|
|
|
Effective September 1, 2007
For Active EMPLOYEES AND THEIR COVERED DEPENDENTS*
|
|
|
Hospital And Medical Benefits
|
|
·
For “In-Network” services, there is a 20% coinsurance. There
is also a $20 co-payment for primary care office visits and a $30 co -payment
for specialist office visits.
·
When you receive “Out-of-Network” services, you have an annual
deductible of $500 per person. The Fund then covers up to 80% of the
Magnacare Schedule. If the provider charges more than the Magnacare
Schedule, you are responsible for the charges in excess of the reimbursement.
·
Note that a $100 deductible applies for each emergency room
visit, whether In-Network or Out-of-Network. After you have met the
per-visit deductible, the reimbursement will be 80% of the Magnacare
Schedule.
·
For hospitalizations, there is a $500 deductible per hospital
stay. Hospital is covered up to 365 days for semi-private room.
·
*Your entitlement to "member-only coverage" or
"member-and-family" coverage is dependent on the rate of
contribution made by your Employer. Please call the Fund office to verify
whether you have member-only coverage or member-and-family coverage before
you attempt to use your plan to obtain medical services for your dependents.
|
|
Prescription Drug Benefits
|
|
·
Prescription drugs are only covered at a participating
pharmacy. There is a $25 co-pay for generic and brand name* drugs and a $30
co-pay for injectable medications. You will receive up to a 30-day supply.
·
If you use the mail order service, you have a $35 co-pay for
generic and brand name* drugs and a $50 co-pay for injectable medications,
but you will receive up to a 90-day supply.
·
There is a $15,000 maximum each fund year per covered
participant ($10,000 limit for the period September 1, 2007 to April 30,
2008).
*The Fund has a mandatory generic policy, which means
that if you request a brand name drug when a generic equivalent is available,
you will be responsible, in addition to your co-pay, for any difference in
cost between the brand name and generic.
|
|
Dental Benefits
|
|
The Fund will provide access to certain participating
dentists who will provide most dental services at a discount for you and your
eligible dependents.
|
|
|
Vision Benefits
|
|
You may go to any vision care provider. However, the Fund
has an extensive panel of vision care providers. You can save out-of-pocket
expenses when you utilize one of the vision care providers on the panel.
When you utilize a vision care provider that is not on the
extensive panel you must obtain a vision care voucher (claim form) from the
Fund Office. Then you pay the full cost up front for any vision services you
obtain and the Fund will reimburse you its allowance for the vision service
(see below for the Fund's reimbursement rate).
When you utilize a vision care provider from the Fund's
extensive panel you must obtain a vision care voucher from the Fund Office in
order to send in your claim. You have to pay the full cost up front for any
vision services you obtain. However, after you receive reimbursement from
the Fund you will have paid only the difference between the Fund allowance
and, if there is one, the balance of the cost of the vision care you
received. That cost will be considerably less than what you would have paid
if you had used a vision provider that is not on the Fund's panel.
The Fund will reimburse you up to:
- $65 for glasses (frames and lenses) or $100 for
contacts.
Benefits are available once every 12 months.
|
|
|
Life Insurance Benefit Subject To The Exclusions Described Later On In This
Booklet
|
|
·
$10,000 is paid to your named beneficiary if you die while
covered by the Fund.
·
$5,000 is paid to you if your eligible dependent dies while
he/she is covered by the Fund. This only applies to members with dependent
coverage.
|
For information on filing a medical claim, see the section
called “Claims and Appeals Procedures.”
You are eligible to participate in the Fund if you work for
an employer who is required by the terms of a collective bargaining or other
written agreement to make contributions to the United Teamster Fund on your
behalf. Please remember that your eligible dependents are covered only if your
employer contributes for family coverage.
If you are eligible for family coverage, then your legal
spouse and eligible dependents will be eligible for coverage at the same time
that you are.
In order for someone to be considered your spouse, you and
your spouse must be legally married as husband and wife, and the marriage must
be recognized by the State of New York. No coverage is provided for domestic
partners. A partner that resides with you, to whom you are not legally
married, will not be considered to be your spouse, regardless of the length of
time you have been together.
A marriage terminates on the date that the judgment of
divorce is signed. Coverage for the spouse will terminate at the end of the
month in which the divorce occurred. At that time of the divorce, the former
spouse has the option of continuing coverage under the Consolidated Omnibus
Budget Reconciliation Act, commonly called COBRA. The Participant, however, is
responsible for notifying the Fund of the divorce. If you fail to notify the
Fund that your former spouse is no longer eligible for benefits you will be
committing an act of fraud upon the Fund and you will be responsible for any
claims that the Fund pays for your former spouse.
Your coverage automatically starts on the first day of the
month following three months that an employer makes contributions to the Fund
on your behalf.
You must wait one year from the date your coverage starts,
as described in the preceding section, "When Coverage Starts", before
you become eligible for substance abuse benefits.
Once you meet the initial eligibility requirement, your
coverage continues on a month-to-month basis.
When you qualify for coverage, the Fund Office will let you
know whether your employer contribution level qualifies you for dependent
coverage. If it does, then coverage for your eligible dependents generally
starts at the same time as your coverage.
Your “eligible dependents” include:
·
Your current legal spouse.
·
Your unmarried dependent children through the last day of the
month in which they reach age 19.
·
Unmarried, unemployed, dependent children who have reached age 19
and who are full-time students at an accredited university or college. Coverage
for such children lasts through the end of the month following the earlier of
the month in which they:
* reach
age 23,
* leave
school (graduate or leave before graduation) or get married.
·
For your child to receive continued coverage during college, you must
submit proof of full-time student status to the Fund Office within 31 days
after he/she reaches age 19. The proof of full-time student status must be
renewed with the Fund each semester.
·
Unmarried handicapped dependent children who are incapable of
self-support because of mental or physical disability. The disability must
have started before the child reached age 19. You must provide the Fund Office
with proof of the child’s disability within 31 days after the child’s 19th
birthday.
|
|
When you enroll a dependent you will be asked to provide
proof of dependent status — for example, a birth certificate, a marriage
certificate, or other proof of dependent status. You may also be required
to give proof that your child or step-child is solely dependent on you for
financial support.
|
|
If you get married, or if you acquire a child by birth,
adoption, or placement for adoption, and you are entitled to family coverage,
your dependent will be covered from the date of the marriage, birth, or
adoption, provided you file an application form at the Fund Office within 31
days of the acquisition. If you do not complete the application within 31 days
from the date of the acquisition, coverage for your dependents will be delayed.
Dependent children include the following:
·
Your natural children (including children born out of wedlock,
but only if proper evidence of paternity is submitted to the Fund Office);
·
Your legal spouse’s natural children if they live in your home,
depend on you for full financial support, and your spouse has legal custody of
them;
·
Legally adopted children or step-children;
·
Foster children who live with you and depend on you for full
financial support and maintenance, as long as no other health benefits are
being provided by any governmental agency;
·
Children required to be recognized as your legal dependent under
a Qualified Medical Child Support Order (“QMCSO”).
A Qualified Medical Child Support Order, or QMCSO, is an
order issued by a court or state administrative agency that requires that medical
coverage be provided to a child or children. A QMCSO usually results from a
divorce, legal separation or paternity proceeding.
The Fund Office will notify you if a QMCSO is received with
regard to your coverage. The Fund’s QMCSO procedures are described in greater
detail later on in this booklet (see the section called “QMSCO Procedures”).
For employees: Your coverage ends on the last day of
the month:
·
you stop working for a contributing employer,
·
you enter active military service,
·
the Fund discontinues group coverage, or
·
you no longer meet the eligibility requirements.
If you lose your coverage because of a compensable
disability, your coverage will continue for up to six months after your last
day of employment with a contributing employer. The Fund may require proof of
disability from your physician. You must apply for such coverage within 30
days of the onset of our disability.
For dependents: Coverage for your dependents ends on
the last day of the month in which:
·
your coverage ends,
·
the dependent no longer meets the Fund’s definition of dependent,
·
for a dependent spouse, in the event of divorce or legal
separation,
·
you die.
When your coverage would otherwise end, you may be able to
continue coverage by electing COBRA Continuation Coverage. The Fund also has
rules for limited extensions of coverage during certain absences, and they are
described in the next section.
If you become disabled your coverage will continue for each
month you are “totally disabled” and cannot work, for up to a total of six
months. You may be required to submit proof of your disability to the Fund
Office.
If your employer has 50 or more employees, you may be
eligible for leave under the Family and Medical Leave Act (FMLA). Under FMLA
you may take up to 12 weeks of unpaid leave for specified family or medical
purposes, such as your own serious medical condition, the birth or adoption of
a child, or to provide care for a spouse, child or parent who is ill. Your
employer, not this Fund, will determine if you are eligible for a FMLA leave of
absence.
If you take an FMLA leave, your employer is obligated to
continue to contribute to the Fund on your behalf and your coverage, through
the Fund, will continue.
