PARTICIPANT GUIDE - Culinary Health Fund

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Y O U R H E A LT H . Y O U R P L A N .PARTICIPANTGUIDEYour Culinarybenefits and allour great programs!Revised January 2020 (Replaces Participant Guide dated October 2019)

CONTACTINFORMATIONQuestions? Concerns?Contact us.Culinary Health Fund Customer Service Office1901 Las Vegas Blvd. South, Suite 107Las Vegas, NV 89104702-733-9938www.culinaryhealthfund.orgHelpful NumbersCulinary Union Local 2261630 S. Commerce StreetLas Vegas, NV 89102702-385-2131Bartenders Union Local 1654825 W. Nevso DriveLas Vegas, NV 89103702-384-7774IATSE Local 7203000 South Valley ViewLas Vegas, NV 89102702-873-3450Pension Office1901 Las Vegas Blvd. SouthSuite 107Las Vegas, NV 89104702-369-0000Culinary Health Center650 N. Nellis Blvd.Las Vegas, NV 89110702-790-8000Mental Health &Addiction Program(Harmony Healthcare)702-251-8000Dentists-In-Network(Nevada Dental Benefits)702-478-2014Pharmacy ProviderOptum Rx1-866-611-59603

ADVOCACYDo you havequestionsaboutYoureligibility? benefits?Dentalplans? Programs?Your advocates can help youwith all your questions!Advocates are your personal Culinary Health Fund“helpers.” They will help you with questions about yourbenefits, coverage, Culinary programs and more.Call them at 702-691-5665or email at4advocacy@culinaryhealthfund.org

Information aboutyour coverageEligibility RequirementsSelf-PayLoss of Time & DisabilityLife InsuranceCulinary Health CenterDr. TomorrowDental PlanCulinary PharmacyNevada Health SolutionsWHAT’S INSIDEUrgent Care78910111213141516

17Durable Medical Equipment18Durable Medical Equipment19CPL20Breast Care21Diabetes Program22Kidney Smart Classes23Culinary Healthier U24Healthy Pregnancy Plus25Call It Quits26Mental Health &Addiction Program27What you need to doBefore & After SurgeryWhat is coveredWhere to get itWHAT’S INSIDE(Clinical Pathology Laboratories)(Stop Smoking Program)

ELIGIBILITYREQUIREMENTS(How to get and keep your benefits)How to getcovered(eligibility)Getting coveragedepends on how manyhours you work (seethe “Getting Eligibility”coverage chart).For every hour youwork, your employer(job) pays into theCulinary Health Fund.You must work atleast 360 hours inthe first three months.That’s about 30 hoursper week.Getting Eligibility360 HoursRequired inWaitTimeCovered inJan - Feb - MarFeb - Mar - AprMar - Apr - MayApr - May - JunMay - Jun - JulJun - Jul - AugJul - Aug - SepAug - Sep - OctSep - Oct - NovOct - Nov - DecNov - Dec - JanDec - Jan - FebAprMayJunJulAugSepOctNovDecJanFebMarMay - JunJun - Jul - AugJul - AugAug - Sep - OctSep - OctOct - Nov - DecNov - DecDec - Jan - FebJan - FebFeb - Mar - AprMar - AprApr - May - JunHow to keepyour benefitsTo keep your coverage,you must work at least 240hours every two months.That’s about 30 hoursper week (see “KeepingEligibility” coverage chart).Keeping Eligibility240 HoursRequired inCovered inJan - FebMar - AprMay - JunJul - AugSep - OctNov - DecMay - JunJul - AugSep - OctNov - DecJan - FebMar - Apr7

SELF-PAY(When you don’t work enough hours)What is a Self-Pay? Self-Pay Due DatesIt’s an option for you to payfor your coverage when youdon’t work enough hours.How will you know ifyou need to self-pay?You will get a Self-Paynotice in the mail*. You mustmake your self-paymentbefore the due date to keepyour coverage.Less than240 hoursworked inPaymentdue byCovered inJan - FebApr 30May - JunMar - AprJun 30Jul - AugMay - JunAug 30Sep - OctJul - AugOct 31Nov - DecSep - OctDec 31Jan - FebNov - Dec Feb 28/29 Mar - AprHere’s how you can make your self-payment: Call our Customer Service Office at 702-733-9938and follow the options to pay by phone. Come by the Customer Service Office from7:30am to 6pm (Monday through Friday) to paywith cash, credit card, check or money order. Mail us a check or money order, or drop it in theCustomer Service Office drop box at:Culinary Health Fund1901 Las Vegas Blvd. South, Suite 107Las Vegas, NV 89104 8Pay online at www.culinaryhealthfund.org.* We need to be able to mail you your Self-Pay notice. Makesure that we have your correct contact information on file. You can changeyour contact information at any time on our website. You canalso call the Customer Service Office.

