activities · 18
what they do
direct service · 17
- Administer COBRA continuation coverageProvides temporary continuation of group health coverage under COBRA for eligible employees, retirees, and dependents following qualifying events, with coverage periods of 18 or 36 months depending on the event. Extends coverage by up to 11 months for disabled beneficiaries, with premium payments due within 45 days of election and by the 20th of the prior month thereafter.
- Administer Care Counseling and preauthorization servicesOperates a Care Counseling program that provides preauthorization and provider cost comparison support for non-emergency medical services, with outpatient preauthorization reviews completed within one business day. Transitioning these services from MedExpert to Health Services Foundation (HSF) effective January 1, 2026.
- Administer Health Reimbursement Arrangements (HRA) Union and Association Health Benefits AdministrationProvides funds through HRA accounts to cover eligible medical expenses including hospitalization, physician visits, prescription drugs, and cost-sharing amounts such as deductibles, copays, and coinsurance.
- Administer death benefits Union Member Death BenefitsPays a $5,000 death benefit to beneficiaries of active bargaining employees and a $2,500 death benefit to beneficiaries of retired bargaining employees, with continued benefits at no cost for bargaining employees who become totally disabled before age 60.
- Administer dental benefits Comprehensive Dental Care AccessOffers a choice of three dental plans to active employees and dependents, including a self-funded Dental PPO Plan and two fully insured prepaid plans. Covers diagnostic and preventive services without an annual deductible, including prophylaxis twice yearly, bitewing x-rays (twice annually for children under 18, once for adults), full mouth x-rays every five years, fluoride treatment twice yearly, and orthodontic benefits up to $2,500 for dependent children paid over 12 months.
- Administer paid maternity leave benefits Comprehensive Prenatal & Postpartum Support ServicesProvides a Paid Maternity Leave Benefit of up to $800 per week or two-thirds of weekly pay for eligible participants, including pre-birth leave starting no earlier than the fourth month of pregnancy (up to six months intermittent) and post-birth leave of up to six weeks (eight weeks for cesarean section deliveries), implemented in collaboration with the Painters and Allied Trades Labor Management Cooperation Initiative.
- Administering Health and Welfare Benefits Union and Association Health Benefits AdministrationAdministers a comprehensive benefits program for active and retired bargaining employees and their dependents, including medical, dental, and death benefits. This includes self-funded plans, COBRA continuation coverage, and utilization review for medical services.
- Conduct medical utilization review Performance Data Collection & AnalysisConducts utilization review to assess the medical necessity, appropriateness, and cost-effectiveness of hospital stays and proposed medical or surgical services, using retrospective review, second and third opinions, concurrent review, and prior authorization.
- Facilitating Employer Reporting and PaymentsOffers an online platform for employers to submit monthly contribution reports, calculate amounts due, and make electronic payments via ACH.
- Offering Paid Maternity Leave Benefits Comprehensive Prenatal & Postpartum Support ServicesProvides paid maternity leave benefits for eligible participants, including pre-birth leave starting in the fourth month of pregnancy and post-birth leave for up to six weeks, with an additional two weeks for cesarean sections, up to $800 per week.
- Offering Virtual Appointments with Trust Fund Representatives Telehealth Consultations & Virtual CareProvides virtual one-on-one appointments with Trust Fund representatives via Zoom or telephone for member convenience.
- Operate nurse advice line Health Information and Member Support LinesOperates a nurse line staffed by registered nurses available seven days a week from 7am to 7pm Pacific Time.
- Process employer contributions onlineOffers online employer reporting to process monthly contribution reports, calculate amounts due, and enable ACH electronic payments.
- Provide virtual member support and language assistance Language Interpretation and Translation ServicesOffers virtual one-on-one appointments with Trust Fund representatives via Zoom or telephone and provides free language assistance services, including qualified interpreters and translated materials, for members with limited English proficiency.
- Providing Care Counseling and Nurse Line Services Health Information and Member Support LinesOperates a Care Counseling program that offers preauthorization and cost comparison support for non-emergency medical services, including copay waivers for PPO providers. Additionally, provides a nurse line staffed by registered nurses available seven days a week.
- Providing Dental Care Coverage Comprehensive Dental Care AccessOffers comprehensive dental coverage including diagnostic, preventive, and orthodontic services for dependent children up to a lifetime maximum of $2,500. This includes coverage for cleanings, bitewing x-rays, full mouth x-rays, and fluoride treatments.
