YOUR HEALTH CARE PLAN

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Plan Overview

Active electrical workers, non-bargaining unit staff and retirees, learn about your benefits coverage, co-pays, deductibles, and more for your Medical, Prescription, Behavioral/Mental Health, Dental, Vision/Hearing and other benefits.

 

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MEDICAL: Benefit Plan Overview

 Active Electrical Workers:
Standard Plan
Active Electrical Workers:
"H" Plan
Non-Bargaining Unit:
Office Plan
Retirees:
Pre-Medicare
Retirees:
Medicare Eligible
Copay0000Medicare Supplemental Coverage Only
Deductible$150 pp/
$300 family
$150 pp/
$300 family
$150 pp/
$300 family
$150 pp/
$300 family
Medicare Supplemental Coverage Only
Coinsurance80% EWTF/
20% member
80% EWTF/
20% member
80% EWTF/
20% member
80% EWTF/
20% member
Medicare Supplemental Coverage Only
Out of Pocket Max$8,000/year$8,000/year$8,000/year$8,000/yearMedicare Supplemental Coverage Only
Annual Benefit MaximumNONONONOMedicare Supplemental Coverage Only
Lifetime Benefit Maximum<$1,000,000: No limit
>$1,000,000: 50% Reduced Benefit
<$100,000: No limit
>$100,000: 50% Reduced Benefit
<$1,000,000: No limit
>$1,000,000: 50% Reduced Benefit
<$1,000,000: No limit
>$1,000,000: 50% Reduced Benefit
Medicare Supplemental Coverage Only
In Network & Out of Network Coverage?BOTHIn-Network ONLYBOTHBOTHMedicare Supplemental Coverage Only
Referral Required for Specialist?NONONONOMedicare Supplemental Coverage Only
Pre-Authorization Required?YES-Hospitalization, Surgery, Speech Therapy; Only After 1st 20 Visits: Chiropractic Care, Physical Therapy, and Occupational TherapyYES-Hospitalization, Surgery, Speech Therapy; Only After 1st 20 Visits: Chiropractic Care, Physical Therapy, and Occupational TherapyYES-Hospitalization, Surgery, Speech Therapy; Only After 1st 20 Visits: Chiropractic Care, Physical Therapy, and Occupational TherapyYES-Hospitalization, Surgery, Speech Therapy; Only After 1st 20 Visits: Chiropractic Care, Physical Therapy, and Occupational TherapyMedicare Supplemental Coverage Only
COVERAGE:
Medical (office visits, doctor charges, etc)YESYESYESYESMedicare Supplemental Coverage Only
Well WomanYESYESYESYESMedicare Supplemental Coverage Only
Routine PhysicalsYESYESYESYESMedicare Supplemental Coverage Only
Lab & X-raysYESYESYESYESMedicare Supplemental Coverage Only
Chiropractice Care, Physical Therapy, & Speech TherapyYES-Pre-Authorization Req’d for Speech Therapy; Pre-Authorization Req’d Only After 1st 20 Visits: Chiropractic Care, Physical Therapy, and Occupational TherapyYES-Pre-Authorization Req’d for Speech Therapy; Pre-Authorization Req’d Only After 1st 20 Visits: Chiropractic Care, Physical Therapy, and Occupational TherapyYES-Pre-Authorization Req’d for Speech Therapy; Pre-Authorization Req’d Only After 1st 20 Visits: Chiropractic Care, Physical Therapy, and Occupational TherapyYES-Pre-Authorization Req’d for Speech Therapy; Pre-Authorization Req’d Only After 1st 20 Visits: Chiropractic Care, Physical Therapy, and Occupational TherapyMedicare Supplemental Coverage Only
Hospitalization & SurgeryYES–Pre-Authorization Req'dYES–Pre-Authorization Req'dYES–Pre-Authorization Req'dYES–Pre-Authorization Req'dMedicare Supplemental Coverage Only
Maternity & Gynecological CareYES–Maternity for Member/Spouse OnlyYES–Maternity for Member/Spouse OnlyYES–Maternity for Member/Spouse OnlyYES–Maternity for Member/Spouse OnlyMedicare Supplemental Coverage Only
Emergency RoomYESYESYESYESMedicare Supplemental Coverage Only

