Recent Changes to the Health and Welfare Coverage
Hospital In-Network Benefits
(effective 4/01/2008)
For service on or after
April 1, 2008, the Board has increased the payment percentage from
80% to 85%.
Diabetic Education Benefit
(effective 4/01/2008)
Effective April 1, 2008, the
Board has added a benefit for Diabetic Educational services limited
to a maximum payable of $500 per calendar year.
Chiropractic Benefits
(effective 4/01/2008)
The calendar year maximum
benefits payable has been increased from $800 to $1,000.
Expenses Not Covered
(effective
12/01/2007)
The INELIGIBLE MEDICAL EXPENSES
section has been amended as follows:
REMOVED:
No benefits are payable for intentionally self-inflicted injury,
whether sane or insane, or injury resulting from the participation
in the commission of a felony.
ADDED:
No benefits are payable for intentionally self-inflicted injury or
injury sustained in the commission of a felony, unless the injury is
the direct result of a medical condition (such as mental illness or
depression).
Weekly Disability Benefit
(effective
6/01/2007)
The Weekly Disability Benefit has
been increased from $100 to $200 per week, for periods of disability
commencing on or after June 1, 2007.
Life Insurance Benefit
(effective
6/01/2007)
The benefits underwritten by
Boston Mutual Life Insurance Company have been increased to the
following:
Employee Life Insurance
Employee AD&D Benefit |
$25,000
$25,000 |
Dependent Life Insurance
Spouse
Child |
$10,000
$5,000 |
Dental
Benefit
(effective 4/01/2007)
This limited benefit will provide a maximum reimbursement of $300
per calendar year per eligible family member for services provided
in a dentist's office. There will be no schedule of allowances
or different percentages for reimbursements based on the type of
treatment. All dental expenses will be covered at
100% up to $300 in a calendar year for each eligible family member.
This program is intended to be a
reimbursement arrangement where you pay the dentist's bill and
submit a receipt to the Fund Office for reimbursement.
However, if you
and the dentist can reach an agreement where the dentist will accept
payment from the Fund, with you responsible for any difference, you
can instruct the dentist to submit his bill directly to the Fund
Office and the Fund's check will be made payable to the dentist.
Preventive Benefit
(effective 4/01/2007)
Benefits for preventive care, as detailed below, will be paid at
100%, up to the reasonable and customary amount for the covered
service, without application of the calendar year deductible,
subject to a calendar year maximum benefit of $1,000 per covered
individual. Covered services include:
- Mammogram, limited to one exam per calendar year;
- Pap smear and related office visit, limited to one exam per
calendar year;
- HPV testing and vaccination, limited to one exam per three
(3) calendar years;
- Immunizations, including flu shots and vaccines;
- Routine physical exam, limited to one exam per calendar
year;
- Prostate exam, limited to one exam per calendar year;
- Colonoscopy exam for screening purposes, limited to one exam
per ten calendar years for individuals less than age fifty (50)
and limited to one exam per five calendar years for individuals
age fifty (50) and over.
Benefits will not be provided under this Preventive Care Benefit
for treatment, including diagnostic testing, of any illness or
injury. Charges for treatment of an illness or injury will be
considered under the Comprehensive Major Medical Benefit.
X-Ray, Laboratory and Exam Benefit
(effective 4/01/2007)
The X-Ray, Laboratory and Exam Benefit has been
eliminated from the Schedule of Benefits.
Hospital Services Payment Factor
(effective 4/01/2007)
The payment factor for in-network (Preferred Provider PPO)
hospital services have been increased from 75% to 80%.
Self-Contribution Provisions -
Retirees
(effective 4/01/2007)
The following language has been revised:
If you work in a jurisdiction outside of the Fund's area and elect
to authorize the transfer of reciprocal hours to this Fund, your
hours earned will be credited based upon the Work Quarter and
eligibility will be granted for the ensuing Benefit Quarter.
If necessary for you to maintain coverage, you will be permitted to
make a self-contribution in an amount equal to the difference
between the required hours for eligibility and the number of hours
credited times the prevailing building trades contribution rate
applicable under the terms of the IUOE Local 132 Collective
Bargaining Agreement in effect at the time.
Calendar Year Deductible
(effective 1/01/2007)
The annual calendar year deductible was decreased from
$500 to $250 per individual. An aggregate family
calendar year deductible of $500 per family has been added to the
Schedule of Benefits.
Annual Maximum
(effective
1/01/2007)
The annual maximum for all covered expenses was
increased from $200,000 to $300,000.
Lifetime Maximum
(effective 1/01/2007)
The Lifetime maximum for all covered expenses was
increased from $500,000 to $750,000.
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