activities · 29
what they do
direct service · 27
- Administration of health and welfare trust funds Health Insurance Plan AdministrationAdministers health and welfare benefits through a main office in Pasadena, California, and a satellite office in Las Vegas, Nevada, providing ongoing management of trust fund operations for eligible members and providers.
- Administration of health and welfare trust funds Health Insurance Plan AdministrationAdministers health and welfare benefits through a main office in Pasadena, California, and a satellite office in Las Vegas, Nevada, providing services to members and providers across multiple states.
- Administration of health and welfare trust funds Health Insurance Plan AdministrationAdministers health and welfare benefits through a main office in Pasadena, California, and a satellite office in Las Vegas, Nevada, providing benefits based on hours reported by signatory employers.
- Automatic enrollment and eligibility management Disability & Eligibility Support for MembersProvides automatic enrollment in health and welfare benefits upon meeting eligibility criteria—200 or more hours reported by a signatory employer in a qualifying quarter or monthly period—with no medical underwriting required.
- Automatic enrollment in health and welfare benefits Disability & Eligibility Support for MembersProvides automatic enrollment in health and welfare benefits upon meeting eligibility criteria based on 200 or more hours worked in a qualifying quarter, with no medical underwriting required.
- Behavioral health and mental health benefits administration Behavioral Health & Substance Use Benefits AdministrationProvides behavioral health services, including mental health and substance abuse treatment, through Carelon Behavioral Health, with enhanced benefits effective January 1, 2022; also administers MAP (Member Assistance Program) benefits via the same vendor.
- Behavioral health and mental health benefits administration Behavioral Health & Substance Use Benefits AdministrationOffers a behavioral health program through Carelon Behavioral Health, including mental health, substance abuse treatment, and MAP (Member Assistance Program) benefits, with enhanced coverage effective January 1, 2022.
- Behavioral health program administration Behavioral Health & Substance Use Benefits AdministrationProvides behavioral health services, including mental health and substance abuse benefits, through Carelon Behavioral Health, with enhanced benefits effective January 1, 2022.
- Dental benefits administration Union and Association Health Benefits AdministrationProcesses dental claims through the Operating Engineers Health & Welfare Fund (Local 12) and provides members with a dental PPO network as the default plan.
- Dental benefits administration Union and Association Health Benefits AdministrationProcesses dental claims through the Operating Engineers Health & Welfare Fund (Local 12) and provides members with a dental PPO network as the default plan option.
- Dependent coverage enrollmentExtends health and welfare benefits to dependents immediately upon participant eligibility, with spouse and child coverage effective from the date of marriage or birth/adoption.
- Disability benefits programs Disability & Eligibility Support for MembersOperates a Weekly Disability program for eligible participants from Southern Nevada employers funded by employer contributions, and provides disability credit to extend full health and welfare benefits for 3 to 6 months when a member becomes disabled during a work quarter.
- Disability credit for continued benefits Disability & Eligibility Support for MembersProvides disability credit to extend full health and welfare benefits for 3 to 6 months for members who become disabled during a work quarter.
- Eligibility determination and enrollment Disability & Eligibility Support for MembersDetermines eligibility for health and welfare benefits based on 200 or more hours reported by a signatory employer in a qualifying quarter or on a monthly basis; automatically enrolls eligible members without medical underwriting.
- Eligibility support through missing and reserve hours programs Disability & Eligibility Support for MembersAllows eligible members to purchase missing hours (if short by 50 or fewer) to maintain eligibility and draw from a reserve hours account capped at 500 hours to meet the 200-hour quarterly requirement during periods of reduced work.
- Eligibility support through missing and reserve hours programs Disability & Eligibility Support for MembersAllows members who are short by 50 or fewer hours to purchase missing hours to maintain eligibility and offers a reserve hours account (capped at 500 hours) that members can draw from to meet the 200-hour quarterly requirement during periods of reduced work.
- Hours purchase and reserve account system Disability & Eligibility Support for MembersAllows eligible members to purchase missing hours (if short by 50 or fewer) to maintain eligibility and maintain a reserve hours account (capped at 500 hours) that can be drawn upon to meet the 200-hour quarterly requirement during periods of reduced work.
- Medical and hospital claims processing Agricultural Worker Health Benefits AdministrationProcesses medical and hospital claims for California providers through the Prudent Buyer Plan and routes non-California claims to local BlueCross BlueShield plans for adjudication.
- Medical and hospital claims processing Agricultural Worker Health Benefits AdministrationProcesses medical and hospital claims for California providers through the Prudent Buyer Plan and routes non-California claims to local BlueCross BlueShield plans.
