FAQ's

 

Please choose a topic to find out the answers to frequently asked questions from participants.

Administrative Topics

Spouse and Dependent Social Security Numbers
Who is my insurance company
Pre-notification Requirements
May the health care provider bill me for the discounted amount
How am I notified of the amount that I owe my doctor
What shall I do if I receive a balance due statement from my health care provider that differs from my EOB
How does a provider of service (health care provider) know that EWTF has an agreement with UnitedHealthcare or OneNet PPO
Emergency Admission and Pre-notification Requirements
How does the provider of service know that EWTF has an agreement with UnitedHealthcare or OneNet PPO?

Medical

Annual Deductible
Hospital Stays 
Out-of-Pocket Maximum or Catastrophic Benefit 
Provider Network - UnitedHealthcare Choice Plus 
Pay at the Time of Service
UHC Group Number
UHC Identification Number
Chiropractic Care, Speech, Occupational and Physical Therapies


Maternity Information

Free Prenatal Education

 
Dental

What is OneNet PPO?
Locate a Participating Dentist
Dental Group Number
Orthodontics

 

Mental Health & Substance Abuse

What is an Employee Assistance Program
What are the pre-certification requirements
Are there any free sessions available
Mental Health Benefits
Is Psychological Testing Covered
Court Ordered Treatment
Marriage Counseling

 

Prescription Benefit Information

Co-pays for Medications Purchased at Local Retail Pharmacy
Co-pays for Medications Purchased thru Caremark's Mail Service Program
Alternative to Mail Service Program (CVS Caremark Maintenance Choice Program)

Formulary Drugs
Difference Between Generic & Brand Name Drugs
Suggestions to Keep Drug Costs Down
Compare the Price of Generics and Brand-Name Drugs



Vision Benefits

Routine Eye Exam
Contact Lens Benefit
Safety Glasses


If you need a clarification on a response, please contact the Fund office during normal business hours at (301) 731-1050 or via email at info@ewtf.org.  Please remember that this web page is governed by the Plan Document. If there is any discrepancy between this web page and the Plan Document, the Plan Document governs. 

 

 

Administrative Topics
 

Why must I provide the Social Security Numbers for my spouse and children?
In March 2009 the Plan was amended to require the social security numbers of any dependents including spouses.  This ammendment is the result of the Medicare Secondary Payor (MSP) requirements.

If the dependent's social security number is not received within 6 months from the date of birth, the date of marriage or the date added, the spouse and/or dependent's coverage will be terminated.

Who is my insurance company?
Your benefits are provided by EWTF and are the result of the collective bargaining process between IBEW Local Union No. 26 and your employer.  EWTF pays your claims. UnitedHealthcare or OneNet prices the claim. EWTF is not an insurance company. It is self-funded plan meaning that your employer’s contributions and any earned income from investments of your employer’s contributions pay for the health care expenses that you and your fellow participants incur. NOTE: The EWTF Plan makes the final decisions about what is covered and what is paid. EWTF writes the checks to pay benefits.

In what circumstances must I pre-authorize or obtain a pre-determination?
If you or an eligible family member is going to seek treatment in one of the following categories, you must obtain prior authorization before beginning any course of treatment. Otherwise, your benefits will be denied.

  • Home Health Care and Hospice Care
  • Hospitalization
  • Physical Therapy, Speech Therapy, Occupational Therapy and Chiropractic Care

Contact the Prior Authorization Department at UnitedHealthcare at 1-800-850-1418.

Is the provider allowed to bill me for the discounted amount?
The provider is not supposed to bill you for the discounted amount because they have agreed to the allowed amount as payment in full. This is provided you pay your patient's portion (20% of allowed amount) and meet your deductible.

How am I notified of the amount that I am owed my doctor? 
For each claim paid, a participant is sent an Explanation of Benefits (EOB).  EWTF pays on the UnitedHealthcare or OneNet discounted amount, NOT the billed amount.  Payment is 80% of the discounted amount for medical services, psychiatric treatment and basic dental services, subject to the deductible.  (There is no deductible on dental claims.)

There are two columns on the right hand side of the EOB.  One column is the "Provider Amount" and the other is "Patient Amount".  Monies in the Provider Amount column are the amount that the provider writes off.  Any monies in the Patient Amount column are owed by you to the provider.