LOSS OF TIME& DISABILITY(When you can’t work)LOSS OF TIME (LOT)DISABILITY CREDITSWhat is LOT?What are Disability Credits?It’s money that you can receivewhile you are not workingbecause you got hurt, are injured,or have an illness that is notbecause of work.They help you keep yourcoverage while you arenot working.What you will get: A 150 check every week(minus FICA taxes)The benefit will last for upto 13 weeks. This benefit isonly available for the eligibleemployeeIt’s only for participants thathave an illness or are hurt,and are seeing a doctor.Keep in mindWhat you get You and your familycan keep your Culinaryhealth coverage for upto 24 months (2 years). Your job might not payfor the first 60 days. Ifthey don’t pay, you willhave to self-pay. After the 24 months areover, you can self-payfor up to 12 monthsor until you are eligiblefor Medicare (whichevercomes first).You will need your LOT paperworkfilled out by your doctor and yourjob showing that you can’t work.Your payments will be sent afterthat, if you qualify.Call the Customer ServiceOffice at 702-733-9938for more information onDisability Credits. Your LOT benefit starts from: The 1st day if you can’t workbecause of an accident orinjury (including maternity); orThe 8th day if you can’t workbecause you have an illness9

A IC 0H E E F 15RE BEN ANEH E PLED LIT Ó N D ENI A(Ud N A C V IDnF u S IG D EhCOa lt D E Re(Ifsomethinghappens and you pass away)E Uy H D EGrO Salin A R I E LuLife insurance is another benefitC UL ARthat you get at no cost to you.RM PALIFE INSURANCEBENEFICIARY DESIGNATIONS710iteSu 4-130938uthSo 8910 3-99 rgvd. ada ) 73 nd.o02 fus Blga s, Nev (7 ealths Ve gaaryhLa Ve01 Lasulinw.cwwFO19107Suite9South 04-130Blvd. a 891 -9938gass Ve gas, Nevad(702) 733 nd.orghfuVe1 La190 LasyhealtRMulinarwww.cFO)H) NLTH IOSL T T IOHEA ICIAREA NAEREEFE H S IGE H E BEN N 150ITRENAL(UNDHE Y Dund ACIÓ DEL PTE RNAlth FN I IC IAHea DESIG DE VIDLTH)FEnaryOTE HERE HEACuli ARIO D EGURFORMNECth Fund (UNISDESIGNATIONLCulinary HealELMUBENEFICIARYINSURANCEFOR PARALIFEPLAN 150107Blvd. South Suite1901 Las Vegas Nevada 89104-1309Las Vegas,(702) 733-9938fund.orgwww.culinaryhealthTMTMTMIf you pass away for a reasoncovered by the Culinary Plan,the person you choose asyour beneficiary will get paid amonetary benefit.Who can you name as abeneficiary?You may choose anyoneyou wish as your beneficiary.Just fill out a Life InsuranceBeneficiary Form at theCustomer Service Office. Youcan change your beneficiarywhenever you want.Who is covered underthe policy?You and your dependentseach have a policy as long asyou are eligible for CulinaryHealth Fund benefits.Would you like to buymore disability/lifeinsurance?Call Boston Mutual at702-386-5179.10What if one of mydependents passes away?If one of your dependentspasses away, there is also abenefit. This benefit gets paidonly to you (the participant).

CULINARYHEALTH CENTER650 North Nellis Blvd.Las Vegas, NV 89110702-790-8000The Culinary Health Center is exclusively for Culinary participantsand their dependents.Services, Hours & CopaysPrimary CareMonday to Saturday7am - 9pmNo copayNot all providers areavailable during nightand weekend hoursCulinary PharmacyMonday to Friday7am - 9pmSaturday and Sunday7am - 5pmNo copayPediatriciansMonday to Friday7am - 6pmSaturday7:30am - 6pmNo copayEye CareMonday to Friday9am - 5pmSaturday9am - 2pm 10 copay for eyeexamsUrgent Care24 hours a day,7 days a weekNo copayDentalMonday to Friday7am - 5pmSaturday7am - 2pmSame copays asa dentist in thenetwork. Refer toDental Booklet formore info.11

