured in an accident that was caused by someone else we need to know. We want to make sure your medical bills get paid by the person who caused the accident. We can’t pay your medical bills until we get the papers back. You may have to pay for your medical care if we don’t get the papers back fromyou.

Here’s what you shoulddo:

  • Fill out and sign thepapers.
  • If you have a lawyer, have them complete the formsalso.
  • Send the completed paperwork back to the Culinary Health Fund. The address is on the coverletter.

If you have a lawsuit and reach a settlement, make sure your settlement includes your healthcare costs. Be sure to include the future cost of your healthcare needs related to the injury. Once you sign a settlement, the Culinary Health Fund may deny futureclaims.

My doctor is sending me bills for services that I thought were covered by my benefits. What should Ido?

Call our Customer Service Office at 702-733-9938. Ask if your doctor sent in a claim, and if it was paid. Our staff may ask you for the date you went to the doctor and the amount of the bill. This can help us find the claim. If the claim was denied, ask our staff to explainwhy.

I got a letter saying that more information is needed before my claim can be paid. What should Ido?

The letter should say what information is needed. It will also say who needs to send us the information. Your doctor may need to send something in. You can call your doctor to make sure they send it. If you need to send something in, please do so. If it isn’t clear what’s needed, call our Customer Service office at702-733-9938.

My claim was denied. I think it should have been paid. What can Ido?

You can appeal the decision by filling out and sending in this formDownload PDF. You can also get this form at our Customer Service office. You can only file an appeal for 12 months after the date your claim wasdenied.

Be sure to include:

  • Your name
  • Your social security number
  • The provider’s name
  • The patient’s name
  • The date of service
  • Any other information that will help us understand theproblem

How much is my copay for a doctor’svisit?

It depends on what type of doctor you go to and what kind of visit it is. You can check your copay in our copaybookDownload PDF.

Is my doctor a PPO doctor?

All PPO doctors are in our online provider directory. Call our Customer Service Office at 702-733-9938 if you need help finding a doctor.

Pharmacies

Can I get medicine at the Culinary Pharmacies forfree?

Yes. Covered generic medicines are free at the Culinary Pharmacies. Check the list of generic medicationsDownload PDF to see if your medicine is covered. Ask your doctor to only choose medicines from that list. That way you’ll have no copay and can get your medicine forfree.

What other pharmacies can Iuse?

There are many pharmacies you can go to for your medicine. You can even get your medicine at pharmacies in other states if you’re away from home. Follow this link to find apharmacy.

How much will my medicine cost at a retailpharmacy?

It depends on your medicine. The cost of your medicine at a retail pharmacyis:

Type of medicineCopay
Tier 1: Generic$10
Tier 2: Brand$20
Tier 3: Exclusive$35

What’s the difference between getting my medicine by mail and picking up mymedicine?

Getting your medicine by mail saves you money. If you get your medicine by mail you will get a 2-month supply for one copay. If you pick up your medicine in person you will only get a 1-month supply for the samecopay.

Plus, getting your medicine by mail saves you time. You won’t have to drive to the pharmacy or wait inline.

What’s a generic medicine?

A generic medicine is created to be the same as a brand-name drug in form, safety, strength, and quality. A generic medicine works the same way and provides the same benefits as a brand-name version. Generics use the same active ingredients as a brand-name drug, and work the same way in your body. The Food and Drug Administration (FDA) sets standards for generic drugs, and does inspections to ensure their safety andquality.

Why do generic medicines costless?

Generic medicines cost less because the companies that make them don’t have to repeat all of the basic research that the name-brand drug companies have already done. They also sell certain medicines to treat more than one medical condition, and competition among several generic drug makers drives pricesdown.

Call our Customer Service Office at 702-733-9938 if you have any otherquestions.

Taxes

What is a 1095-B form?

A 1095-B form is used to show the Internal Revenue Service (I.R.S.) that you had health insurance. It also lists which of your dependents were covered by health insurance, and for howlong.

Why didn’t I get a 1095-B form in the mail?

The I.R.S. no longer requires the Culinary Health Fund to mail you a 1095-B form. But for your records, you can view and print a copyonline.

How can I get a copy of my 1095-B form?

  • Online

    1. Log in to your account
    2. Click the link labeled 1095-B Tax Forms
    3. You can then print or save a copy of your 1095-Bform
  • By email

    culinaryfund@zenith-american.com

  • By phone

    702-733-9938

  • By mail

    Culinary Health Fund
    1901 Las Vegas Blvd South
    Suite 107
    Las Vegas, Nevada 89104

For more information about 1095-B forms, see the I.R.S.website.

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