During your leave, you may continue all of your medical
coverage and other benefits offered through the Fund. You are generally
eligible for an FMLA leave if you:
·
worked for an employer for at least 12 months,
·
worked at least 1,250 hours in Covered Employment over the
previous 12 months, and
·
worked at a location where at least 50 employees are employed by
the employer within 75 miles.
If you do not return to employment following an FMLA leave
during which coverage was provided, you may be required to provide
reimbursement for the cost of coverage received during the leave.
Call your employer if you have questions regarding your
eligibility for an FMLA leave. Call the Fund Office regarding coverage during
such a leave.
If you do not return to work after the end of your FMLA
leave, you may be eligible to continue coverage under COBRA described in a
later section.
Military leave: If you are on active military duty
for 31 days or less, you will continue to receive health care coverage in
accordance with the Uniformed Services Employment and Reemployment Rights Act
of 1994 (USERRA). If you are on active duty for more than 31 days, your
coverage ends, but USERRA permits you to continue health care coverage for you
and your dependents at your own expense for up to 18 months. This continuation
right operates in the same way as COBRA coverage, which is described in the
next section. In addition, your dependent(s) may be eligible for health care
coverage under the federal program known as TRICARE (which includes the old
"CHAMPUS" program). This Fund coordinates its coverage with TRICARE.
If you receive an honorable discharge and return to work
with a contributing employer, your full eligibility will be reinstated on the
day you return to work as long as you return within the applicable time frame
prescribed by law.
Under USERRA an active employee is required to notify the
employer (in writing or orally) that he or she is leaving for military service
unless circumstances or military necessity make notification impossible or
unreasonable. Your employer is required to notify the Fund within 30 days
after you are reemployed following military service; however, it is a good idea
for you to notify the Fund Office, too.
The Consolidated Omnibus Budget Reconciliation Act of 1985,
as amended (“COBRA”), requires that this Fund offer you and your eligible
dependents the opportunity for a temporary extension of health care coverage at
group rates in certain instances when coverage would otherwise end (called
“qualifying events”). Continued coverage under COBRA applies to the medical,
hospital, prescription drug, dental and vision benefits described in this
booklet.
You should keep in mind that each individual entitled to
coverage as the result of a qualifying event has a right to make his or her own
election of coverage. For example, your spouse or other covered dependent may
elect COBRA coverage even if you do not. In addition, one qualified beneficiary
can elect COBRA for others.
The chart below shows when you and your eligible dependents
may qualify for continued coverage under COBRA, when coverage may start and
when it ends.
|
Coverage Ends Because Of
This reason
|
These People Would Be
Eligible
|
For COBRA Coverage Up to
(measured from the date
coverage is lost)
|
|
Your employment terminates*
|
You and your covered spouse
and children
|
18 months **
|
|
Your working hours are reduced
|
You and your covered spouse
and children
|
18 months **
|
|
You die
|
Your covered spouse and
children
|
36 months
|
|
Your dependents lose coverage because you divorce or
legally separate
|
Your covered spouse and
children
|
36 months
|
|
Your dependent child no longer qualifies as an eligible
dependent
|
Your covered children
|
36 months
|
|
You become entitled to Medicare
|
Your covered spouse and
Children
|
36 months
|
* For any reason other than gross misconduct (and including
military leave and approved leaves granted according to the Family Medical
Leave Act).
** Continued coverage for up to 29 months from the date of
initial event may be available to those who by no later than the first 60 days
of your qualifying event, are totally disabled within the meaning of Title II
or Title XVI of the Social Security Act. This additional 11 months is
available to employees and enrolled dependents if notice of disability is
provided within 60 days after the Social Security determination of disability
is issued and before the 18-month continuation period runs out. The cost of
the additional 11 months of coverage will increase to 150% of the full cost of
coverage.
If you have a newborn child, adopt a child, or have a child
placed with you for adoption while continuation coverage under COBRA is in
effect, [and you are eligible for family coverage], you may add the child to
your coverage. To add coverage for the child, notify the Fund Office within 31
days of the child’s birth, adoption or placement for adoption. Legal proof of
your relationship to the child must also be provided.
If your covered dependents experience more than one
qualifying event while COBRA coverage is in force, they may be eligible for an
additional period of continued coverage not to exceed a total of 36 months from
the date of the first qualifying event.
For example, if your employment ends, you and your
covered dependents may be eligible for 18 months of continued COBRA coverage.
If you die (a second qualifying event) during this 18-month period, your
covered dependents may be eligible for an additional period of COBRA
continuation coverage. However, the two periods of coverage combined may not
exceed a total of 36 months from the date of the first qualifying event (your
termination).
This extended period of COBRA continuation coverage is not
available to anyone who became your spouse after the termination of employment
or reduction in hours. However, this extended period of coverage is available
to any child born to, adopted by, or placed for adoption with you during the
18-month period of continuation coverage.
Also note that if your first qualifying event is a reduction
in hours, and then your employment is terminated, the termination of employment
is not treated as a second qualifying event (so there is no extension beyond
the initial 18-month period of coverage).
Your employer must notify the Fund Office of your death,
termination of employment, reduction in hours of employment or Medicare entitlement
no later than 60 days after your loss of coverage due to one of these events.
However, you or your family should also notify the Fund Office if such an event
occurs, in order to avoid confusion as to your status.
As a covered member or qualified beneficiary, you are
responsible for providing the Fund Office with timely notice of certain
qualifying events. These events include:
·
Divorce or legal separation.
·
A child losing dependent status under the Fund.
·
The occurrence of a second qualifying event after a qualified
beneficiary has become entitled to COBRA with a maximum of an additional 18
months, up to 36 months in total. This second qualifying event could include
an employee’s death, entitlement to Medicare, divorce or legal separation, or a
child losing dependent status.
When a qualified beneficiary entitled to receive COBRA
coverage with a maximum of 18 months has been determined by the Social Security
Administration to be disabled. If this determination is made at any time
during the first 60 days of COBRA coverage, the qualified beneficiary may be
eligible for an 11-month extension of the 18 months maximum coverage period,
for a total of 29 months of COBRA coverage.
You must make sure that the Fund Office is notified of any
of the events listed above. Failure to provide this notice in the form and
within the timeframes described below will prevent you and/or your dependents
from obtaining or extending COBRA coverage.
Your notice should be sent to:
United Teamster Fund
2137-2147 Utica Avenue
Brooklyn, New York 11234
Please include the following in your notice:
·
your name,
·
the names of your dependents,
·
your Social Security number and the Social Security numbers of
your dependents,
·
your address, and
·
the nature and date of the occurrence you are reporting to the
Fund.
You must provide notice to the Fund within 60 days of the
date of the event (and do not forget to provide addresses for both you and the
dependent(s)). If you do not notify the Fund by the end of the period, your
dependents will not be entitled to continuation coverage.
The Fund must notify you and/or your covered dependents of
your right to COBRA coverage within 14 days after it receives timely notice or
becomes aware that a qualifying event has occurred. You will have 60 days to
respond if you want to continue coverage – measured from the date coverage
would otherwise end or, if later, the date the COBRA notice is sent to you.
You will be charged the full cost of continued coverage
under COBRA, plus a 2% administrative fee. (If you are eligible for 29 months
of continued coverage due to disability, the law permits the Fund to charge
150% of the full cost of the plan during the 19th to 29th months of coverage.)
The following rules apply in making your COBRA payments:
It is easiest to make your first payment when you file your
COBRA election form, that is, within 60 days from the date your Fund coverage
would otherwise end. In no event may your payment be made later than 45 days
from the date you mail your signed election form to the Fund Office. Your
first check must cover the period from the date your group coverage ended and
COBRA coverage began through the current month.
After the first payment all subsequent COBRA payments will
be due by the 30th of each month. Keep in mind that the Fund Office does not
send bills for COBRA coverage and it is your responsibility to see that your
payment is at the Fund Office by the due date.
COBRA premiums are generally reviewed at least once a year
and are subject to change.
You will be notified by the Fund Office if the amount of
your COBRA payment changes. In addition, if the benefits change for active
employees, your coverage will change as well.
Your continued coverage under COBRA may end for any of the
following reasons:
·
Coverage has continued for the maximum 18, 29 or 36-month period,
measured from the date coverage is lost.
·
The Fund terminates. If the coverage is replaced, you may be
continued under the new coverage.
·
You or your dependent(s) fail to make the necessary payments on
time.
·
You or a covered dependent(s) become covered under another group
health fund that does not exclude coverage for pre-existing conditions or the
pre-existing conditions exclusion does not apply.
·
You or a covered dependent becomes entitled to benefits under
Medicare.
·
You or your dependent(s) are continuing coverage during the 19th
to 29th months of a disability, and the disability ends.
·
Continuation coverage may also be terminated for any reason that
would terminate coverage of any participant or beneficiary not receiving
continuation coverage (such as fraud).
Full details of COBRA continuation coverage will be
furnished to you or your eligible dependents when the Fund Office receives
notice that a qualifying event has occurred.