What do I do if I receive a balance due statement from my doctor that differs from my EOB?
If you experience an occasion where the doctor, dentist or other medical provider sends a bill for a balance of charges corresponding with UnitedHealthcare or OneNet discounts, it is important that you bring it to the attention of the Fund office.  If you did not present your EWTF ID card at the time of service, the provider is entitled to charge you the full amount.

How does the provider of service know that EWTF has an agreement with UnitedHealthcare or OneNet PPO?
At each visit to a doctor, dentist, lab or any other health care provider, present your EWTF/UnitedHealthcare identification card which also serves as your EWTF prescription card.  This card includes all the information that your provider needs to submit your claims to the appropriate party and also ensures that the proper discounts are applied.

If you are a retired participant that has Medicare as the primary coverage, present your EWTF Medicare Supplemental card that also serves as your prescription card to any medical or dental provider.

I went to the emergency room and was admitted through the ER. Will my benefits be denied because I did not get prior authorization before this emergency admit?
If UnitedHealthcare is notified within 2 days after an emergency admission, your hospital bill will not be denied due to not getting authorization. The telephone number to the Notification Department is 1-800-850-1418.

What is the web address to verify that my doctor participates with UHC or to locate a new medical provider?
The web address is http://directory.uhis.com. You are responsible for verifying that your provider/hospital is in the UHC Choice Plus Network.   HINT: Do not enter www. prior to “directory” in the web address.


Medical

What is the annual deductible?
The current deductibles are:

Type of Benefit 

Type of Deductible 

Amount of Deductible

Medical

Individual

$150

Medical

Family

$300


 

What is the benefit for inpatient hospital stays?
The first $7000 of covered expenses is paid at 100% of the allowance (no deductible) per spell of illness with the remaining covered expense paid at 80% of the allowed amount. This includes outpatient hospital stays as well. 

Is there someone I have to notify if I or a covered family member has inpatient hospital stay?
Yes. Your medical provider is responsible for obtaining prior authorization from UnitedHealthcare at least 48 hours prior to an elective hospital stay and within 2 days after an emergency admission. The telephone number is 800-850-1418.

What is the Catastrophic Benefit?
The EWTF Plan rules provide that an individual or family who furnishes proof to the Fund office that the "Out-of-Pocket" expenses that have been paid by the participant exceed the Plan's "Out-of-Pocket" maximum is entitled to have the remainder of their covered medical expenses paid at 100% of allowed costs for the remainder of that calendar year.

The Out-of-Pocket expense maximum is $10,000 per family per calendar year.

This means that before anyone can claim 100% coverage for medical expenses exceeding the Out of Pocket maximum, they must furnish documentary proof (receipts, paid invoices, etc.) clearly indicating that the person claiming the benefit has paid Out-of-Pocket medical expenses of $10,000.

Claims submitted for the Catastrophic Benefit must be filed with the Fund office within one year from the end of the calendar year for which out of pocket expense is requested.

What is the UnitedHealthcare Choice Plus Network?
UnitedHealthcare (UHC) Choice Plus Network is a network with which Electrical Welfare Trust Fund (EWTF) has an agreement to help reduce your out-of-pocket expenses.

What is the web address to verify that my doctor participates with UHC or to locate a new medical provider?
The web address is http://directory.uhis.com. You are responsible for verifying that your provider/hospital is in the UHC Choice Plus Network.

Who do I contact to get a physical copy of medical providers in my area?
EWTF does not have any medical directories to send to participants.  If you have access to the internet, you may access the medical provider network by pasting this address in your browser:  http://directory.uhis.com

If you don't have access to the web, contact the service representatives at EWTF between 8 am and 4:30 pm to help you. The EWTF office number is (301) 731-1050. The toll-free number from surrounding states is (800) 929-EWTF (3983).

Do I have to pay at the time of service?
Yes, the provider can collect the estimated financial liability at the time of service.


What is the UnitedHealthcare Group Number?
The EWTF group number with UnitedHealthcare is 78-340001.

What is my UnitedHealthcare Identification Number?
Your UHC ID number is a 12 digit number that begins with 304000 (zeroes). The remaining six digits is your ID number and is located on the front of your 4-sided EWTF/UnitedHealthcare hospitalization card.

Do I have to notify anyone about chiropractic care, physical therapy, speech therapy and/or occupational therapy? 

Yes. Your medical provider is responsible for obtaining prior authorization from UnitedHealthcare before beginning any services. If prior authorization is not obtained from UHC then you run the risk of having the claim denied. The telephone number to the Prior Authorization Department at UHC is 1-800-850-1418.
 