- Providing Language Assistance Services Language Interpretation and Translation ServicesOffers free language assistance services, including qualified interpreters and translated materials, to members with limited English proficiency.
advocacy · 1
- Issuing Nondiscrimination Notices Non-Discrimination Policy ImplementationIssues formal notices of nondiscrimination based on protected characteristics such as race, color, national origin, age, disability, or sex.
strategies · 32
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.
- Adhering strictly to minimum federal COBRA requirements minimum_legal_complianceThe organization follows only the minimum statutory mandates under COBRA without expanding coverage or rights beyond what is federally required, limiting liability and administrative burden.
- Aligning medical expense eligibility with IRS standards irs_section_213_eligibility_standardEligible medical expenses are defined according to Internal Revenue Code Section 213, ensuring reimbursement policies are consistent with federal tax-qualified standards.
- COBRA Compliance and Coverage Continuity cobra_complianceProvides continuation of health coverage in accordance with federal COBRA regulations following qualifying life events, adhering strictly to statutory requirements without expansion.
- Centering services around members and clients client-and-member-centered service deliveryService delivery is designed to be timely, efficient, and accurate, with a focus on meeting the needs of members, families, clients, and professionals, ensuring high satisfaction and trust.
- Client-Centered Service Delivery client-and-member-centered service deliveryDelivers timely, accurate, and efficient services tailored to the needs of members, families, clients, and professionals, prioritizing responsiveness and service quality.
- Collaborating with labor-management partners to design benefits labor-management_collaborationThe organization works jointly with labor-management initiatives to co-create and implement targeted benefit programs that meet the specific needs of eligible participants.
- Controlling costs through utilization review utilization_review_for_cost_controlThe organization conducts utilization review to prevent unnecessary or excessively costly medical services, ensuring the long-term affordability and sustainability of health benefits.
- Coordinated Benefit Payments benefit_coordinationAligns maternity benefit payments with state programs to prevent total compensation from exceeding 100% of weekly pay, ensuring compliance and financial sustainability.
- Coordinating benefits with state programs to prevent overpayment benefit_coordinationMaternity benefit payments are coordinated with state programs to ensure that total benefits do not exceed 100% of weekly pay, maintaining compliance and financial integrity.
- Cost-Transparent Care Navigation cost transparency counselingSupports members in making informed healthcare decisions by providing cost transparency and provider comparison counseling, promoting selection of high-value, lower-cost care options.
- Defining coverage based on medical necessity and standards medically_necessary_care_criteriaCovered services are determined by clinical necessity, professional guidelines, and regulatory requirements, ensuring that benefits support appropriate and evidence-based care.
- Direct Trust-Funded Benefits with Tax Compliance direct trust-funded benefitsProvides death benefits funded directly through the Trust Fund, ensuring financial support to beneficiaries while treating payouts as taxable income in compliance with federal tax regulations.
- Direct funding of benefits through Trust Fund with tax compliance direct trust-funded benefitsDeath benefits are funded directly from the Trust Fund and treated as taxable income, ensuring transparent, compliant, and reliable disbursement to recipients.
- Encouraging use of cost-effective dental networks preferred_provider_network_modelMembers are incentivized to use in-network PPO dentists to reduce out-of-pocket costs, while retaining freedom of provider choice, balancing affordability with access.
- Enhancing trust fund administration through technology technology-enhanced administrationThe organization leverages innovation and technology to improve service delivery and operational support in the administration of Taft-Hartley Trust Funds, increasing efficiency and reliability.
- Ensuring COBRA compliance for continued health coverage cobra_complianceThe organization provides continuation of health coverage in accordance with federal COBRA regulations when qualifying events occur, ensuring legal compliance and continuity of care.
- Ensuring clear beneficiary designation and equitable distribution designated beneficiary distributionThe organization uses a designated beneficiary system based on formal enrollment forms, with default equal distribution among multiple beneficiaries when specific allocations are not provided, promoting clarity and fairness in benefit disbursement.
- Equitable Beneficiary Distribution Framework designated beneficiary distributionImplements a designated beneficiary system where benefits are distributed according to the Plan Enrollment Form, with equal allocation among multiple beneficiaries when no specific instructions are provided.
- IRS Tax-Compliant Medical Expense Reimbursement irs_section_213_eligibility_standardAligns eligibility for medical expense reimbursement with Internal Revenue Code Section 213, ensuring compliance with federal tax-qualified standards for medical spending.
- Incentivized Health Engagement incentive-based wellness programEncourages participants to adopt health-improving behaviors by offering financial rewards and enhanced benefits, leveraging behavioral incentives to promote wellness and long-term health outcomes.