Under the federal law called the Health Insurance
Portability and Accountability Act of 1996 (commonly called “HIPAA”) the Fund
is required to provide the following.
HIPAA requires that funds like ours guarantee that participants
and dependents not otherwise covered by a fund have special enrollment rights
if certain events occur, known as “qualifying circumstances.” [Note that, with
regard to dependents, these rights apply only if you are entitled to family
coverage.] Qualifying circumstances include:
- A change in family status,
such as marriage, divorce, birth, adoption, placement for adoption, or
death.
- You previously stated in
writing that you and/or your dependents were waiving Fund coverage because
of coverage under another medical plan, and that other coverage is lost
for any of the following reasons:
·
termination of employment;
·
reduction in hours worked;
·
your spouse dies;
·
you and your spouse divorce or legally separate;
·
the other coverage was COBRA continuation coverage, and you or
your dependent reaches the maximum length of time for COBRA continuation
coverage; or
·
the other plan terminates because the employer [or other sponsor]
did not pay the premium when due.
More information about these rights is available from the
Fund Office.
When your Fund coverage ends, you and/or your dependents
will be provided with a "Certificate of Creditable Coverage."
Certificates of Creditable Coverage indicate the period of time you and/or your
dependents were covered under the Fund (including COBRA coverage), as well as
certain additional information required by law. The Certificate of Creditable
Coverage may be necessary if you and/or your dependents become eligible for
coverage under another group health plan, or if you are covered under a health
insurance policy, within 63 days after your coverage under this Fund ends
(including COBRA coverage). The Certificate of Creditable Coverage is
necessary because it may reduce any exclusion for pre-existing coverage periods
that may apply to you and/or your dependents under the new group health plan or
health insurance policy.
The Certificate of Creditable Coverage will be provided to
you:
·
on your request, within 24 months after your Fund coverage ends,
·
when you are entitled to elect COBRA,
·
when your coverage terminates, even if you are not entitled to
COBRA,
·
when your COBRA coverage ends.
You should retain these Certificates of Creditable Coverage
as proof of prior coverage for your new health plan. For further information,
call the Fund Office.
Other HIPAA rules. This Fund is a covered entity
under HIPAA’s privacy regulations. For a copy of the Fund’s “Notice of Privacy
Practices’” please contact the Fund Office.
Military Leave: If you are on active military
duty for 31 days or less, you will continue to receive health care coverage in
accordance with the Uniformed Services Employment and Reemployment Rights Act
of 1994 (USERRA). If you are on active duty for more than 31 days USERRA
permits you to continue health care coverage for you and your dependents at
your own expense for up to 24 months. This continuation right operates in a
similar way as COBRA coverage, which is described in this booklet. When your
coverage ends because of a reduction in hours due to your military service, you
and your eligible dependents may also have COBRA rights. You should contact
the Fund Office if you are called up for service in order to determine how the
leave affects your and your eligible dependents’ eligibility for Plan benefits
and how USERRA protects your rights. In addition, your dependent(s) may be
eligible for health care coverage under the federal program known as TRICARE.
Coverage will not be offered for any illness or injury
determined by the Secretary of Veterans Affairs to have been incurred in, or
aggravated during, performance of service in the uniformed services. The
uniformed services and the Department of Veterans Affairs will provide care for
service-connected disabilities.
Under USERRA an active employee is required to notify the
employer (in writing or orally) that he or she is leaving for military service
unless circumstances or military necessity make notification impossible or
unreasonable. Your employer is required to notify the Plan within 30 days
after you are reemployed following military service; however, it is a good idea
for you to notify the Fund Office, too.
When you are discharged (not less than honorably) from
service in the uniformed services, your full eligibility will be reinstated on
the day you return to employment with a contributing employer, provided that
you return to employment within:
- 90 days from the date of
discharge if the period of service was more than 180 days; or
- 14 days from the date of
discharge if the period of service was at least 31 days, but less than 180
days; or
- at the beginning of the first
full regularly scheduled working period on the first calendar day
following discharge (plus travel time and an additional eight hours) if
the period of service was less than 31 days.
If you are hospitalized or convalescing from an injury
caused by active duty, these time limits are extended up to two years.
This section describes the medical benefits available to you
and your covered dependents. To help you understand how the Fund’s medical
coverage works, you will find the following information in this section:
·
An overview of how coverage works.
·
A side-by-side comparison of In-Network and Out-of-Network
benefits in the section called “Your Benefits At A Glance.”
·
More details on covered medical expenses, starting in the section
called “More About Covered Expenses.”
·
An explanation of ineligible and/or limited medical expenses in
the section called “What is Not Covered.”
·
Definitions of key terms in the section called “Glossary.”
If you have been covered by the Fund for a while, you may be
accustomed to seeing some benefits described as covered by “Major Medical.” We
do not use that term now, but the Fund works pretty much the same way it always
has. Benefits provided through the Magnacare network are described as
“In-Network.” Other benefits are described as “Out-of-Network.”
The Fund covers a wide range of health care services, from
office visits, to lab tests and x-rays, to major surgery and hospital care.
Most eligible expenses are covered through either a Magnacare network provider
or an Out-of-Network provider.
The Magnacare network consists of doctors, hospitals and
other health care facilities selected by Magnacare to provide medical
services. When you use a Magnacare provider for your medical care, the care is
called “In-Network.” Here are some of the advantages of In-Network care:
·
an extensive network of medical care providers to choose from,
·
a co-payment for most covered charges and a 20% co-insurance, and
·
there are usually no claim forms to file.
Here is how to find a network participating doctor,
hospital, lab or other network facility near you.
·
Look at Magnacare’s online directory. To locate an
In-Network doctor, hospital or other provider in the Magnacare network, log on
to www.magnacare.com and browse the online provider directory.
·
Contact
the Fund Office. The Fund Office can also help you find an In-Network
provider.
| The Magnacare Network- While you have the option of going to an In-Network provider or an Out-of-Network provider for your medical care, you pay the least when you use In-Network providers. |
How Out-Of-Network Care Is Covered
You also have the option of going to an Out-of-Network
provider. When you see a provider that does not participate in Magnacare’s
network, the services are considered “Out-of-Network”. Here are key facts you
need to know if you choose to go Out-of-Network for your medical care:
·
You must meet a $500 annual deductible before being reimbursed
for any eligible expenses. (Note that there is a separate $100 deductible for
emergency room visits, as described in the Schedule of benefits.)
·
After you have met the annual deductible, expenses are only
reimbursed at 80% in accordance with of the “Magnacare Schedule”.
·
You are responsible for paying the balance, which is your
coinsurance.
·
You must file a claim form. In most cases, you have to pay the
provider when the service is rendered, then submit a claim for reimbursement to
Magnacare.
You must submit satisfactory proof of each charge for which
benefits are being claimed, and each charge used to satisfy the deductible. Be
sure to keep an accurate record of your medical expenses and retain all bills
and receipts.
YOUR BENEFITS AT A GLANCE
|
MEDICAL BENEFITS
|
|
Key Features and Benefits
|
In-Network
|
Out-of-Network
|
|
Annual Maximum Benefits (Fund Year-May 1st –
April 30th)
|
The Fund Will pay up to a maximum of $250,000 per
person per lifetime. There is a $5,000 annual reinstatement towards maximum.
|
|
|
|
Annual
Deductible (For all covered services except emergency care)
|
None
|
$500 per person
|
|
|
|
Physicians Services (Office Visits)
|
$20 co-pay, then 80% of Magnacare Schedule
|
80% of Magnacare Schedule
after deductible
|
|
|
|
Specialist Consultations
(Referral Required)
|
First visit, $30 copay, then
80% of Magnacare
Schedule
Subsequent visits, $20
copay, then 80% of
Magnacare Schedule
|
80% of
Magnacare Schedule after deductible
|
|
|
|
X-ray
|
$10 copay, then 80% of Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Lab Tests
|
$20 copay, then 100% of Magnacare Schedule
|
$20 copay, then 100% of Magnacare Schedule after
deductible
|
|
|
|
Well Baby/Well Child Care
|
$20 copay, then 80% of Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Annual Physical Exam
|
$20 copay, then 80% of Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Immunizations
|
$20 copay, then 80% of Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Podiatric Services
($1,000 annual maximum benefit, In-and Out-of-Network
combined)
|
$20 copay, then 80% of Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Key Features and Benefits
|
In-Network
|
Out-of-Network
|
|
Chiropractic Services
($1,000 annual maximum benefit, In- and Out-of-Network
combined)
|
$20 copay, then 80% of Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Outpatient Physical Therapy
($60 Visits each plan year)
|
$20 copay, then 80% of Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Outpatient Radiation Therapy
|
$20 copay, then 80% of Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Speech Therapy
|
$20 copay, then 80% of Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Inpatient Hospital
|
$500 deductible per admission. Up to 365 days semi-private
room.
|
$500 deductible per
admission. Up to 365 days
semi-private room.