Maternity Information

What is the Healthy Pregnancy Program? 

This free program provides prenatal education and information to all EWTF members and spouses. The focus is on keeping healthy during a pregnancy, and keeping your baby healthy after it's born.

How do I register for the Healthy Pregnancy program?
Call (800) 850-1418 to register.  You may notice that this is the same telephone number at UnitedHealthcare for prior authorizations. Identify yourself as a participant of Electrical Welfare Trust Fund and give the current group number (78-340001) so you are enrolled with the correct group. By enrolling in this program, you have the opportunity to take advantage of the following benefits:

  • 24-hour toll-free access to experienced nurses
  • Identification of your risks and special needs
  • Pregnancy and childbirth education materials and resources

Is there any benefit to taking part in the Healthy Pregnancy Program?
Once EWTF is notified that the Healthy Pregnancy program has been completed, EWTF will pay the attending obstetrician an additional 5% of the allowed amount for the delivery charge for a total of 85% paid on the allowed amount.  This percentage increase only pertains to the attending obstetrician delivery charge. The increased percentage rate does not include any ancillary charges including the hospital charges, anesthesiologist's fees, etc.



Dental

What is OneNet PPO? 
OneNet PPO is a dental provider network with which Electrical Welfare Trust Fund (EWTF) has an agreement to help reduce your out-of-pocket dental expenses, if necessary.  "PPO" is an abbreviation for Preferred Provider Organization. Currently EWTF has an agreement with OneNet to price your dental claims and to use their network of dentists.

May I contact OneNet for the name dentist?
Yes.  Contact OneNet Member Services at 1-800-342-3289 to find out the name of a dental provider.  They are open 24 hours a day.  If you already have a dentist, you can call OneNet Member Services to find out if he/she participates with OneNet. If you prefer, follow this link to the OneNet Dental PPO Network to look up a dental provider close to home or work.

When selecting a dental provider please be aware that not all dentists in a group or office may participate with the OneNet Dental PPO network.  Dentist participation in the OneNet Dental PPO ntwork is by contract with individual dentists, and not through dental groups or offices that the dentist may be a part of.

Do I have a group number with OneNet?
The EWTF group number with OneNet is AM0011.

Are orthodontics covered under the EWTF Plan?
Orthodontics are not covered under the EWTF Plan.  However, the consultation and work-up fees are considered.

 

Mental Health and Substance Abuse

What is an Employee Assistance Program and what do they do?
Business Health Services (BHS) is EWTF's Employee Assistance Program (EAP).  The Care Coordinators at BHS are qualified professionals and can assist you with personal and emotional problems such as family stress, relationship issues, financial or legal difficulties and alcohol and drug abuse.  The counseling and/or referrals provided by BHS are conducted on a strictly confidential basis and at no cost to you.

Business Health Services will provide up to eight free counseling sessions.  The counselors at Business Health Services may be able to resolve a situation at no cost to you during the free visits, but when necessary or clinically appropriate, will refer you to a qualified low cost or no cost provider or program to meet your needs.
The toll-free number for Business Health Services is (800) 765-EAPS (3277).

Do I have to have to pre-certify before I can see a therapist or go in for treatment?
No. You are, however, strongly urged to contact Business Health Services (BHS) to take advantage of their free Benefit Navigation program. The Care Coordinators at BHS are there to help you navigate through the process of finding an appropriate mental health professional if your issue cannot be treated within the eight free sessions. Keep this is mind if you must change providers during the course of treatment or if your level of care changes. Level of care could include group therapy in additional to individual counseling, etc.

Are the 8 free sessions by BHS provided on a calendar year basis?
You and members of your household are eligible for up to 8 free sessions per issue, per year.   This means that if your mother or father or other family member is living in your household but not on the EWTF coverage, they have access to the free visits by the Business Health Service counselors.

What are the benefits for mental health including substance abuse treatment?
 

Type of Service

Type of Service Percentage Paid
of Allowed Amount;
Subject to the Ded

Plan Limits

Inpatient Doctor Visit

80%

none

Inpatient Hospital/Facility

100% of the first $7000;
balance at 80%
(deductible does not apply)

none

Outpatient Doctor Visit

80%

none

 NOTE: Benefit navigation provided by Business Health Services can help if there are any changes in treatment or provider. It's a free service.

What if I am referred for psychological testing?
Benefits are payable at 80% of EWTF allowance, subject to the deductible.  If psychological testing is ordered to determine if a patient has Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD), contact Business Health Services for free access to the Benefit Navigation program that includes  referral to a cost efficient provider of service.