URGENT CARE(It’s cheaper than the Emergency Room!)WHEN SHOULD YOU USE IT? When your doctor is not available. Outside of normal office hours(nights & weekends). When you need medical attentionright away.Urgent Care is for emergenciesthat are not a danger to your lifeor risk of loss of limb.EXAMPLES OF PROBLEMS TREATED AT URGENT CARE Accidents and fallsSprains and strainsFever or fluSore throat High feverVomiting, diarrheaBleeding cuts that needstitchesURGENT CARE LOCATIONS OPEN 24HRS, 7 DAYS A WEEKSouthwest Medical Associates888 South Rancho DriveLas Vegas, NV 89106702-877-5108Culinary Health Center650 N. Nellis Blvd.Las Vegas, NV 89110702-790-8000For a complete list of available Urgent Care locations visit our webpage at www.culinaryhealthfund.org, or call the CustomerService Office at 702-733-9938.12

DR. TOMORROWTMDr. Tomorrow is a service to help youget a doctor’s appointment within 24hours if your doctor’s office is closedor does not have any appointments.Sometimes Dr. Tomorrow can get youan appointment the same day.When should you callDr. Tomorrow?When you are feeling sick and yourdoctor can’t see you right away.What do you have to do?Just call Dr. Tomorrow at 702-691-565624 hours a day, 7 days a week.Dr. Tomorrow willalso save you alot of money!Take a look at the differentcopays for "Dr. Tomorrow",Urgent Care, Urgent Care atthe Culinary Health Center,and the Emergency Room!Your Co-pays per visit.Dr. Tomorrow 15 co-payUrgent Careat the CulinaryHealth Center 0 co-payUrgent Care 40 co-payEmergencyRoom 350 co-pay13

DENTAL PLAN(Nevada Dental Benefits)In-Network Plan (Culinary Dentists)Who is coveredParticipants and their eligibledependents.Maximum Yearly BenefitNo maximum.CopaymentsNo copayments for: examinations basic cleanings x-rays silver fillings, and othercovered servicesBraces(Dental services must be from adentist in the network). For kids:Copay is 850 per eligiblechild under the age of 19 For adults:Copay is 3,100Ask for a copy of the DentalBooklet for more detailedinformation about bracesand co-payments.Other copays can changeaccording to the service.Out-of-Network Plan (NOT Culinary Dentists)Who is coveredCopaymentsMaximum Yearly BenefitBracesParticipants and their dependents 1,500 for you and each of youreligible dependents.Depends on the serviceNot coveredYou are responsible for the difference between the Culinarypayment and the doctor charges.14For more information callNevada Dental Benefits at 702-478-2014.

CULINARYPHARMACY(Free pharmacy)GET YOUR MEDICATIONSFOR A 0 COPAY!The Culinary Pharmacies are onlyfor Culinary participants and eligibledependents.They have more than 300 genericmedications, including most diabeticprescription medicines and supplies.FOR A LIST OF CULINARY PHARMACY MEDICATIONSYou can: Visit the Culinary PharmacyGet a copy of the free Pharmacy BookletGo to our website at www.culinaryhealthfund.orgPHARMACY HOURS & LOCATIONSCulinary Pharmacyat the Culinary Health Fund1945 Las Vegas Blvd. SouthLas Vegas, NV 89104Culinary Pharmacyat the Culinary Health Center650 N. Nellis Blvd.Las Vegas, NV 89110Tel: 702-650-4417Fax: 702-369-5940Tel: 702-963-9400Fax: day-Friday7am-9pmSaturday-Sunday 7am-5pm15

NEVADA HEALTHSOLUTIONSNevada Health Solutions (NHS).Is the Culinary’s Medical ManagementTeam. They have a team of nurses andhealth coordinators to help you get themedical care you need: at homein the hospital, orin the communityWhat can you get help with?Nevada Health Solutions will: help you get ready for surgery (see the next page) visit you at the hospital and make sure you are getting thecare you need help you with your transition when you get out of the hospitalcall you if you have been to the Emergency Room to makesure you are doing ok help coordinate care if you have a chronic disease such as:DiabetesKidney DiseaseHigh Blood PressureHeart ProblemsCOPD & AsthmaCall Nevada Health Solutions at 702-216-1653.16