|
|
|
|
Emergency Care
|
$100 deductible per visit, then 80% of Magnacare Schedule.
|
80% of Magnacare Schedule after $100 Deductible
|
|
|
|
Presurgical Testing
|
$0 copay, then 80% of
Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Outpatient Surgery
|
$0 copay, then 80% of
Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Dialysis
|
$0 copay, then 80% of
Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Anesthesia
|
$0 copay, then 80% of
Magnacare Schedule
|
80% of Magnacare Schedule after deductible
|
|
|
|
Mental Health
(30 days inpatient maximum per Fund year)
(50 days outpatient maximum per Fund year)
|
$500 deductible for inpatient admissions
50% copay for outpatient visits
|
$500 deductible for inpatient admissions
50% copay after deductible
|
|
|
|
Substance Abuse
(Lifetime maximum benefit of up to $10,000/person
and$15,000/family) [Contact the Fund Office to pre-certify]
|
$0 for inpatient admission. $0 copay for outpatient visits
|
Not covered
|
|
|
|
|
|
|
|
Key Features and Benefits
|
In-Network
|
Out-of-Network
|
|
Home Care
(Limited to 60 visits per Fund year)
|
80% of Magnacare
Schedule after $50
deductible. However, there is no deductible if care is
received within seven days of hospital discharge
|
80% of Magnacare Schedule after deductible, $500 annual
deductible
|
|
|
|
Hospice Care
(210 days per lifetime for “terminally ill” patients)
|
$500 deductible
|
100% of Magnacare
Schedule after deductible of $500.
|
|
|
|
Hearing Aid Benefit
(Maximum benefit of $500/ear for purchase and fitting –
available once every three years)
|
Full coverage
(up to maximum benefit)
|
Full coverage
(up to maximum benefit)
|
|
|
|
|
|
The “deductible” is an initial annual amount that you pay
for Out-of-Network and certain In-network services before the Fund pays any
benefits. You only have to pay the deductible once in each Fund Year except in
hospital stays are $500 for each admission. When you are treated by a
provider, you are responsible for the deductible and any amount of covered
expenses that exceed the Magnacare Schedule reimbursed allowance. Emergency
room visits are subject to a $100 deductible per visit.
When you are hospitalized, the Fund covers semiprivate room
and board after the $500 per admission deductible. (If you have a private
room, the Fund still pays no more than the semiprivate rate.) Also covered when
you are hospitalized are the types of services and supplies typically required
when you are hospitalized, including:
·
anesthesia supplies and use of anesthesia equipment
(administration only when given by a hospital employee, otherwise see the
section called “Anesthesia”),
·
bed and board including special diets,
·
dressings,
·
drugs and medicines for use in the hospital,
·
electrocardiographic equipment use,
·
general nurse care,
·
laboratory examinations consistent with the diagnosis and
treatment of the condition for which hospitalization is required (note that lab
interpretations may be billed independently and therefore may not be covered in
full),
·
operating room and recovery room use,
·
chemotherapy,
·
oxygen and equipment use for its administration,
·
physiotherapeutic equipment use,
·
plaster casts,
·
x-ray examinations consistent with the diagnosis and treatment of
the condition for which hospitalization is required (note that x-ray
interpretations are generally billed separately and are not covered under this
benefit).
If you are hospitalized for an illness that does not require
surgery or maternity care, you are eligible for hospital medical expense
benefits. Coverage applies to illnesses that include heart disease, pneumonia,
etc.
The in-hospital medical expense benefit does not cover
services performed in conjunction with functional nervous and mental disorders,
dental work or surgery covered by Workers’ Compensation. In addition, benefits
are not provided at a veteran’s facility for care in connection with a military
service related disability or at a hospital operated by a federal or state
agency (except for emergency care).
The Fund covers up to 365 days per hospital confinement. A
“confinement” is a period of hospitalization that is separated from the
previous and following confinement by at least 90 days.
The Fund covers up to two inpatient days for dental services
that require extractions. Hospitalization must be “medically necessary” and
pre-certified by the Fund Office.
In the event of an emergency, you should first consult with
your family physician. If this is not possible, locate a hospital nearby or go
to the nearest medical facility. The following emergency services are covered:
·
The Fund covers emergency first aid rendered within 24 hours
after accidental injury or 72 hours from the onset of illness.
·
For the use of operating room facilities at the hospital for a
surgical operation, the hospital must contact the Fund Office before treatment
begins. If the Fund office is closed you must contact the Fund office as soon
as possible after treatment has begun.
You are responsible for a $100 deductible for each emergency
room visit. After that, the Fund pays 80% of Magnacare allowance and you have
to pay the balance of the charges, regardless of whether you are at an
In-Network or Out-of-Network hospital.
The Fund’s coverage for an emergency room and minor surgery
includes:
·
closed reduction of fractured or dislocated bones,
·
endoscopies requiring the use of the hospital’s surgical
facilities, and
·
any incisions or punctures of the skin or other tissue except for
inoculation, vaccination, collection of blood, drug administration, or
injection.
The Fund provides coverage for surgery that is recommended,
approved and performed by a legally qualified physician or surgeon.
If two or more surgical procedures are performed
simultaneously during any one period, the most expensive is paid in full up to
the limits on the Schedule and charges for the second procedure are reimbursed
at half the allowance, but no more than two times the largest amount. The
surgical expense benefit for an assistant surgeon is equal to 25% of the
surgical expense benefit.
If two or more operations are performed through the same
abdominal incision, the total amount paid for all operations cannot be more
than the maximum amount specified on the Magnacare Schedule for the operation
for which the largest benefit is payable.
Benefits for sterilization procedures or for reversal of
such procedures are payable only once during an individual’s lifetime for
either or both procedures.
If the services are provided In-Network, then you pay the
20% co-insurance. If they are provided on an Out-of-Network basis, then you
pay the deductible and coinsurance and any amount for services that exceeds the
allowed reimbursement.
Under federal law, group health plans that provide medical
and surgical benefits in connection with a mastectomy must provide benefits for
certain reconstructive surgery. This includes coverage for the following:
·
reconstruction of the breast on which the mastectomy has been
performed,
·
surgery and reconstruction of the other breast to produce a
symmetrical appearance, and
·
prostheses and physical complications associated with all stages
of mastectomy, including lymphedemas, in a manner determined in consultation between
the attending physician and the patient.
This coverage is subject to the Fund’s standard rules and
regulations for payment of benefits.
The Fund covers anesthesia benefits if the anesthesia is
administered by a legally qualified physician or a legally qualified
anesthetist other than the operating surgeon or an employee of the hospital.
Services are paid at 80% of the Magnacare allowance. If
out-of-network, the annual deductible must first be satisfied.
The Fund also covers diagnostic tests prescribed by your
doctor performed in the same hospital as the surgery.
The Fund provides hospital maternity benefits for eligible
members and eligible dependents. Regular hospital benefits are paid for normal
delivery (including false labor) for at least two days and at least four days
for a caesarian. Newborn surgery care is covered to the same extent as the
mother. If a longer stay is required, authorization must be obtained from the
Fund Office/Pre-certification Department.
The Fund may not, under federal law, restrict benefits for
any hospital length of stay in connection with childbirth for the mother or the
newborn child to less than 48 hours following a vaginal delivery, or less than
96 hours following a Cesarean section. However, federal law generally does
not prohibit the mother’s or newborn’s attending provider, after consulting
with the mother, from discharging the mother or her newborn child earlier than
48 hours (or 96 hours, as applicable). In any case, the Fund may not, under
federal law, require that a provider obtain pre-authorization for prescribing a
length of stay not in excess of 48 hours (or 96 hours). If a longer stay is
required, authorization must be obtained from the Fund Office/Pre-certification
Department.
If you have family coverage, hospitalization benefits are
provided for newborn children from birth for the treatment of illness or
injury. This includes care for the following:
·
Premature infants weighing less than 4.4 pounds when care is
provided in an approved premature unit, for as long as care is needed;
·
All infants weighing between 4.4 to 5.5 pounds, from the time the
mother leaves the hospital; and
·
Premature infants in an approved premature unit because they need
incubator care, regardless of how much the infant weighs.
NOTE: There is no coverage for a newborn child
of a dependent child.
The Fund also covers semi-private accommodations for up to
two days for elective abortion. If tubal ligation is performed during the same
period of hospitalization, the Fund provides coverage for up to three days.
The Fund covers visits to these facilities the same as an
office visit.
The Fund covers visits to the offices of physicians and
specialists. Specialist consultations are covered only when referred by your
attending physician. If you go to an In-Network doctor, then you pay the
standard co-pay (usually $20, or $30 in the case of your first visit with a
specialist) and the 20% co-insurance. If you go to an Out-of-Network doctor,
then you pay the standard deductible and coinsurance.
If you have family coverage, the Fund covers 12 physician
visits during the first 12 months of a child’s life, including the hospital
visit upon birth. The Fund also covers three visits per calendar year for
children ages one to six.