- Member and provider support services Health Benefits Customer Support ServicesProvides toll-free phone support to members and healthcare providers during business hours for benefit inquiries, claims assistance, and service coordination.
- Member and provider support services Health Benefits Customer Support ServicesOffers toll-free phone support during business hours for members and providers to access benefits and services.
- Member and provider support services Health Benefits Customer Support ServicesOffers toll-free phone support during business hours for members and providers to access benefits and resolve inquiries.
- Monthly eligibility for special agreement workers Disability & Eligibility Support for MembersOffers monthly eligibility for health and welfare benefits to individuals working for employers with special agreements, as an alternative to quarterly eligibility.
- Provider network access and navigation Healthcare Provider DirectoriesProvides members access to United Healthcare's physician directory and enables them to locate Anthem Blue Cross providers by using 'OEH' as a prefix to their OE ID number.
- Provider network access for members Healthcare Provider DirectoriesProvides members access to United Healthcare's physician directory and enables them to locate Anthem Blue Cross providers by using OEH as a prefix to their OE ID number.
- Weekly Disability program for Southern Nevada members Disability & Eligibility Support for MembersOperates a Weekly Disability program for eligible participants who worked for Southern Nevada employers, funded by additional employer contributions.
- Weekly Disability program for Southern Nevada members Disability & Eligibility Support for MembersOperates a Weekly Disability program for eligible participants who worked for Southern Nevada employers, funded by additional employer contributions, providing income and benefit continuity during disability.
capacity building · 2
- Publication of annual financial and operational reports Annual Impact & Transparency ReportingProduces and publishes a Summary Annual Report for the Operating Engineers Health & Welfare Fund, covering the fiscal year ending June 30, 2024, to ensure transparency and regulatory compliance.
- Publication of annual financial reports Annual Impact & Transparency ReportingPrepares and publishes a Summary Annual Report for the Operating Engineers Health & Welfare Fund, covering the fiscal year ending June 30, 2024, to ensure transparency and regulatory compliance.
strategies · 22
how they think
Theories of action extracted from this org's own source material. Click any to see the full field of orgs running the same approach.
- Centralized fund with regional service delivery regional_service_modelOperates through a centralized fund office while maintaining regional presence and region-specific programs to effectively serve members across multiple states, ensuring localized responsiveness within a unified structure.
- Centralized fund with regional service delivery regional_service_modelOperates through a centralized fund office while maintaining regional presence and regionally-targeted programs to effectively serve members across multiple states, ensuring localized responsiveness within a unified structure.
- Dependent eligibility criteriaDefines clear, inclusive criteria for eligible dependents—including spouses, children under 26, adopted and foster children, and legal wards—to ensure consistent and equitable benefit access.
- Flexible eligibility maintenance mechanisms reserve_hour_bank, eligibility_buy-upEnables members to maintain continuous health and welfare coverage during periods of reduced work or eligibility gaps through a reserve hour bank and self-funded buy-up options.
- Flexible eligibility maintenance systems reserve_hour_bankEnables continuous coverage through mechanisms like a reserve hour bank and buy-up options, allowing members to maintain eligibility during periods of reduced work or contribution gaps.
- Flexible eligibility maintenance systems reserve_hour_bank, eligibility_buy-upSupports continuous coverage through mechanisms like a reserve hour bank and eligibility buy-up options, allowing members to maintain benefits during periods of reduced work or contribution gaps.
- Guaranteed issue and automatic enrollment guaranteed_issueEnsures universal access to health and welfare benefits by enrolling members automatically and guaranteeing coverage regardless of health status, reducing barriers to entry.
- Guaranteed issue and automatic enrollment guaranteed_issueEnsures universal access to health and welfare benefits by enrolling members automatically and guaranteeing coverage regardless of health status, removing barriers to entry.
- Integrated behavioral health benefits integrated-behavioral-healthPartners with specialized behavioral health providers to integrate mental health and substance use services into the core health plan, improving access and coordination of care for members.
- Integrated behavioral health benefits integrated-behavioral-healthPartners with specialized behavioral health providers to integrate mental health services into the core health plan, improving access and coordination of care for members.
- Integrated behavioral health care integrated-behavioral-healthPartners with specialized behavioral health providers to integrate mental health services into the core health plan, improving access and coordination of care for members.
- Joint labor-management governance joint_governanceAdministers trust funds through a jointly governed board of labor and management trustees, ensuring balanced decision-making and accountability in fund operations.
