Frequently Asked Questions

Find answers to the most frequently asked questions. If you have further questions, please call NWPP Administrator WPAS at (206) 441-7574 or (866) 417-4240 or email us.

Download a copy of your Summary Plan Description booklet or contact NWPP for a hard copy.

Using Your Benefits

Who is our Preferred Provider Organization (PPO)?

NWPP has contracted with Premera Blue Cross to provide access to care to NWPP plan participants and their eligible family members at a discounted rate. Participants also have access to the BlueCard® PPO network, one of the largest national networks available. (Does not apply to Medicare Retirees or Medicare eligible dependents).

How do I find a preferred provider?

To find an in-network medical provider or specialist online or call (800) 810-BLUE (2583) and reference the prefix FIT.

How can I find out what is covered and how many visits I may have a year?

You can find detailed information about your plan, costs, and the allowed visits per calendar year in your Summary Plan Description (SPD) booklet or Summary of Benefits and Coverage (SBC), or by calling the Administration Office at (206) 441-7574 or (866) 417-4240.

What is the plan year for my deductible and coinsurance?

Your plan year runs from January 1 – December 31, with your deductible and coinsurance renewing every year.

What expenses do not apply to coinsurance?

While your benefits offer coverage for most things, some items do not apply to your co-insurance limit. These include: balance-billed charges, health care this plan doesn’t cover, vision services, alternative provider benefits, non-PPO coinsurance, expenses more than the usual, customary and reasonable (UCR) allowance, benefits for foot orthotics, non-PPO hospital copay and penalty and expenses in excess of plan limits. Please refer to the most recent Summary Plan Description booklet for full details.

What services require pre-authorization and who do I contact?

All in-patient hospital admissions (emergency admissions must be pre-authorized by the next business day following admission). Certain outpatient procedures also require pre-authorization. A complete list of those services can be found in the benefit booklet or by calling Qualis Health at the number below in the next Q&A. To request a pre-authorization, contact Qualis Health at (800) 783-8606.

General Plan Information

How do I become eligible to receive benefits?

To be eligible for benefits you will need to work the minimum number of hours and have contributions remitted by your employer(s) to meet the dollar bank eligibility requirements. After initial eligibility has been established, self-payment is permitted to retain coverage. Please refer to the most recent Summary Plan Description booklet for full details.

When are my dependents covered on my insurance?

Your dependents will be covered when you are. You must complete and submit an enrollment form listing your eligible dependents. You are required to provide documentation verifying your dependents’ eligibility and relationship to you, the subscriber. Acceptable forms of documentation include marriage certificate, birth certificate, adoption decrees, legal guardianship orders, Qualified Medical Child Support Orders and/or parenting plans (if applicable).

Where can I find my Plan identification number?

Your identification number is listed on your ID card. Your identification number begins with the letters FIT.

Should my dependent(s) have their own insurance card with their name on it?

No, dependents are on the data base, but cards are not issued in their name, only the plan participant’s.

How do I add or remove a spouse or dependent on my insurance?

You may add or remove dependents at any time. New dependents are covered on the date of marriage or birth, or in the case of adoption, the date the child is legally placed in the employee’s home. To make changes to your dependents please contact NWPP. It is important to notify the Administration Office right away whenever you have a change in family status or have an address change.

How do I update my (or my dependent’s) address or contact information?

You may fill out a new enrollment form, download and complete an address change form, or submit the request in writing to the Administration Office.

How do I update my beneficiary on my Life Insurance or Pension Plan?

To update beneficiary information, please fill out a new enrollment form and submit it to NWPP Administration Office.

Where can my healthcare provider submit claims?

Medical and vision claims for any service by Premera contracted providers, or any provider in WA or AK are submitted to:
Premera Blue Cross
P.O. Box 91059
Seattle, WA 98111-5159

Medical and vision claims for services by Premera contracted providers outside of WA or AK are submitted to the local Blue Cross Plan.

Medicare, member paid claims, maternity leave and time loss claims should be submitted to:
NW Plumbers Trust
P.O. Box 34684
Seattle, WA 98124-1684

Medicare claims can also be submitted electronically to the Medicare Cross Over program through Change Healthcare Group F31 payer ID 91136.

Dental claims should be submitted to:
Delta Dental of Washington
PO Box 75983
Seattle, WA 98175-0983

COBRA Coverage

What is COBRA?

COBRA (the Consolidated Omnibus Budget Reconciliation Act) is a federal law that requires group health plans to provide temporary continuation of group health coverage that otherwise might be terminated.

For example:

  • You lose or quit your job
  • You divorce the covered employee
  • The covered employee dies
  • You are no longer covered as a dependent due to your age

I am a new employee and just got a COBRA letter, what do I do next?

Initial COBRA notices are mailed to all new participants who recently gained Health coverage under NWPP. This notice explains your COBRA rights, typically no action is required.

Why am I still receiving COBRA?

If you do not have enough contributions built up in your dollar bank for at least one additional month of coverage, you will receive a notice. The COBRA election form gives you the option to self-pay for coverage in the months that you do not have enough hours of eligibility based on active employment. If you are currently working full time, you will probably have enough hours reported to continue your coverage without a break. Participants can always call NWPP at the end of the month, prior to losing eligibility to confirm the hours and confirm eligibility.