Well-woman care includes pelvic exams and Pap smears for
female participants (age 18 or older), as well as annual mammograms when
recommended by your doctor.
The Fund covers one physical exam per plan year. Coverage
includes diagnosis and x-rays.
The Fund covers immunizations. The Fund also covers the
office visits for immunization if charged separately.
Durable medical equipment (“DME”) is covered in full when
obtained from a Magnacare preferred provider. Otherwise, DME is covered at the
standard Out-of-Network level of benefits.
The Fund provides coverage for outpatient chemotherapy,
including medications, when care is given at a participating facility. Do not
forget that if you go to an Out-of-Network provider, you will have to pay the
deductible and any applicable coinsurance, as well as any amount that exceeds
the Magnacare Schedule.
The Fund covers deep x-ray therapy and the physician's
component of the charges. Hospital charges for the use of the technical
component will be paid on the same basis as for therapy. If you go to an
Out-of-Network provider, you will have to meet the deductible and any
applicable coinsurance, as well as any amount that exceeds the Magnacare
Schedule.
The Fund covers dialysis benefits until you become eligible
for such coverage under Medicare. Coverage includes hemodialysis and
peritoneal dialysis during an inpatient hospitalization. Outpatient dialysis
is covered as follows:
·
At home coverage – All appropriate and necessary supplies
required for home dialysis treatment, as well as the rental of equipment.
·
Coverage in a hospital or freestanding facility –
Necessary treatment if the facility’s dialysis program is approved by the
appropriate governmental authorities.
If you go to an Out-of-Network provider, you will have to
pay the deductible and any applicable coinsurance, as well as any amount that
exceeds the Magnacare Schedule.
The Fund covers a maximum of 60 home care visits for the year
that runs from May 1 to April 30. Services must be rendered under a
physician-approved treatment plan through a New York State certified home
health agency. Home care benefits will be provided only if hospitalization or
confinement in a skilled nursing facility would otherwise have been required.
Covered services include the following:
·
part-time professional nursing,
·
part-time home health aide services (up to four hours of such
care is equal to one home care visit),
·
physical, occupational or speech therapy,
·
medical supplies, drugs and medicines prescribed by a physician,
and
·
necessary laboratory services.
The home care benefit also covers the following:
·
the services of a registered nurse or licensed practical nurse,
·
the services of a licensed state certified home health aide,
provided the individual does not live with you or is not a member of your
immediate family,
·
visits by hospice staff personnel who are full-time employees of
the hospice,
·
physical and respiratory therapy,
·
oxygen and equipment for its administration,
·
rental of wheel chairs and hospital type beds, and other medical
equipment for patient’s care, and
·
medicine and drugs.
When care is provided within seven days of hospital
discharge, coverage at 80% of Magnacare Schedule, will be provided. When care
is provided without prior hospitalization, you must pay a $50 deductible. Once
you have met the deductible, the Fund covers 80% of the Magnacare Schedule. If
you go to an Out-of-Network provider, you will have to pay the deductible and any
applicable coinsurance, as well as any amount that exceeds the Magnacare
Schedule.
The Fund covers up to 30 (thirty) days of skilled nursing
facility care, each Fund Year when a physician determines that the care is
"medically necessary.” The stay at the skilled nursing facility must be
immediately following a hospital confinement for a serious illness. Benefits
are payable only after the Fund Office receives a letter of medical necessity
from your physician.
In addition to the Fund’s general exclusions, the following
are not covered under the skilled nursing facility care benefit:
·
benefits for an employment-related illness or accident,
·
any service rendered by a person who is a member of the patient’s
family or who ordinarily lives with the patient, and
·
services for any illness that is not covered.
Full coverage is provided if you receive care at an
In-Network participating facility. If you go to an Out-of-Network provider,
you will have to pay the deductible and any applicable coinsurance, as well as
any amount that exceeds the Magnacare Schedule.
The Fund covers up to 210 days of hospice care less the $500
deductible for patients with a “terminal illness.” Benefits are payable only
after the Fund Office receives proof of your attending physician’s prognosis.
The following services and supplies are covered under the
hospice care benefit:
·
anesthesia supplies and use of anesthesia equipment
(administration of anesthesia only by a hospital employee; otherwise see
section on anesthesia),
·
bed and board including special diets,
·
dressings,
·
drugs and medicines for use in the hospice,
·
electrocardiographic equipment,
·
general nursing care,
·
laboratory examinations (note that lab interpretations may be
billed independently and therefore may not be covered in full),
·
operating room and recovery room use,
·
oxygen and equipment use for its administration,
·
physiotherapeutic equipment use,
·
plaster casts, and
·
x-ray examinations (note that x-ray interpretations may be billed
independently and therefore may not be covered in full).
Exclusions. In addition to the general exclusions,
the following are not covered under the hospice care benefit:
·
benefits for an employment-related illness or accident,
·
any service rendered by a person who is a member of the patient’s
family or who ordinarily lives with the patient, and
·
services for any illness that is not covered under this Fund.
Full coverage is provided after the $500 deductible if you
receive care at a participating facility. If you go to an Out-of-Network
provider, you will have to pay the deductible and any applicable coinsurance,
as well as any amount that exceeds the Magnacare Schedule.
What is a Hospice – A facility provides hospice care
if it operates as a unit or program that only admits terminally ill patients.
Such facility must be separate from any other facility. However, it may be
affiliated with a Hospital or Home Health Care Agency. The Hospice must be
approved by the Fund as meeting the legal requirements, if any, of the state,
province, locality or authority having jurisdiction over licensing and approval
of such institutions or facilities.
Terminally Ill Patients – are defined to mean those
patients with a life expectancy of six months or less, as diagnosed by a
physician.
The Fund covers medically necessary services provided by
registered and licensed practical nurses, for up to 60 outpatient visits and 30
inpatient days per Fund year. Coverage includes the services of certified home
health aides. Coverage is provided at 80% of the Magnacare Schedule for
in-network and 80% the Magnacare Schedule after satisfying the $500 annual
deductible for an out-of-network provider.
The Fund covers Private duty nursing by a registered
graduate nurse or a licensed practical nurse. Benefits are limited to 30
inpatient days and 60 home visits. Coverage is provided at 80% of the
Magnacare Schedule for in-network and 80% of the Magnacare Schedule after
satisfying the $500 annual deductible for an out-of-network provider.
The Fund covers chiropractic services on an In-Network and
Out-of-Network basis, up to a maximum benefit of $1,000 each Fund Year. If you
go to an In-Network provider, you pay the standard co-pay. If you go to an
Out-of-Network provider, you pay any amount that exceeds the Magnacare Schedule
plus any deductible and co-insurance.
The Fund covers injections to the joints, but not the cost
of drugs. Coverage does not include:
·
visits for injections of liver, iron and vitamin B-12 for
secondary anemia, and
·
hormone injections for menopause and for other non-specific
medications, such as penicillin and other antibiotics.
The Fund covers for medically necessary podiatric services,
including services for treatments arising from diabetics for up to $1,000 each
Fund Year, In-Network and Out-of-Network combined. Covered services include
treatment for corns, bunions, calluses, toenails, flat feet, fallen ankles,
weak feet, chronic foot strain or systematic foot problems. Office visits are
not covered on the same day as surgical procedures. If you go to an In-Network
provider, you pay the $20 copay and the 20% co-insurance. If you go to an
Out-of-Network provider, you pay any amount that exceeds the Magnacare Schedule
plus any deductible and co-insurance.
The Fund covers a maximum of 60 physical therapy visits each
Fund Year, per diagnosis, for In-Network and Out-of-Network services combined.
If you go to an In-Network provider, you pay the $20 co-pay and the 20%
co-insurance. If you go to an Out-of-Network provider, you pay any amount that
exceeds the Magnacare Schedule plus any deductible and co-insurance.
The Fund covers treatment by a speech therapist when
requested by a legally qualified physician to restore loss of speech or to
correct impairment due to a congenital defect for which corrective surgery has
been performed, or for an accident or sickness (except for a functional nervous
disorder). Speech Therapy is covered on an In-Network and Out-of-Network
basis. If you go to an In-Network provider, you pay the standard co-pays and
the co-insurance. If you go to an Out-of-Network provider, you pay any amount
that exceeds the Magnacare Schedule plus annual any deductible and 20%
co-insurance.
The Fund covers hearing evaluations by an audiologist and
hearing aids prescribed by legally qualified physicians. The Fund covers a
maximum of $500 per ear every three years for the purchase and fitting of a
hearing aid. Repair and maintenance are not covered.
The Fund covers both inpatient and outpatient services.
Benefits are provided for the administration of convulsive therapy, whether
administered on an inpatient or outpatient basis. Hospitalization benefits are
available only in general hospitals and in psychiatric hospitals when shock
therapy is administered. Hospitalization benefits are not provided at a
veteran’s facility for care in connection with a service-related disability or
a hospital operated by a federal or state agency (except for emergency care).