- Incentivizing health-improving behaviors through financial rewards incentive-based wellness programThe organization uses a health promotion program that provides financial incentives and enhanced benefits to encourage participants to adopt and maintain health-improving behaviors, leveraging behavioral economics to improve long-term wellness outcomes.
- Integrated Clinical and Cost Preauthorization Review preauthorization with clinical and cost reviewEnsures medical appropriateness and cost efficiency by integrating clinical review with cost analysis during preauthorization, supporting delivery of high-quality, cost-effective care.
- Integrating clinical and cost review in preauthorization preauthorization with clinical and cost reviewPreauthorization decisions are based on both clinical appropriateness and cost efficiency, ensuring that care is medically necessary and economically sustainable.
- Labor-Management Collaborative Program Design labor-management_collaborationPartners with labor and management stakeholders to co-develop and implement targeted benefit programs that meet the needs of eligible participants through shared governance.
- Least-Cost Medically Necessary Reimbursement cost-effective_treatment_reimbursementReimburses for the least expensive dentally necessary treatment option when multiple clinically appropriate methods are available, promoting cost-effective care without compromising necessity.
- Medically Necessary Care Standard medically_necessary_care_criteriaDefines covered services based on clinical necessity, professional standards, and regulatory compliance to ensure benefits support only medically necessary care.
- Preferred Provider Cost Incentive Model preferred_provider_network_modelEncourages use of in-network PPO dental providers to reduce out-of-pocket costs while preserving freedom of choice, balancing affordability with access.
- Promoting cost-conscious healthcare decisions through transparency counseling cost transparency counselingMembers receive cost transparency and provider comparison counseling to guide them toward lower-cost, high-value care options, supporting informed decision-making and cost containment.
- Reimbursing least expensive dentally necessary treatments cost-effective_treatment_reimbursementWhen multiple treatment options are available, reimbursement is based on the least expensive dentally necessary option, promoting cost-effective care without compromising clinical standards.
- Streamlining contribution processing via electronic systems electronic remittance processingBy using online reporting and electronic payment systems, the organization improves accuracy and efficiency in processing employer contributions, reducing administrative errors and delays.
- Technology-Driven Fund Administration technology-enhanced administrationLeverages digital systems and innovation to streamline trust fund operations, including electronic reporting and payments, to improve accuracy, efficiency, and member support in administering Taft-Hartley Trust Funds.
- Utilization Review for Cost Containment utilization_review_for_cost_controlImplements utilization review to evaluate medical services for necessity and cost-effectiveness, preventing overuse and ensuring long-term affordability of health benefits.
named programs · 4
what they call their work
COBRA Continuation Coverage
Provides temporary continuation of healthcare coverage for union members, retirees, and their dependents who lose coverage due to qualifying events such as job termination, reduction in hours, divorce, or death
California State Continuation Coverage
Provides additional continuation rights under California law for participants in the medical HMO plan, extending coverage beyond federal COBRA limits in certain cases.
Extended COBRA for Disability
Allows disabled individuals and their families to extend COBRA coverage up to 29 months if the Social Security Administration determines disability began before the 60th day of COBRA enrollment.
Medical, Dental, and Vision Benefits
Comprehensive health benefits offered through the Trust Fund including medical, prescription drug, mental health, substance abuse, dental, and vision coverage for eligible participants
relationships · 10
who they work with
- Blue Cross Network Partner — Used as a reference model for the structure of the Dental PPO Plan.
- Delta Dental Partner — Administrative partner for the Dental PPO Plan, providing network and allowed charge determinations.
- HSBA Government — Administrative contact and email domain (hsba.com) associated with the Trust Fund operations.
- Health Insurance Marketplace Partner — Provides information and referral to Health Insurance Marketplace as an alternative to COBRA coverage.
- Health Services Foundation (HSF) Partner — Provides the Care Counseling program and nurse line services for the Trust Fund.
- Health Services Foundation (HSF) Partner — Will provide Care Counseling services for Indemnity Medical Plan participants starting January 1, 2026.
- Herlache & Sons Partner — Employer using the Trust Fund's online reporting system
- Painters and Allied Trades Labor Management Cooperation Initiative Partner — Collaborating organization in the implementation of the Paid Maternity Leave Benefit program.
- Patrick J. Ruane, Inc Partner — Employer using the Trust Fund's online reporting system
- UM Company Partner — Contracted to administer the inpatient utilization review program, including determining medical necessity and appropriateness of services.