Your questions answered

We get it. It’s natural for you to have questions. There’s a lot of information on this website and in our other materials. Sometimes it’s hard to understand it all. If you’re not sure about something, please ask us.

We’re happy to answer your questions. It’s important for you get the answers you need. It can help you make the right choices for you and your health.

The number for our Customer Service Office is 702-733-9938.

Here are the answers to some of the questions we get asked a lot:

Eligibility and Enrollment

What are my benefits?

The Culinary Health Fund offers the best health plan in Nevada. We offer medical, dental, vision and pharmacy benefits. Hospital stays, home health, and life insurance are also part of your benefits. To learn how your benefits work, read the Summary Plan Description. Log in to this website to view it.

When will my dependents and I get benefits?

After you work 360 hours within 3 months you are eligible for benefits. You then have to wait one month before you can use your benefits, and they start the 1st day of the next month. Be sure to enroll your dependents before your benefits start. Learn more here.

Can I put my niece, nephew or parents on my coverage?

No. The only people you can add to your coverage are your spouse (if you’re legally married) and your children.

I got divorced. What should I do?

If you get divorced, you have to let us know. You can do that by calling our Customer Service office at 702-733-9938.

I just had a baby. Is my baby automatically covered?

Yes. We cover your baby for the first 30 days. But you still have to enroll your baby. Bring your baby’s birth certificate to our Customer Service office to enroll them. Your baby will not have benefits if you don’t enroll them within 30 days.

I didn’t get my ID card. What should I do?

Call our Customer Service office at 702-733-9938. We’ll make sure you get one.

My employer didn’t report all of my work hours. What should I do?

Call Customer Service at 702-733-9938. Ask how many work hours your employer reported for you. Let us know if all of your hours weren’t reported. We’ll contact your employer to get the right number of hours.

I went on vacation, but my vacation hours weren’t reported for the work period I was gone. What should I do?

Call our Customer Service office right away at 702-733-9938. Tell us when you went on vacation. Your employer may have put in your vacation hours wrong. We’ll contact your employer to check.

What’s Self-Pay?

Self-Pay is an option to pay us to keep your benefits when you don’t work enough hours. Once you have benefits, you need to work 240 hours every 2 months to keep them. If you work less than that you can pay us for the hours you’re short. Learn more about self-pay.

How do I know how much my self-payment is?

You’ll get a notice in the mail. The notice will tell you how much you owe and when you have to pay by. Call our Customer Service office at 702-733-9938 if you don’t get a notice but think you’re short hours.

Benefits and claims

I got an “Explanation of Benefits” in the mail. What is this and do I need to do anything?

An Explanation of Benefits is not a bill.

It tells you what the doctor charged and what we paid. It may also tell you if we didn’t pay for a service, and why. If you have any questions about your Explanation of Benefits, call our Customer Service office at 702-733-9938.

My doctor sent in a claim and I got a letter asking questions about an accident. What should I do?

We ask for information if it looks like you were hurt in an accident or if someone else might have caused your injury. Please answer the questions in the forms that came with the letter and send them back to us. You will get a bill from your doctor if you don’t send the completed forms back. We can’t pay your medical bill until we get the forms back from you.

I was in an accident and I got paperwork about my accident. What is it and what should I do?

Please complete the paperwork and send it back. If you were injured in an accident that was caused by someone else we need to know. We want to make sure your medical bills get paid by the person who caused the accident. We can’t pay your medical bills until we get the papers back. You may have to pay for your medical care if we don’t get the papers back from you.

Here’s what you should do:

• Fill out and sign the papers.
• If you have a lawyer, have them complete the forms also.
• Send the completed paperwork back to the Culinary Health Fund. The address is on the cover letter.

My doctor is sending me bills for services that I thought were covered by my benefits. What should I do?

Call our Customer Service Office at 702-733-9938. Ask if your doctor sent in a claim, and if it was paid. Our staff may ask you for the date you went to the doctor and the amount of the bill. This can help us find the claim. If the claim was denied, ask our staff to explain why.

I got a letter saying that more information is needed before my claim can be paid. What should I do?

The letter should say what information is needed. It will also say who needs to send us the information. Your doctor may need to send something in. You can call your doctor to make sure they send it. If you need to send something in, please do so. If it isn’t clear what’s needed, call our Customer Service office at 702-733-9938.

My claim was denied. I think it should have been paid. What can I do?

You can appeal the decision by filling out and sending in this formDownload PDF. You can also get this form at our Customer Service office. You can only file an appeal for 12 months after the date your claim was denied.

Be sure to include:

• Your name
• Your social security number
• The provider’s name
• The patient’s name
• The date of service
• Any other information that will help us understand the problem

How much is my copay for a doctor’s visit?

It depends on what type of doctor you go to and what kind of visit it is. You can check your copay in our copay bookDownload PDF.

Is my doctor a PPO doctor?

All PPO doctors are in our online provider directory. Call our Customer Service Office at 702-733-9938 if you need help finding a doctor.

Pharmacies

Can I get medicine at the Culinary Pharmacies for free?

Yes. Covered generic medicines are free at the Culinary Pharmacies. Check the list of generic medications to see if your medicine is covered. Ask your doctor to only choose medicines from that list. That way you’ll have no copay and can get your medicine for free.

What other pharmacies can I use?

There are many pharmacies you can go to for your medicine. You can even get your medicine at pharmacies in other states if you’re away from home. Follow this link to find a pharmacy.

How much will my medicine cost at a retail pharmacy?

It depends on your medicine. The cost of your medicine at a retail pharmacy is:

What’s the difference between getting my medicine by mail and picking up my medicine?

Getting your medicine by mail saves you money. If you get your medicine by mail you will get a 2-month supply for one copay. If you pick up your medicine in person you will only get a 1-month supply for the same copay.

Plus, getting your medicine by mail saves you time. You won’t have to drive to the pharmacy or wait in line.

What’s a generic medicine?

A generic medicine is created to be the same as a brand-name drug in form, safety, strength, and quality. A generic medicine works the same way and provides the same benefits as a brand-name version. Generics use the same active ingredients as a brand-name drug, and work the same way in your body. The Food and Drug Administration (FDA) sets standards for generic drugs, and does inspections to ensure their safety and quality.

Why do generic medicines cost less?

Generic medicines cost less because the companies that make them don’t have to repeat all of the basic research that the name-brand drug companies have already done. They also sell certain medicines to treat more than one medical condition, and competition among several generic drug makers drives prices down.

Taxes

Below is important information on how to access your 1095-B tax form, which shows the months in which you and your dependents had health coverage during 2023. Please note, there are no federal fines if you did not have health coverage in 2023, but some states do have their own health coverage requirements.

The Culinary Health Fund will not mail the 1095-B Form to you, unless you lived in California, Massachusetts, or New Jersey at any time in 2023 or you request a copy. To request a copy of your form:

• Online
  

  1. Log in to your account
  2. Click the link labeled 1095-B Tax Forms
  3. You can then print or save a copy of your 1095-B form

• Email
  

  culinary​fund@​Zenith-​American.com

• By phone
  

  702-733-9938

• By mail
  

  Culinary Health Fund
  1901 Las Vegas Blvd South
  Las Vegas, Nevada 89104