The Fund covers 30 inpatient days subject to the $500 deductible per hospital
stay and 50 outpatient visits per 52-week period running from May 1st
to April 30th.
The Fund provides benefits for the treatment of alcohol and
drug addiction on an In-Network basis only. You must contact the Fund Office
before receiving benefits. The Fund Office will make arrangements with
professionals in the field for an evaluation of the problem. The professional
evaluation will determine whether you require inpatient or outpatient
treatment. You will then be directed by the Fund Office to an appropriate
facility for treatment. Note that there is a lifetime maximum benefit of
$10,000 for individuals and $15,000 for families (if you have family coverage).
The following benefits are also available under the Fund
subject to the 20% co-insurance if in-network or the $500 annual deductible and
the 80% of Magnacare Schedule for out-of-network:
·
Blood and blood plasmas, artificial limbs and eyes, surgical
dressings, casts, splints, trusses, braces, crutches, wheelchair rental,
hospital bed or iron lung, oxygen and rental of equipment for its
administration.
·
Orthoptic training under the supervision of an optometrist.
·
Non-surgical services, equipment and supplies provided for TMJ.
·
Radium treatments and treatments with other radioactive
substances.
·
Licensed health aid from the state where service is provided.
There are two ways that the Fund helps you manage your
medical care: through “Preadmission Certification” and “Case Management.” Both
programs are handled by Magnacare.
For an operating room facility other than a Hospital,
expenses are limited to $3,000, which includes the use of the equipment.
All non-emergency hospital stays must be approved under
Magnacare’s Preadmission Certification Program before you are admitted.
To do this, you, a family member or your doctor should call Magnacare at
516-282-8000. In addition to approving the admission itself, Magnacare will
determine the appropriate length of your hospital stay. Should your doctor
want you to stay longer than the number of days that have been approved, your
additional days in the hospital must be approved by Magnacare.
Case Management is designed to assist individuals who need
special or extended care for serious illness or injuries. Its primary goal is
to ensure that the patient receives appropriate care in the most effective
setting (at home, in a hospital or in a specialized facility, for example).
Your Magnacare Case Manager, whose role is advisory, will help you arrange for
treatment and work with you, your family and your doctor to coordinate the
treatment program, arrange for necessary resources and provide ongoing support
for the family in times of medical crisis.
Case Management is voluntary, and offered at no cost to
you. However, when certain types of specialized care are recommended (home
health care, hospice care or a stay in a skilled nursing facility, for example),
you are encouraged to request Case Management, which you can do by calling
Magnacare member services at 516-282-8000. (A family member or attending
physician can also make the call.)
|
Cancer
|
AIDs
|
|
Multiple Sclerosis
|
Kidney failure
|
|
Obstructive pulmonary disease
|
Heart conditions
|
|
Long-term rehabilitation therapy following an accident
|
Newborn with high-risk complications or multiple birth
defects
|
|
Alzheimer’s disease
|
Child and adolescent mental and nervous disorders
|
|
Diagnosis involving long-term IV therapy
|
|
What Is Not Covered Under Hospitalization And Medical
The following expenses are not covered by the Fund:
·
any services that are not medically necessary, not necessary for
treatment of the injury or disease or are not recommended and approved by the
attending physician;
·
hospital confinements for custodial or convalescent care, rest
cures, or long-term care;
·
hospital confinements or any period of hospital confinement
primarily for diagnostic studies;
·
hospitalization furnished pursuant to federal, state, or other
laws (except Medicaid);
·
care which is provided for under any law of a government;
·
care rendered in a hospital operated by federal or state
government, municipality or agency;
·
ambulance or ambulette service (except as provided under the
section called “Home Care”);
·
hospital benefits for services of physicians or private or
special nurses, or other private attendants or their board;
·
expenses covered by or which could be covered by motor vehicle
insurance. This would include insurance for motorcycles and, motorbikes.
·
technology treatments and any hospitalization in connection with
such technology including surgery, treatments, procedures, drugs, biologicals
or medical devices which, in the sole discretion of the Fund, are either
experimental, investigational, obsolete or ineffective (see the section called
“Glossary” for definitions of these terms);
·
admissions primarily for physical therapy;
·
veteran’s facilities for care in connection with a military
service related disability or a hospital operated by a federal or state agency
(except for emergency care);
·
medical and hospital services, supplies and equipment which are
paid or provided for because or your (or any person’s) past or present service
in the armed forces of any government or are paid or provided for under any law
of a government;
·
medical and hospital services and supplies rendered in connection
with accidents, illnesses or injuries covered by, or required to be covered by,
Workers’ Compensation insurance;
·
expenses for eye refractions or fitting of glasses (except
coverage provided through Fund’s Vision Care benefits);
·
cosmetic surgery except to correct defects caused by traumatic
injury or disease that occurs while covered, such as breast surgery after a
mastectomy or lumpectomy;
·
charges for dental care, dental treatment or, drugs, except if
hospitalization is required.
·
Charges for services or supplies which are furnished, paid for or
otherwise provided because of your past or present service in the armed forces
of any government;
·
charges that would not have been made if no coverage existed;
·
charges that you are not required to pay;
·
charges that are unreasonable;
·
X-ray and laboratory expenses in connection with dental work
exams performed at a veteran’s facility in connection with a military service
related disability or at a hospital operated by a federal or state agency;
·
hospitalization which began before the effective date of coverage
or after the end of coverage;
·
charges for a private room in excess of semi-private rates;
·
charges that have been paid for by another insurance carrier (see
the section called “Coordination of Benefits”);
·
confinement provided at a veteran’s facility for care in
connection with a military service related disability;
·
expenses resulting from an act of war occurring while covered;
·
admissions or continuing hospitalizations primarily for any one
of the following: diagnosis, physical therapy, X-ray therapy, radium therapy,
transfusions for blood or blood plasma, custodial care, convalescent care, or
rest cure;
·
when hospitalized, the services of physicians, private nurses or
special nurses who are on the hospital staff;
·
nursing care rendered by you or your spouse, or a child, brother,
sister or parent of you or your spouse;
·
personal services such as haircuts, shampoos and sets, guest
meals and radio/television rentals received in any in-patient or out-patient
facility;
·
personal convenience items such as air conditioners, humidifiers,
physical fitness equipment or other such devices which are useful in the
absence of illness or injury;
·
services, supplies and equipment provided in connection with
elective sterilization, except for elective sterilization as covered by the
Plan;
·
services involving equipment or facilities used when the rental
or construction has not been approved in compliance with applicable state laws
or regulations;
·
travel or transportation whether or not recommended by a
physician;
·
care in a nursing home or home for the aged;
·
custodial care such as sitters, homemaker’s services or care in a
place that serves you primarily as a residence;
·
services, supplies and equipment provided to the donor of an
organ for transplant, unless both the donor and the recipient are eligible
participants and members of the same immediate family;
·
services, supplies and equipment provided in connection with the
testing or treatment of infertility, including but not limited to in vitro
fertilization or genetic testing or counseling;
·
services, supplies and equipment provided in connection with a
sex change operation;
·
treatment considered experimental or investigative in terms of
generally accepted medical standards;
·
a condition resulting from the illegal act of the individual with
the condition;
·
test to determine a donor match;
·
services and supplies which are not necessary for or consistent
with the diagnosis and treatment of the accident, illness or injury or which
are not recommended and approved by a legally qualified physician operating
within the scope of his or her specialty;
·
self-inflicted injury;
·
committing an unlawful act, or seeking to avoid lawful
apprehension or arrest by a law enforcement officer;
·
accidents caused by the operation of a manual or motor vehicle
while under the influence of either intoxicating substances or general mind
altering substances, regardless of the natural or artificial content of the
substance or whether the substance is legal or otherwise;
·
accidents caused by operating a motor vehicle in a race or speed
test;
·
accidents caused by operation or occupying a motor vehicle known
to be stolen;
·
care rendered in a hospital operated by federal or state
government, municipality or agency;
·
ambulance or ambulette service (except as provided under the
section called “Home Care”);
·
hospital benefits are not provided for services of physicians or
private or special nurses, or other private attendant or their board;
·
any loss, or portion thereof, resulting from a motor vehicle
accident or which is covered by, or which could be covered by motor vehicle
insurance;
·
technology treatments, procedures, surgeries, drugs, biologicals
or medical devices which, in the sole discretion of the Fund, are either
experimental, investigational, obsolete, and/or ineffective (see the section
called “Glossary” for definitions of these terms);
·
admissions primarily for physical therapy;
·
Note: Motor vehicle is to include motorcycle, motorbike, etc.
Experimental or Investigational. A process,
treatment, device or surgery is experimental if it is not:
·
of proven medical efficacy for the particular diagnosis or
treatment of the covered person’s condition, and
·
generally recognized by the medical community, as reflected in
the published peer-reviewed medical literature as effective or appropriate for
the particular diagnosis or treatment of the covered person’s particular
condition.
Government approval of a technology is not necessarily
sufficient to render it of proven benefit or appropriate or effective for a
particular diagnosis or treatment of a covered person’s particular condition.