WHAT YOU NEED TO DOBEFORE & AFTERSURGERYWe understand a surgery can bestressful and you might not know whatyou need to do.That is why Nevada Health Solutionswould like to give you some advice, soyou can be ready for your surgery andhave a faster recovery.The Nevada Health Solutions careteam is ready to help you. Call702-216-1653 if you have questionsor need help.Here are some things to keep in mind before your surgery: Always tell your doctor all of the medications that you are taking. Plan for your return home. Things to think about are:Who will be taking you home after surgery?Do you have to use stairs to get into your home?Do you have stairs inside your home?Will you need to stay with family or friends afteryour surgery?Remember, your surgery and recovery will be easier if you andyour family are involved in the preparation of your surgery, andplanning of your recovery.17

Durable MedicalEquipmentWhat is coveredYou may need Durable Medical Equipment (DME) to help you with acan get it. They will also tell you how to check if it is covered.What is Durable Medical Equipment (DME)?It is equipment that helps you with a health condition. For example,if you have problems breathing, you may get oxygen equipment.Your doctor orders these devices for you to use at home. It is usedevery day, or for a long period of time.How do I know if my DME is covered?DME products over 500 must be approved before they arepurchased. This is called prior authorization. Tell your doctoror provider to fax a prior authorization request to NHSat 702-691-5614.Please note: you can only go to the places listed on the nextpage for your DME products. Call the Customer Service18

Durable MedicalEquipmentWhere to get itOrthotics & ProstheticsBrace It Orthotics andProsthetics3170 W. Sahara Ave. D17Las Vegas, NV 89102702-478-5848D. Danz & Sons, Inc2820 W. Charleston Blvd. #D39Las Vegas, NV 89102702-258-6256Field Ocular Prosthetics3752 E. Flamingo Rd.Las Vegas, NV 89121Prosthetics Advancement Lab3663 E. Sunset Rd. #506Las Vegas, NV 89120Precision Orthotics andProsthetics526 S. Tonopah #120Las Vegas, NV 891068915 S. Pecos Rd. #18AHenderson, NV 890747330 W. Cheyenne Ave.Las Vegas, NV 89129Prosthetic Center of Excellence400 Shadow Ln. #110Las Vegas, NV 89106Other DME providersApria Healthcare LLC1951 Ramrod Ave.Henderson, NV 89014Bennett Medical6125 S. Valley View Blvd. #BLas Vegas, NV 89118Epic Medical Solutions3230 Hacienda Ave. #305Las Vegas, NV 89118Everything Medical1811 W. Charleston Blvd.Las Vegas, NV 89102Gabel Distributors, LLC5985 Hauck St. #107Las Vegas, NV 89118702-489-2288Preferred Homecare871 Grier Dr. #C & B2Las Vegas, NV 89119702-951-690019

CPL(Clinical Pathology Laboratories)CPL is the exclusive lab provider (bloodwork and other tests)for the Culinary Health Fund. There are several locations you can goto, including the office located right next to the Culinary Health Fund’sCustomer Service Office.CPL Lab at the Culinary Health Fund1901 Las Vegas Blvd South, Suite 140Las Vegas, NV 89104702-795-4900All other CPL locations:Main Lab6830 Spencer St.,#102Las Vegas, NV 89119702-795-4900Burnham4275 Burnham Ave.,#130Las Vegas, NV 89119702-795-4900Decatur4001 S. Decatur, Suite 5Las Vegas, NV 89103702-795-4900Town Center653 N Town Center Dr.,#408Las Vegas, NV 89144702-795-4900Rainbow6295 S. Rainbow Blvd.,#103Las Vegas, NV 89118702-795-4900Cheyenne2045 E. Cheyenne Blvd,Suite 150N. Las Vegas, NV 89030702-795-4900Cascade Valley7180 Cascade Valley Ct.,#150Las Vegas, NV 89128702-795-4900Jeffreys10521 Jeffreys St., #121Henderson, NV 89052702-795-4900Green Valley100 N. Green Valley Pkwy#315Las Vegas, NV 89074702-795-4900Maryland Parkway3201 Maryland Parkway,#101Las Vegas, NV 89109702-795-490020E. Charleston4255 E. Charleston,Suite ILas Vegas, NV 89104702-795-4900W. Charleston1815 W. Charleston Blvd.Suite 1Las Vegas, NV 89102702-795-4900

