Line Construction Benefit Fund
LINECo
Payment of Benefits
Health care benefits are payable individually for you and each of your dependents up to but not to exceed the maximum benefits shown on the Schedule of Benefits. Benefits are payable only when the required forms and information have been received by the Fund Office.
- Claims submitted by PPO providers are paid directly to the provider.
- Other hospital benefits are paid directly to the hospital unless you submit a paid receipt.
- All other benefit payments on claims for yourself and your dependents will be made to you (employee or retiree) except as follows: if you are divorced and the claim is for one of your dependent children living with your ex-spouse, benefits may be paid to the providers of the services and supplies unless a paid receipt is submitted with the claim.
- You or your spouse can assign benefits. This means that you sign a form that tells the Fund Office to make payments directly to a doctor, laboratory, ambulance service, etc., instead of to you. In such a case, payment will be made to the assignee and not to you. You are responsible for paying any expenses not paid by the Plan.
- Life Insurance and loss of life benefits under the AD&D Insurance benefit will be paid to your beneficiary.
- If the Trustees decide that a person isnt mentally, physically, or otherwise capable of handling his business affairs, the Plan may pay benefits to his guardian or, if there is no guardian, to the individual who has assumed his care and principal support. If the person dies before all due amounts have been paid, the Trustees may make payment to the executor or administrator of his estate, to his surviving spouse, parent, child or children, or to any individual the Trustees believe is entitled to the benefits.
In determining the satisfaction of any deductible amounts and the amount of benefit payments, a charge for any service, treatment, or supply will be considered incurred on the date the service or treatment was rendered or on the date the supply was provided.
Any payments made by the Plan in accordance with these rules will fully discharge the Plan's liability to the extent of its payments.