The Fund may apply any or all of the following criteria at
its discretion in determining whether a technology is experimental or
investigational, obsolete or ineffective:
·
Any medical device, drug or biological product must have received
final approval to market by the U.S. Food and Drug Administration (FDA) for
the particular diagnosis or condition. Once FDA approval has been granted for
a particular diagnosis or condition, use of the medical device, drug, or
biological product for another diagnosis or condition may require that any or
all of these five criteria be met.
·
Conclusive evidence from the published peer-reviewed medical
literature must exist that over time the technology leads to improvement in
health outcomes, i.e., the beneficial effects outweigh any harmful effects.
·
Proof as reflected in the published peer-reviewed medical
literature must exist that the technology is at least effective in improving
health outcomes as established technology, or is usable in appropriate clinical
contexts in which established technology is not employable.
The Fund provides coverage through Express Scripts for
prescription drugs purchased at a participating pharmacy or through the Express
Scripts mail-order program. Coverage depends on which option you use. The
following table summarizes these benefits. There is a $15,000 maximum per Fund
year per participant for prescription drugs ($10,000 for the period September
1, 2007 to April 30, 2008). This $15,000 maximum is for both retail and
mail-order combined.
|
Prescriptions From A Participating Pharmacy (up to
30-day supply) |
What You Pay |
|
Generic drugs |
$25 co-pay |
|
Brand name drugs when no generic equivalents are available |
$25 co-pay |
|
Brand name drugs when generic equivalents are available |
$25 co-pay, plus cost difference between brand name and
generic |
|
Injectable medications |
$30 co-pay |
|
Prescriptions Through The Mail-Order Program (up to
90-day supply) |
What You Pay |
|
Generic drugs |
$35 co-pay |
|
Brand name drugs when no generic equivalents are available |
$35 co-pay |
|
Brand name drugs when generic equivalents are available |
$35 co-pay, plus cost difference between brand name and
generic |
|
Injectable medications |
$50 co-pay |
Covered drugs include all federal or state legend drugs as
well as insulin. Insulin syringes, lancets, and test strips are covered only
through mail order. There are quantity limitations on certain drugs for the
treatment of impotence, migraine headaches, asthma, and allergies as indicated
by the manufacturer.
The Fund has a mandatory generic policy, which means that if
you request a brand name drug when a generic equivalent is available, you will
be responsible for the price difference between the brand and generic, plus the
applicable co-payment.
The mail-order option must be used for drugs that you take
on a regular or long-term basis (called “maintenance medications”). You are
allowed to fill your initial prescription and to obtain one additional refill
at a retail pharmacy. After these two initial fillings, you must use the
mail-order pharmacy to fill your prescription.
| If you lose your Express Scripts ID card, you should call the Fund office at (718) 859-1624, (718) 842-1212 or (732) 882-1901 for a replacement card |
Mail Order
Refills- Prescription drug refills are not sent
automatically. You must complete the refill form included with each shipment
from Express Scripts and send it with your check or credit card number in the
mailer provided. You may also call in your refill request by calling
800-451-6245 or by visiting the web site at
WWW.EXPRESS-SCRIPTS.COM.
Your order will be held up if your balance due exceeds $50. You should allow
two weeks delivery time.
The following items are not covered by the Fund:
·
vitamins,
·
smoking cessation products,
·
dental treatments,
·
diet pills,
·
fertility treatments,
·
medications used for cosmetic purposes,
·
over-the counter items such as cold remedies and wound dressings.
·
Medications or drugs that are not medically necessary,
·
Medications or drugs that are covered by, or required to be
covered by, Workers Compensation Insurance
·
Medications or drugs that are covered by, or required to be
covered by, automobile insurance
Your prescription drug coverage is also subject to the following
limitations:
·
Oral and injectable contraceptives are covered only for
non-contraceptive purposes. You must submit a letter of medical necessity to
the Fund Office to request authorization for these drugs.
·
Vaccines, growth hormones, and some cancer treatments also
require a letter of medical necessity.
The Trustees of the United Teamster Fund are continuously
searching for ways to improve the health and welfare of you and your family.
As a result of this effort, a new pain free device for diabetes has been
brought to our attention.
One of the prominent providers in the industry is Pharmacy
Distributor Services who will provide our members with their family members if
covered, who have diabetes with Freestyle meter, strips and lancets at NO
COST TO YOU. The Freestyle monitor allows diabetics to test their
blood sugar from their forearm or other body sites without the pain associated
with the traditional finger stick test. The meter is rated the most accurate
for home testing and is quick and easy to use.
Pharmacy Distributor Services will provide the meter strips
and lancets to you at NO COST AND WILL WAIVE THE CO-PAY if you
use their services. It is important that diabetics control their blood sugar
to live a healthy life and that is why the Trustees feel this benefit is
important to you.
Pharmacy Distributor Services will provide diabetic supplies
to your home by mail at no cost. They can be reached during the hours of 9:00
a.m. to 5:00 p.m. Monday through Friday at (800) 440-2417.
The company has also assured us that they will answer all
questions in a courteous and prompt manner and will assist in any way possible.
The Pharmacy Distributor Service does not provide insulin.
Insulin should be obtained from the mail order pharmacy program.
For information on filing prescription drug claims, see the
section called “Claims and Appeals Procedures.”
The vision benefits described in this section are provided
through the Fund Office. You and if applicable, your eligible dependents, are
eligible to receive the allowance for vision benefits as described below for an
eye examination and one pair of eyeglasses once every consecutive twelve months
counting from the last time you received the vision benefits.
Note: if you utilize one of the vision care providers
on the Fund's panel, you will receive considerable savings as compared to using
a provider outside of the panel. You may obtain a list of providers on the
Fund's panel from the Fund Office.
You can use any provider of your choosing. First call the
Fund Office for an optical voucher. You will be required to pay the full cost
of services and supplies up front, and the Fund will reimburse you once every
consecutive twelve month period starting from the date that you last received
the benefit for vision care services, up to the following amounts:
·
$15 for eye exams
·
$65 for prescription eyeglasses (lenses and frames) or
up to $100 for prescription contact lenses.
You will only be reimbursed up to the amounts listed above.
If your exam, glasses or contacts cost more than the amount listed above, you
will be responsible for that additional amount.
Keep in mind that medical treatment of the eyes and surgery
performed on the eyes may be covered by your medical and/or surgery benefits.
See the section called “Hospital and Medical Benefits” for more information.
The Fund does not provide coverage for the following:
·
sunglasses (plain or prescription)
·
any benefits covered, or required to be covered by, or which
could be covered Workers’ Compensation insurance
·
benefits payable through “no-fault” insurance law or an uninsured
motorist law or other automobile insurance for such expenses; and
·
services or benefits received from federal, state or municipal
agencies or the Veteran’s administration
To get reimbursed for services, call the Fund Office for an
optical voucher. Submit the completed voucher with the itemized receipt or
bill for the vision service attached and sent it to the Fund Office. For more
information on claiming benefits, see the section called “Claims and Appeals
Procedures.”
The Fund pays a $10,000 lump sum to your named beneficiary
if you die while covered by the Fund. This insurance is provided through the
Fund Office.
|
Covered Loss
|
Benefit
|
|
Life
|
$10,000
|
To designate or change your beneficiary for your life
insurance benefit, you must complete a Designation of Beneficiary Card, which
is available at the Fund Office.
If you do not name a beneficiary, or if the person you name
dies before you, the benefit will be paid to the following surviving
individual(s) in this order:
·
your spouse,
·
your children (in equal shares),
·
your parents (in equal shares), or
·
your sisters and brothers (in equal shares).
If you do not designate a beneficiary and the person(s)
listed above are not living at the time of your death, benefits will be paid to
the estate.
If one of your covered dependents dies while covered by the
Fund, you will receive a $5,000 life insurance benefit.
The following exclusions and limitations apply to the life
insurance benefit.
·
In the untimely event of your death, your beneficiary will
receive a lump sum under the life insurance benefit, but not an
accidental death benefit.
·
No benefits will be payable if death occurs as a result of
participation in automobile races, or riding in a stolen vehicle.
·
No benefits will be payable if death occurs as a result of your
intentional violent and/or criminal act or suicide.
·
No benefits will be payable if death occurs as a result of the
operation a motor vehicle while intoxicated or while the ability to operate
such vehicle is impaired by use of a drug, whether legal or otherwise.
·
No benefits will be payable if death occurs as a result of the
commission of an act that constitutes a felony, or the avoidance lawful
apprehension or arrest by a law enforcement officer.
·
No benefits will be payable if death occurs as a result of the
operation or occupation of a motor vehicle known to be stolen.
·
No benefits will be payable if death occurs as a result of the
operation a private passenger vehicle as a public or livery conveyance.
For information on filing a life insurance, see the section
called “Claims and Appeals Procedures.”