What if a judge orders me or my child to go to treatment?
Court ordered treatment is not covered by the EWTF.

My spouse and I are having difficulty -- is marriage counseling covered?
Marriage counseling is not covered by EWTF. However, this is one of the services that may be resolved during the eight free sessions provided by Business Health Services.
 


Prescription Benefits

What are the co-pays for prescriptions purchased at my local pharmacy?
The current retail co-pay for a one month supply is:

  • is $10.00 for a generic medication
  • is $25.00 for a preferred brand (formulary) drug
  • is $35.00 for a non-preferred brand (non-formulary). Non-preferred brands are typically medications advertised in the media and print ads.

What are the co-pays for using Caremark's mail service program?
To determine the current co-pay for the mail service program, multiply the retail co-pay by 2.

For example, a 90 day supply of a generic medication using the mail service program is $20 (co-pay for generic at retail is $10 x 2 = $20). Remember this – you are paying for a two month supply and receiving an extra month’s supply FREE!

CVS Caremark Maintenance Choice Program
There is another option available to participants who want to take advantage of the savings offered through the mail order program but don't want the hassle of having the medications delivered to your home.  Use the CVS Caremark Maintenance Choice® program.  This program allows participants who are on long term medications (also known as maintenance medications) to pick up a 90 day supply of medicine at the local CVS pharmacy.

 

The chart below shows the co-pay and supply amount for each option:

 

Generic

Formulary

Brand

Day's Supply

At local pharmacy

$10

$25

$35

up to 30 days

Thru Caremark's Mail Service Pharmacy

$20

$50

$70

90 days

CVS Caremark Maintenance Choice

$20

$50

$70

90 days

 

Remember
Caremark's Mail Service Pharmacy or CVS/Caremark Maintenance Choice®
you pay for 60 days supply and get 30 days free
for a total of a 90 day supply

What is a formulary drug?
A formulary is a list of preferred medications developed by a committee of pharmacists and physicians to include drugs that are the safest, most effective and most economical.

What is the difference between generic and brand name drugs?
A generic drug is the term used to describe a drug once the original drug manufacturer's brand name patent has expired.  Generic drugs tend to cost less since many of the research, development and marketing costs have been paid by the original manufacturer.  Each generic drug manufacturer must meet the same strict Food & Drug Administration (FDA) guidelines followed by the original manufacturer. For more on generic drugs, you can also go to the website for the FDA.

So how can I keep my drug costs down?

1. Take a copy of the formulary list with you when you visit the doctor.  Contact the Fund office to request a formulary list .

2. Ask for generic drugs whenever they are available. Remember, that FDA approved generic drugs are chemically equivalent to their brand name counterparts.

3. Use a pharmacy in the Caremark network.
 

How can I compare the price of generics and brand-name drugs?
Visit www.caremark.com to register and check the drug cost under "Find Savings and Opportunities" on Caremark's home page.


Vision

Do I have benefits for a routine eye exam?
If you are an Active Participant, Active Non-Bargaining Unit Employee, Retired Participant, Surviving Spouse or an eligible dependent of these classifications, routine vision benefits are available to you.  Currently eyeglass lenses and frames are covered once in every two calendar years.  However, if your lens prescription changes before you are eligible for new lenses and the prescription meets the criteria shown below, lenses and frame will be replaced every one calendar year instead of every two calendar years.

  • a new prescription differs from the original by at least .50 diopter sphere or cylinder
  • an axis change of 15 degrees or more
  • .5 prism diopter change in at least one eye

Is there a benefit for contact lenses?
Yes, if you are an Active Participant, Active Non-Bargaining Unit Employee, and Retired Participant, Surviving Spouse or an eligible dependent of these classifications.  Contact lenses will include coverage for the eye exam and $70 toward the cost of the contact lenses and are available once every two years.  If your prescription should change and meets the criteria shown above, you will be able to use this benefit to replace your old prescription.

Are Safety Glasses available?
Safety Glasses are available under this benefit to actively working eligible Members once each calendar year. Lenses are covered in full. Safety frames are covered up to $65 plus 20% of any out of pocket costs.

The lenses and frame provided are certified as safe for the work environment by meeting the necessary requirements set forth by ANSI (American National Standards Institute).

Contact VSP to find out if  you are eligible for an exam and glasses/contacts by calling (800) 877-7195. You can also find out this info on the web.


 

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