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
<$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?BOTHIn-Network ONLYBOTHBOTHMedicare Supplemental Coverage Only
Referral Required for Specialist?NONONONOMedicare Supplemental Coverage Only
Pre-Authorization Required?YES–Chiropractic Care, Physical Therapy, Occupational Therapy, Speech Therapy, Hospitalization, SurgeryYES–Chiropractic Care, Physical Therapy, Occupational Therapy, Speech Therapy, Hospitalization, SurgeryYES–Chiropractic Care, Physical Therapy, Occupational Therapy, Speech Therapy, Hospitalization, SurgeryYES–Chiropractic Care, Physical Therapy, Occupational Therapy, Speech Therapy, Hospitalization, SurgeryMedicare 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'dYES–Pre-Authorization Req'dYES–Pre-Authorization Req'dYES–Pre-Authorization Req'dMedicare 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