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To ensure the best coverage available for you and your eligible dependents, please read all of the information very carefully. Once you have elected a medical plan, you may change your election only during the next Annual Open Enrollment. Exceptions are made only if you move outside of your selected plan's service area, so please choose carefully. All completed enrollment forms received by the 15th of the month are processed for an effective date of the 1st day of the following month. Important: This is not a contract. this is a summary of the medical plan options available to you. The group agreements and Plan documents must be consulted to determine the exact terms and conditions of coverage. All benefits are subject to change. You have a choice of the following 4 medical plan options:
The Fee-for-Service Plan - is a comprehensive major medical plan which offiers you the flexibility of "choice". Under this Plan, you may use any doctor or go to any facility you choose, within the United States. There are deductibles to be met, and out-of pocket expenses for most care received, however, if you utilize a provider participating in the Plan's PPO network, your out-of-pocket expenses are greatly reduced. To avoid additional unexpected out-of pocket expenses, pre-authorization is highly recommended prior to receiving certain services. For pre-authorization, please call Intracorp at 800-527-9226. All claims for services incurred must be submitted to the Administrative Office for processing and benefit determination. The HMO Plans (Health Maintenance Organizations) - provide quality care under a managed care environment, within a defined service area. When you enroll in an HMO plan, you must use their medical providers and hospitals for all of your medical care, including prescription drugs. No benefits are provided if you, or your eligible dependents, use non-HMO providers or providers of a different HMO, except for certain medical emergencies. There are no claim forms to fill out, and the Fund pays the HMO directly for your health care needs. Health care services are provided to you for specified co-payment amounts at the time of service. Each HMO has a limited service area, which is defined in each enrollment packet. To enroll in an HMO, you must reside in and have all medical services performed within their defined service area. If you enroll in an HMO and have an eligible dependent(s) residing in a separate household which is outside of your selected Plan's service area (i.e. college students or children residing with ex-spouses), there may be no benefits available for that dependent. In addition, if you travel out of town to work, or plan to do so, you may have no benefits available while you are outside of your selected plan's service area. Regardless of which medical plan you select, your Dental, Vision, Death Benefits, and Accidental Death & Dismemberment Benefits will continue to be provided by the Trust Fund. For Specific Medical Benefits available, please call the appropriate Memeber Services numbers indicated below:.
You have a choice two Dental Plan Options:
Your Dental Benefits For the first month of coverage, ALL eligible Plan B participants will be covered under the Fee for Service B plan. You have 60 days from your initial eligibility date to elect the United Concordia Dental plan. If you enroll in United Concordia, the Fee for Service B plan will be continued until your United Concordia effective date. After 60 days, you will not have the option to switch dental plans until the next Annual Open Enrollment. Fee-for-Service Dental Plan: Under the Fee-for-Service Dental plan, you may use any dentist you wish. The schedule of allowable benefits is detailed on pages 72 through 85 of your Summary Plan Description. Claims for services performed must be submitted to this Administrative Office for payment. If you wish to remain on the Fee-For-Service dental plan, please indicate so on the New Eligible Reply Form. United Concordia Dental Plan: Under the United Concordia plan, you must select a United Concordia DHMO dentist, and have all services performed by that dentist. After your initial selection, you may change your United Concordia Dental office by calling United Concordia Customer Service at (800) 937-6432. While you are enrolled in United Concordia, if you go to a dentist other than the United Concordia network dentist you have selected, you and/or your dependents will not have any dental coverage for those services rendered, except for certain dental emergencies. There are no claim forms to fill out and the Fund pays United Concordia directly for your dental care needs. Covered services and supplies are provided for specified co-payments. Questions on specific dental benefits? Please call Customer Service at the following toll-free numbers, you may also click the links below to view summary information:
Your Vision Benefits Vision Service Plan - Regardless of which medical plan you choose, your Vision benefits are a separate benefit available under VSP. The enclosed flyer explains the benefits that are available . To utilize your benefits, simply make an appointment with a participating VSP provider. Your provider will then contact VSP to verify your eligibility. If you need help in locating a VSP provider, call VSP at (800) 877-7195, or log on to www.vsp.com. Your Substance Abuse Benefits Beat It! Program - Regardless of which medical plan you choose, you will still have benefits under the Beat It! Program. If you are enrolled in an HMO, you may choose between the HMO substance abuse benefits, or use them in combination with the Beat It! Program. This pamphlet explains the benefits available under the Beat It! program. Questions? For information on specific benefits under the Fee-for-Service Plan, or to check the status of a claim submitted, please contact the Claims Department of the Administrative Office, at 800-947-4338. For information on your Eligibility or Hour Bank status, or if you are not sure which plan you are currently enrolled on, please contact the Eligibility Department of the Administrative Office, at 800-947-4338. Moving? Please contact the Eligibility Department at the Administrative Office immediately if you change your mailing address! If you are enrolled in an HMO, a change of residence could result in a lapse of coverage!
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