BREAST CAREAre you 35 or older? Was your lastmammogram done over 11 months ago?If you answered yes to both questions,you are eligible to receive a preventivemammogram through Desert Radiologyfor a 0 copay.Talk to your doctor about getting yourmammogram every year.What are the steps you need to follow toget a mammogram?123Get a referral from your doctor.Call Desert Radiology at 702-759-8600 to schedulean appointment.Preventive mammograms are a 0 copay benefit.If you are interested in a 3D mammogram,they are available for a 60 fee.IMPORTANT INFORMATIONSometimes, women are told that they need to go back for more viewsor a diagnostic mammogram. If this happens to you, do not panic. Thismay be simply because the technician did not get enough clear images.Or it may be because your doctor just needs to see more. These otherviews and diagnostic mammograms will have a copay. These otherviews may be: Ultrasound MRI of the breast Another mammogram21

DIABETESPROGRAMDID YOU KNOW THAT DIABETES AFFECTS YOUR:The Diabetes Program will help youtake care of your diabetes.What you get with the programFree Diabetes Classes whereyou will learn:The different types ofdiabetesFree Supplies:Accu-Check orOne Touch metersStripsThe medications availableto youLancetsThe best way to check thesugar in your blood(glucose) with your meterInsulinSyringesOral medicationCall the Advocacy Line at702-691-5665 to sign up for a class!22

KIDNEY SMARTCLASSESDo you haveDiabetes?High Blood Pressure?High Cholesterol?Did you know yourkidneys are at risk?The Culinary Health Fund offersKidney Smart Classes!Come to a Kidney Smart Class to learn: How your kidneys work and what are the common causes ofChronic Kidney Disease. How your diet, medicine and lifestyle affect your kidneys. What treatments are available to you.Call the Advocacy Line at 702-691-5665 to sign up!23

CULINARYHEALTHIER UDo you have problems with your weight? Do you suffer from chronicillnesses like diabetes or heart problems?Then the Culinary Healthier U program can help. Through the program youcan see a certified dietitian/nutritionist. They will teach you how to choosebetter foods to keep a healthier weight and/or control your chronic illnesses.Want to join the program?Call one of the following dietitians/nutritionists to make an appointment. Theywill do a screening to see if you qualify. There are no copays for these visits.Anders & DunawayNutrition Consultants2121 E. Flamingo Rd., Suite 110Las Vegas, NV 89119702-382-8841 (English & Spanish)Medical Nutrition Therapy Services7721 Leavorite Dr.Las Vegas, NV 89128702-242-5730 (English only)My Nutrition, My Life170 S. Green Valley Parkway, Suite 325Henderson, NV 89102702-606-3106 (English only)Nutrition by Joey8275 S. Eastern Ave., Suite 118Las Vegas, NV 89123702-878-5639 (English only)LiveWell Nutrition500 N. Rainbow Boulevard, #300Las Vegas, NV 89107702-508-0630 (English only)Creating A New Norm3277 E. Warm Springs Road, #300Las Vegas, NV 891206040 S. Fort Apache Rd., Suite 100Las Vegas, NV 89148702-475-4007 (English & Spanish)Your Dietician for Diabetes& Weight Control170 S. Green Valley Pkwy.,Suite 300Henderson, NV 891027656 W. Sahara Ave., Suite 110Las Vegas, NV 89117702-525-1105 (English & Spanish)Food Connection, LLC4215 S. Grand Canyon, Suite 101Las Vegas, NV 891479070 W. Cheyenne Ave.Las Vegas, NV 89129702-664-1204 (English & Spanish)For more information call the Advocacy Line at 702-691-5665.24

HEALTHYPREGNANCYPLUSThe Culinary Health Fund wants you to have a Healthy Pregnancy!If you’re pregnant, the Healthy Pregnancy Plus programis for you.The program will help make this exciting new time in your lifeeasier and more enjoyable. There is no copay for this program.What will you get if you sign up for the program? Educational Materials Breastfeeding Classes A Breast Pump (if youchoose to breastfeed) Access to a LactationConsultant (they canhelp with breastfeedingproblems) 200 after your baby isborn (if you go to yourdoctor before 12 weeksof pregnancy and go to allyour appointments)To sign up:Call the Advocacy Line at702-691-5665 when youfind out you are pregnant.Healthy moms have healthy babies25

CALL IT QUITS(The Culinary Stop Smoking Program)“Call It Quits” is a program to help youstop smoking.It includes: Counseling - You can chooseto attend a group class, onlinecounseling, or ph

The Culinary Health Center is exclusively for Culinary participants and their dependents. Services, Hours & Copays 650 North Nellis Blvd. Las Vegas, NV 89110 702-790-8000. 12 For a complete list of available Urgent Care locations visit our web page at www.culinaryhealthfund.org, or call the Customer

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