Protections from Surprise Medical Bills
Effective July 1, 2022, you will have protection against surprise medical bills from out-of-network providers and facilities under a new federal law called the No Surprises Act. This law mainly applies to Out-of-Network Emergency Services, services provided by out-of-network providers at network facilities, and Out-of-Network Air Ambulance Services. To learn more, click here to read the full notice.
Over-the-Counter In-Home COVID-19 Test Kits
Beginning January 15, 2022, the Health & Welfare Fund will cover the costs of at-home, over-the-counter (OTC) COVID-19 tests. The tests must be FDA-approved or FDA-authorized OTC COVID tests. The Plan will cover the full cost of the tests purchased during the public health emergency. There is no cost-sharing to the participant or any type of pre-authorization, and a prescription or doctor’s order is not required.
Each individual eligible under the Plan is entitled to receive up to 8 tests per 30-day period or per calendar month. For example, a family with two parents and two children could receive 32 tests per month, free of charge. Also, there is guidance which clarifies that if there are multiple tests in a box, each test in the box counts toward the 8 per month maximum. The tests must be purchased for the primary purpose of your individual diagnosis or treatment of COVID. The Plan does not provide coverage of OTC COVID-19 tests that are for employment reasons. We have prepared the appropriate Claim Form for your convenience.
Get informed on COVID-19 vaccines
Recently, the United States Food and Drug Administration (FDA) issued emergency use authorization (EQU) for coronavirus vaccines from Pfizer/BioNTech and Moderna. The Centers for Disease Control and Prevention (CDC) advisory committee also officially recommend the vaccines. OptumRx has prepared the included notice to assist with any questions you may have.
Remember, the Fund is committed to ensuring your benefits continue to support you and your loved ones during the coronavirus (COVID-19) health emergency. A Summary of Material Modification (SMM) is attached detailing updated benefits for COVID-19 testing as well as important information below for your reference. We encourage you to follow all local, state and national COVD-19 regulations, and the advice and practice tips offered by medical professionals.
Important Reminders about Your Benefits
Dental/Vision Care Benefit
The Board of Trustees are pleased to announce that due to the continued improvement in the financial standing of the Health & Welfare Fund, they have made the following benefit improvements at their most recent meeting.
Effective January 1, 2021, the maximum benefit which will be paid on behalf of a covered individual for expenses incurred in a calendar year has been increased from $750 to $1,500, reimbursed at 100%.
In regards to the pediatric dental/vision care benefit, if an eligible minor child(ren), age 19 or less, incurs expenses for dental or vision care services which are not covered under the Major Medical benefit, such expenses will be reimbursed at 100% of the first $1,500, then 50% thereafter.
Medical Benefits
The Plan covers preventive care at 100%, up to $1,000, when you go to an in-network or out-of-network provider. If you have been in close contact with someone with COVID-19 or you are a resident in a community where there is ongoing spread of COVID-19 and develop symptoms of COVID-19, call your doctor. Your provider will decide whether you need to be tested and, as the tests become more readily available, it is covered 100%. Keep in mind, there is no treatment for COVID-19 and people who are mildly ill may be able to isolate and care for themselves at home.
You can also use the Fund’s telehealth service – LiveHealth Online – for a consultation without leaving your home. Sign up at www.livehealthonline.com and, if using a smartphone, download the app. You will need the Subscriber ID number (including the three letter prefix that is printed on your Anthem ID card.
Prescription Drug Benefits
If possible, utilize OptumRx’s mail order pharmacy to save yourself a trip to the pharmacy. You can do this by logging on to www.optumrx.com to register or call 1-855-295-9140.