- Member identification and network access system member_id_prefix_systemUses a standardized member ID prefix system (OEH) to streamline access to Anthem Blue Cross network providers, improving enrollment and claims processing efficiency.
- Member identification system for network access member_id_prefix_systemUses a standardized member ID prefix (OEH) to streamline access to the Anthem Blue Cross provider network, ensuring seamless service delivery across regions.
- Member identification system for network access member_id_prefix_systemUses a standardized member ID prefix (OEH) to streamline access to the Anthem Blue Cross provider network, ensuring seamless service for members.
- Network-based dental benefits delivery dental_ppo_network_modelProvides dental benefits through a PPO network model as the standard offering, ensuring access to a broad network of providers while managing costs.
- Prudent Buyer Plan claims processing prudent_buyer_planUses a Prudent Buyer Plan model to process medical and hospital claims for California providers, aiming to balance cost efficiency with quality care.
- Regional service and administration model regional_service_modelOperates through a centralized fund office with regional presence to effectively serve members across multiple states, leveraging localized administration and partnerships to deliver benefits.
- Standardized dental benefits through PPO network dental_ppo_network_modelProvides dental benefits using a PPO network model as the standard offering, balancing cost control with provider choice for members.
- Standardized dental benefits through PPO network dental_ppo_network_modelProvides dental coverage using a PPO network model as the standard benefit structure, balancing cost control with provider choice for members.
- State-specific claims administration model prudent_buyer_plan, third_party_administrationUses a Prudent Buyer Plan to process claims for California providers, while leveraging third-party administrators (local BlueCross BlueShield plans) for out-of-state benefits, optimizing claims processing efficiency by region.
- State-specific claims administration model prudent_buyer_plan, third_party_administrationUses a Prudent Buyer Plan model for processing medical and hospital claims in California, while leveraging third-party BlueCross BlueShield plans to administer benefits in other states, ensuring efficient, locally-adapted claims processing.
named programs · 9
what they call their work
COBRA Continuation Coverage
Allows eligible beneficiaries to continue health coverage at their own expense after qualifying events such as job loss or reduction in hours
Dental Plan
Offers multiple dental plan options including Operating Engineers Dental PPO, DeltaCare, and United Concordia to eligible participants
Eligibility Buy-Up Program
Enables active members short by 50 or fewer hours to purchase additional eligibility at the employer contribution rate
Health & Welfare Medical Plan
Provides comprehensive health coverage including PPO, HMO, and Kaiser options to eligible active and retiree participants and their dependents
Member Assistance Program (MAP)
Behavioral health program administered through Carelon Behavioral Health offering counseling and mental health support
Prescription Drug Coverage
Provides prescription drug benefits through CVS Caremark with a defined formulary for covered medications
Vision and Prescription Drug Coverage
Provides vision benefits and prescription drug coverage through CVS Caremark with formulary-based pricing
Weekly Disability Program
Provides weekly disability benefits to eligible participants in Southern Nevada funded by additional employer contributions
Weekly Disability Program (Nevada)
Provides disability benefits to eligible Southern Nevada participants funded by additional employer contributions
relationships · 14
who they work with
- Anthem Blue Cross Partner — Network provider for medical care accessible to members using OEH prefix.
- BlueCross BlueShield Partner — Processes medical and hospital claims for non-California providers on behalf of the fund.
- Carelon Behavioral Health Partner — Administers mental health, substance abuse, and MAP benefits for the fund.
- Carelon Behavioral Health Partner — Behavioral health service provider available to Non-Medicare PPO members.
- Carelon Behavioral Health Partner — Provides the behavioral health program for members of the Operating Engineers Health & Welfare Fund.
- Delta Dental – Delta Care USA Partner — Dental provider under DHMO plan.
- DentalXchange Partner — Processes dental claims for the Operating Engineers Health & Welfare Fund (Local 12).
- Health Plan of Nevada Partner — Health plan provider available exclusively to Nevada residents.
- Kaiser Permanente Partner — Network provider for medical care accessible to members.
- Metlife Partner — Dental benefits provider, closed to new enrollment except for spouses or dependents of currently enrolled subscribers.
- United Concordia Dental Partner — Dental provider offering Preferred and Plus Plans, with Plus Plan limited to CA residents.
- United Healthcare Partner — Network provider for medical care accessible to members.
- Western Dental Partner — Dental provider under DHMO plan (Select Plan 8000C3).
- signatory employer Partner — Employers who contribute to the fund on behalf of members and report work hours for eligibility determination