DENTAL: Benefit Plan Overview

 Active Electrical Workers:
Standard Plan
Active Electrical Workers:
"H" Plan
Non-Bargaining Unit:
Office Plan
Retirees:
Pre-Medicare
Retirees:
Medicare Eligible
Lifetime Benefit MaximumNon-Ortho–Dependents < 18 yrs old: $ 0 Non-Ortho Member/Spouse: $3,000 N/ANon-Ortho– Dependents < 18 yrs old: $ 0 Non-Ortho Member/Spouse: $3,000 Non-Ortho–Dependents < 18 yrs old: $ 0 Non-Ortho Member/Spouse: $3,000 Non-Ortho–Dependents < 18 yrs old: $ 0 Non-Ortho Member/Spouse: $3,000
Pre-Authorization Required?Treatment Plan > $600 OnlyN/ATreatment Plan > $600 OnlyTreatment Plan > $600 OnlyTreatment Plan > $600 Only
COVERAGE:
Preventive ServicesIn Network: 100%
Out of Network: 80%
N/AIn Network: 100%
Out of Network: 80%
In Network: 100%
Out of Network: 80%
In Network: 100%
Out of Network: 80%
Basic Dental ServicesIn Network: 80%
Out of Network: 50%
N/AIn Network: 80%
Out of Network: 50%
In Network: 80%
Out of Network: 50%
In Network: 80%
Out of Network: 50%
Major Dental ServicesIn Network: 80%
Out of Network: 50%
N/AIn Network: 80%
Out of Network: 50%
In Network: 80%
Out of Network: 50%
In Network: 80%
Out of Network: 50%
OrthodontiaDependent Children: 50% up to $3,000
Member or Spouse: No Coverage
N/ADependent Children: 50% up to $3,000
Member or Spouse: No Coverage
Dependent Children: 50% up to $3,000
Member or Spouse: No Coverage
Dependent Children: 50% up to $3,000
Member or Spouse: No Coverage

VISION & HEARING: Benefit Plan Overview

 Active Electrical Workers:
Standard Plan
Active Electrical Workers:
"H" Plan
Non-Bargaining Unit:
Office Plan
Retirees:
Pre-Medicare
Retirees:
Medicare Eligible
AllowanceVision–$150 glasses/$100 contacts
Hearing–$3,000 first hearing aid; $1,000 second hearing aid
N/AVision–$150 glasses/$100 contacts
Hearing–$3,000 first hearing aid; $1,000 second hearing aid
Vision–$150 glasses/$100 contacts
Hearing–$3,000 first hearing aid; $1,000 second hearing aid
Vision–$150 glasses/$100 contacts Hearing–$3,000 first hearing aid; $1,000 second hearing aid
VisionYESNOYESYESYES
HearingYESNOYESYESYES

