Mo-Kan Sheet Metal Workers Welfare Fund
P.O. Box 300019, Kansas City, MO 64130-0019
(816) 531-0334 or Toll Free at (866) 531-5488
On January 01, 2011 the Fund implemented a new benefit entitled the “Working Spouse Incentive Program”. This program allows a working spouse who has voluntarily elected to have primary coverage with his/her current employer to receive a quarterly reimbursement of employee contributions paid by that spouse. This benefit has been extended to the 2018 plan year due to its utilization and cost savings to the Fund.
While this Incentive Program is strictly voluntarily, the Fund strongly encourages all spouses of Mo-Kan SMW members who are offered health insurance benefits through a qualified health plan at their place of employment elect to take that plan as their primary health insurance coverage.
The reason behind the implementation of this benefit was simple, more and more corporate and public employers are shifting the liability of health insurance coverage to union health plans. Many employers offer their employees incentives to not enroll in their employer sponsored plan. When employers do this, they are shifting millions of dollars of liability from themselves to union health plans. After careful review, the cost savings of this program has been upwards of $850K and Mo-Kan believes that by offering this incentive program will keep the rising cost of health care benefits to the Fund at a reasonable level.
Exceptions: The following are circumstances under which spouses will not be required to enroll in employer sponsored health coverage.
A list of frequently asked questions is enclosed for your review. If you have any questions, please contact a Fund Representative at 816-531-0334 or toll-free at 866-531-5488.
Board of Trustees
Frequently Asked Questions
***Example: Suppose that both your plans provide benefits for out-patient medically necessary surgery. If the provider charges $10,000, your primary insurance carrier will process the claim first. Let’s say your primary carrier has a calendar year deductible of $1000.00 and once met processes all claims at 80%. The primary carrier would pay $7200.00, leaving the patient responsible for $2800.00. That same claim would then be sent to the secondary carrier for payment. Your secondary insurance carrier has a $500.00 calendar year deductible and then pays 80%. If the secondary carrier would have paid first their benefit would have been $7600.00. Since the secondary carrier would have paid more than $2800.00 as the primary carrier the secondary carrier will pay the entire $2800.00, leaving you responsible for zero.
Is my spouse required to enroll other family members into his/her employer sponsored coverage?
No. However, if the spouse chooses to cover other family members the birthday rule for coordination of benefits (COB) will apply. If the spouse is primary on the child/ren due to the birthday rule, Mokan will reimburse at the employee plus child/ren rate and the premium benefit rate summary would be required to determine the rate for employee plus child/ren coverage.
When my spouse signs up for other coverage, how is coverage with the Fund affected?
Your spouse’s coverage will be the primary payer on their claims and the Mo-Kan Plan will pay as secondary. In most situations, this will result in 100% coverage.
How is prescription coverage affected?
The primary plan will be ran at the pharmacy. Spouse must turn in pharmacy receipts to MoKan to process as secondary.
How are vision and dental coverage affected?
You’re spouses plan will be primary if your spouse elected vision or dental coverage. MoKan will pay as secondary.
In order to receive the Working Spouse Incentive benefit, the spouse only needs to enroll for primary Medical and Prescription coverage. However, if there is other dental and vision coverage, Mo-Kan will pay secondary.
The Working Spouse Incentive Program at Mo-Kan Sheet Metal Workers Welfare Fund was implemented in January 2011 and has saved the Fund and its members a considerable amount of money over the 7 years it has been offered as a benefit. If you are an actively working sheet metal worker and a member of Mo-Kan Sheet Metal Workers Welfare Fund and your spouse has or has access to a qualified medical health insurance plan through his/her employer, you can benefit from this program. The cost savings is proven in two ways: those actively working member spouses who participate are getting 100% of their primary medical health insurance premium reimbursed up to $200.00 a month, and because these spouses have another insurance company paying primary on their medical health expenses, the Fund is saving money as well. To learn more about this program and the details of eligibility, please contact the Mo-Kan Fund office at 816-531-0334.
To participate in the program for the first time, please complete and return the spousal coverage verification form. Certain medical plans are not eligible for the benefit so this form will help us determine if a members plan qualifies. In addition to the spousal verification form, you will need the spousal reimbursement form for the current year along with all paystubs for each month and a medical premium rate summary from your employer. All forms are available on the Mo-Kan website under Claim Forms.