FAQ's
Please choose a topic to find out the answers to frequently asked questions from participants.
- Annual Deductible
- Hospital Stays
- Free Prenatal Education
- UnitedHealthcare Choice Plus Network (Effective May 1, 2010)
- Find a Participating Medical Provider
- UHC Group Number
- UHC Identification Number
- Pre-notification Telephone Number
- OneNet PPO LLC (Dental Claims)
- Member Services (Find a Participating Dental Provider)
- Employee Assistance Provider
- Pre-certification
- Pay at the Time of Service
- Business Health Services
- Mental Health Benefits
- Court Ordered Treatment
- Marriage Counseling
- Formulary Drugs
- Difference Between Generic & Formulary Drugs
- Co-pays for Medications Purchased at Pharmacy
- Suggestions to Keep Drug Costs Down
- Compare the Price of Generics and Brand-Name Drugs
- 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 to 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.
What is the annual deductible?
The current deductibles are:
| Type of Benefit | Type of Deductible | Amount of Deductible |
| Medical | Individual | $150 |
| Medical | Family | $300 |
| Dental | Individual | N/A |
| Dental | Family | N/A |
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. You are required to contact UHC prior to your inpatient stay. The pre-notification telephone number is 800-850-1418.
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 notifications. 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
- 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.
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.
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 EWTF/UnitedHealthcare hospitalization card.
Is there someone I have to notify if I or a covered family member has inpatient hospital stay?
Yes, you are responsible to notify 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 OneNet PPO, LLC?
OneNet PPO, LLC is a managed care 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.
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 (AFL-CIO) and your employer. EWTF pays your claims. UnitedHealthcare or OneNet prices the claim.
Can 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 dentistr, you can call OneNet Member Services to find out if he/she participates with OneNet. If you have an OneNet dental directory or have chosen one from the OneNet web site, we strongly recommend that you contact Member Services to verify that the provider still participates with OneNet PPO, LLC.
Do I have a group number with OneNet?
The EWTF group number with OneNet is AM0011.
Do I have to notify anyone about chiropractic care, physical therapy, speech therapy and/or occupational therapy?
Yes, you are responsible to notify UnitedHealthcare prior to beginning these services. If you do not pre-notify UHC then you run the risk of having the claim denied.The telephone number is 1-800-850-1418.
Do I have to pay any money up front when I visit an UnitedHealthcare provider?
Yes, the provider can collect the estimated financial liability at the time of service.
Can the provider 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 co-insurance amount (20% of allowed amount) and meet your deductible.
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.
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 (50% for major dental work), subject to the deductible.
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 should write off. Any monies in the Patient Amount column are owed by you to the provider.
Who is our Employee Assistance Provider and what do they do?
Business Health Services (BHS) is EWTF's employee assistance provider (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 Trustees have arranged with Business Health Services to access the MAPSI network of mental health providers. This will provide greater savings for you.
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.
Do I have to have to pre-certify before I can see a therapist or go in for treatment?
Yes, before beginning any course of psychological treatment including substance abuse, you are required to contact Business Health Services at 1-800-765-3277 to set up an appointment for a “face to face” assessment and if necessary, a referral. This is not a change in the Plan. If you are referred to a provider, Business Health Services will send a pre-certification to EWTF so that your claims will be considered. If you fail to get pre-certified, your claims will be denied.
If you change providers during a course of treatment, you must contact Business Health Services to have a new pre-certification form completed.
If the level of care you are receiving changes, you must contact Business Health Services to get pre-certification. For example, you are having individual outpatient psychotherapy visits and the provider suggests you attend group therapy. You agree to go and want the fund to pay for it. You must contact Business Health Services for pre-certification prior to attending group therapy so that your claim is not denied for failure to get pre-certification.
What are the benefits for mental health including substance abuse treatment?
| Type of Service Effective January 1, 2007 |
Type of Service Percentage Paid of Allowed Amount; Subject to the Deductible |
Plan Limits |
| Inpatient Doctor Visit | 80% | none |
| Inpatient Hospital/Facility | 100% of the first $7000; balance at 80% (deductible does not apply) |
Effective January 1, 2010 there are no limits |
| Outpatient Doctor Visit | 80% | Effective January 1, 2010 there are no limits |
NOTE: Any change in treatment or a change in the provider of service requires a new pre-certification.
What if I am referred for psychological testing?
If pre-certified by Business Health Services, benefits are payable at 80% of EWTF allowance, subject to the deductible. When psychological testing has been ordered to determine if a patient has Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD), contact Business Health Services for pre-certification and 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 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.
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. The current retail co-pay for a one month supply for a preferred brand (formulary) drug is $25.00 while a non-preferred brand (non-formulary) is $35.00. The co-pay for the generic drug is $10.00.
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. Take advantage of the mail order program to fill your maintenance medication prescriptions. Contact the Fund Office to request information concerning the mail order program.
4. 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 "My Coverage" on Caremark's home page.
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. Effective January 1, 2006 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.
Retired Participants, and their eligible dependents are entitled to the routine vision benefits listed here.
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 purchased on or after January 1, 2006 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.
Retired Participants, Surviving Spouses and their eligible dependents are entitled to the benefits for contact lenses listed above.
Are Safety Glasses available?
Safety Glasses are available under this benefit to actively working eligible Members once each calendar year effective January 1, 2006. 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).