BEHAVIORAL/MENTAL HEALTH: Benefit Plan Overview

 Active Electrical Workers:
Standard Plan
Active Electrical Workers:
"H" Plan
Non-Bargaining Unit:
Office Plan
Retirees:
Pre-Medicare
Retirees:
Medicare Eligible
Copay0000Medicare Supplemental Coverage Only
Deductible$150 pp/$300 family$150 pp/$300 family$150 pp/$300 family$150 pp/$300 familyMedicare Supplemental Coverage Only
CoinsuranceEAP: 8 Free Counseling Sessions/Year Inpatient: 100% up to $7,000; After $7,000, 80% EWTF / 20% member Outpatient: 80% EWTF/20% memberEAP: 8 Free Counseling Sessions/Year No Inpatient/Outpatient CoverageEAP: 8 Free Counseling Sessions/Year Inpatient: 100% up to $7,000; After $7,000, 80% EWTF / 20% member Outpatient: 80% EWTF/ 20% memberEAP: 8 Free Counseling Sessions/Year Inpatient: 100% up to $7,000; After $7,000, 80% EWTF / 20% member Outpatient: 80% EWTF/ 20% member
Out of Pocket Max$8,000/year$8,000/year$8,000/year$8,000/yearMedicare Supplemental Coverage Only
Lifetime Benefit Maximum<$1,000,000:
No limit >$1,000,000: 50% Reduced Benefit
<$1,000,000:
No limit >$1,000,000: 50% Reduced Benefit
<$1,000,000:
No limit >$1,000,000: 50% Reduced Benefit
<$1,000,000:
No limit >$1,000,000: 50% Reduced Benefit
Medicare Supplemental Coverage Only
In Network & Out of Network Coverage?BothEAP onlyBothBothBoth
Pre-Authorization RequiredBHS Navigation Requiredsame as MedicalBHS Navigation RequiredBHS Navigation RequiredBHS Navigation Required
COVERAGE:
Employee Assistance Plan (EAP)YES–Contact BHS for BenefitYES–Contact BHS for BenefitYES–Contact BHS for BenefitYES–Contact BHS for BenefitMedicare Supplemental Coverage Only
Substance Abuse & Mental HealthYES–Contact BHS for BenefitNOYES–Contact BHS for BenefitYES–Contact BHS for BenefitMedicare Supplemental Coverage Only

PRESCRIPTION: Benefit Plan Overview

 Active Electrical Workers:
Standard Plan
Active Electrical Workers:
"H" Plan
Non-Bargaining Unit:
Office Plan
Retirees:
Pre-Medicare
Retirees:
Medicare Eligible
Regular CopayGeneric Drug:
$10 Brand (Formulary)
Drug: $25 Non-Formulary Drug: $35
N/AGeneric Drug:
$10 Brand (Formulary)
Drug: $25 Non-Formulary Drug: $35
Generic Drug:
$10 Brand (Formulary)
Drug: $25 Non-Formulary Drug: $35
Generic Drug:
$10 Brand (Formulary)
Drug: $25 Non-Formulary Drug: $35
Mail Order Maintenance CopayGeneric Drug: $20
Brand (Formulary) Drug: $50
Non-Formulary Drug: $70
N/AGeneric Drug: $20
Brand (Formulary) Drug: $50
Non-Formulary Drug: $70
Generic Drug: $20
Brand (Formulary) Drug: $50
Non-Formulary Drug: $70
Generic Drug: $20
Brand (Formulary) Drug: $50
Non-Formulary Drug: $70
Annual Benefit MaximumNON/ANONON/A
Lifetime Benefit MaximumImmuno Therapy subject to Medical Lifetime MaxN/AImmuno Therapy subject to Medical Lifetime MaxImmuno Therapy subject to Medical Lifetime MaxN/A
In Network & Out of Network Coverage?BOTHNOBOTHBOTHBOTH
Pre-Authorization Required?Non-Formulary Drugs OnlyN/ANon-Formulary Drugs OnlyNon-Formulary Drugs OnlyNon-Formulary Drugs Only
COVERAGE:
Presciption DrugsYESNOYESYESYES

OTHER BENEFITS COVERAGE

 Active Electrical Workers:
Standard Plan
Active Electrical Workers:
"H" Plan
Non-Bargaining Unit:
Office Plan
Retirees:
Pre-Medicare
Retirees:
Medicare Eligible
Death Benefit$25,000 Member Only0$25,000 Member Only$6,000 Retiree Only0
Accidental Dismemberment & Loss of SightYESNOYESNONO
Weekly Accident & Sickness BenefitYESNOYESNONO
Supplemental Occupational BenefitYESNOYESNONO