The Fund does not provide coverage for all types of
health-related expenses. In addition to any exclusions already mentioned in
the various sections, no benefits are payable for the following:
·
charges that have been paid for by another insurance carrier (see
Coordination of Benefits Section);
·
charges that would not have been made if coverage did not exist
or for charges that neither you nor any of your dependents are required to pay;
·
charges for services, treatment or supplies that are received
from a dental or medical department sponsored by or for an employer, mutual
benefit association, labor union, trustee or any similar person or group;
·
charges for services or treatments to the extent the Fund is
prohibited by law or regulation from providing such benefits;
·
cosmetic services or supplies, except to correct defects caused
by traumatic injury or disease that occurred while covered;
·
expenses for eye refractions or fitting of glasses, except as
provided for under the section called “Vision Benefits”;
·
expenses resulting from an act of war occurring while covered;
·
when hospitalized, the services of physicians, private nurses or
special nurses who are on the hospital staff;
·
charges for telephone consultations, missed appointments or fees
sometimes added for filling out a claim form;
·
drugs or vitamins which do not require a prescription order even
if a prescription order has been written;
·
services, supplies and equipment rendered in connection with
functional nervous and mental disorders, dental work, accidents, illnesses or
injuries covered by, or required to be covered by, Workers’ Compensation
insurance;
·
services, supplies and equipment rendered in connection with
functional nervous and mental disorders, dental work, accidents, illnesses or
injuries resulting from an accident involving motor vehicles or covered by, or
which could be covered by, no-fault auto insurance, uninsured motorist
insurance or any other type of automobile insurance;
·
services, supplies and equipment which are not necessary for or
consistent with the diagnosis and treatment of the accident, illness or injury
or which are not recommended and approved by a legally qualified physician
operating within the scope of his or her specialty;
·
charges that result from committing a felony or seeking to avoid
lawful apprehension or arrest by a law enforcement officer;
·
charges that result from operating a motor vehicle in a race or
speed test or operating/occupying a stolen motor vehicle.
The Fund has a coordination of benefits (COB) provision.
This provision ensures that if you or a covered dependent is covered by another
group medical plan, there will be a coordination of benefits for reimbursement.
For purposes of this Fund, “group medical plan” means:
·
a group or blanket insurance company, or
·
a group hospital or medical service plan or other group medical
payment coverage program.
If you or members of your family are covered by another
group medical plan, the programs will coordinate their benefit payments so that
payments from the two plans combined will pay up to the amount of covered
expenses, but not more than the amount of actual expenses.
When you are covered under two funds, one fund has primary
responsibility to pay benefits and the other has secondary responsibility. The
fund with primary responsibility pays benefits first. In order to determine
whether or not this Fund is the first payor fund, original bills for medical
expenses must be submitted with your claim.
The order of payment is determined as follows:
·
a fund without a coordination provision always pays first.
·
if both funds have a coordination provision, the fund covering
you as an employee pays your expenses first.
·
if your spouse is covered under a separate fund, his or her fund
should cover your spouse first.
·
if you and your spouse are both covered employees in this Fund,
you will receive payment first as an employee and second as a dependent.
·
if you are covered by more than one fund, other than an
individual fund, the fund which covered you the longest pays first.
·
if your dependent children are covered under the funds of both
parents, the fund that covers the parent whose birthday falls earliest in the
year pays first (regardless of age). If both parents have the same birthday,
the fund which has covered the parent for a longer period of time pays first.
If you are separated or divorced, there are special rules
regarding coverage for your eligible, dependent children unless otherwise
directed by court order. If a court order establishes responsibility for the
health care expenses of your children, benefits are paid according to that
court order. If there is no court order, benefits are paid as follows:
·
If the parents are not remarried:
* The fund
covering the parent with custody pays first;
* The fund of
the other parent pays second.
·
If the parents are remarried:
* The fund
covering the parent with custody pays first;
* The fund
covering the stepparent with custody pays second;
* The fund
covering the parent without custody pays last;
When this fund pays second, a statement from the other
insurance carrier indicating the benefits paid must be submitted with your
claim for Fund benefits.
There is no COB provision for prescription drugs. This fund
will make no secondary payments for prescription drug claims.
The medical care benefits are provided under this Fund for
injuries resulting from a motor vehicle accident. Such benefits are subject to
a $25,000 deductible when:
·
the owner/operator of the motor vehicle and the claimant are the
same person;
·
the owner/operator of the motor vehicle did not have motor
vehicle insurance for the applicable motor vehicle on the date injuries were
sustained, regardless of whether maintaining motor vehicle insurance is
required by state or federal; and
·
medical care coverage would have been available under a motor
vehicle insurance contract if the claimant had maintained motor vehicle
insurance such as "No-Fault" insurance in the State of New York or
the Personal Injury Protection or Compulsory Medical Payments provisions of a
New Jersey motor vehicle insurance contract or under similar provisions of a
motor vehicle insurance contract required by any other federal or state
no-fault motor vehicle insurance law.
·
any deductible applicable to a motor vehicle insurance contract
providing for hospital or medical expenses as a result of a motor vehicle
accident is counted toward meeting the $25,000 deductible under this Fund.
·
In addition, effective July 1, 2008, no coverage is provided for
the injuries to the driver or operator of a motor vehicle whose injuries arise
from operating such motor vehicle and the vehicle is not covered by any motor
vehicle insurance or the motor vehicle insurance provides no coverage for the
operator’s medical care.
No benefits are available to you or your eligible
dependents, whether the claimant maintains Automobile Insurance or not if the
claimant:
·
intentionally causes own injury;
·
is injured as a result of operating a motor vehicle while in an
intoxicated condition or while the ability to operate such vehicle is impaired
by use of a drug;
·
is committing an act that would constitute a felony, or seeking
to avoid lawful apprehension or arrest by a law enforcement officer;
·
is operating a motor vehicle in a race or speed test; or
·
is operating or occupying a motor vehicle known to be stolen; or.
·
is operating a private passenger vehicle as a public or livery
conveyance.
If you or a dependent receive any benefits from the Fund for
which you are not entitled, you will be legally liable to reimburse the Fund
for any payments you receive. The Fund reserves the right to collect this
reimbursement by denying payment of future claims until an amount equal to the
improper payment is recovered. The Trustees may also file a criminal complaint
with respect to any fraud or misrepresentation resulting in the improper claim
and payment by the United Teamster Fund.
If you or your dependent have the opportunity to recover
monies in connection with an illness, injury, accident, occurrence, condition
or other loss for which the Fund has paid, or will pay, medical expenses, the
Fund must be reimbursed from any such monies to the full extent of benefits
paid by the Fund. Further, the Fund has a lien against any monies recovered,
and the Fund is subrogated to any such claim. A “claim against any third
party” means a claim of any type whatsoever, whether the claims exists or may
exist, or the monies are or may be recovered, from a third party through a
claim, lawsuit, settlement, insurance policy or pool, uninsured or underinsured
motorist or other policy or pool, governmental or private right of recovery,
workers compensation or disability award or order, judgment, no-fault program,
or personal injury protection, financial responsibility, medical benefit
reimbursement insurance coverage not purchased by you, by compromise, or in any
other way from any third party, person, agency, organization or fund of money,
to the extent necessary, the Fund has an equitable lien.
The Fund is entitled to its full lien/and or its full
recovery of the total amount of benefits which are payable, regardless of the
amount of monies paid or awarded to you by the third party, even if those monies
are less than the full amount which you do seek or could seek against the third
party, regardless of whether the monies are or are described as for medical
expenses, and regardless of how they are described or what they are for, and
regardless of whether full compensation from the third party is obtained or
available. No reduction in the Fund’s full right to recover the total amount
of Fund benefits payable is effective without the Fund’s written consent. The
Fund retains the sole and final discretion to decide whether and in what case
such consent will be granted, if requested.
This provision applies to any type of payment, which in any
way arises from or in connection with the illness, injury, accident,
occurrence, loss or condition, whether or not the payor caused or is legally
responsible or liable for it. It is applicable regardless of whether such
liability or responsibility is or is not denied or is in dispute.
The Fund has sole and final discretion to determine whether
to assert its rights under this provision as a lien, through subrogation, or
through reimbursement, to advance payments of benefits and require repayment,
or through any combination or variation of these methods. The determination of
which method(s) will be used in a particular case will be made to protect the
interests of the Fund and its participants, and is at the Fund’s sole and final
discretion.
If any claim exists or may exist by you or your dependent
against any third party, you must notify the Fund within thirty (30) days of
the date such claim becomes apparent in writing, stating the name, address,
telephone number of the attorney, representative or other agent handling the
claim on behalf of you or your dependent. You must also notify the third party
and its counsel or representative in writing of the Fund’s lien within thirty
(30) days of the date you assert your claim against the third party.
You, your dependent, and any attorney, representative or
agent who is representing you in connection with any claim against any third
party, are required to sign and have notarized a written statement provided by
the Fund saying that they acknowledge, agree to and will adhere to the Fund’s
lien, right of subrogation and/or reimbursement and this provision of the
fund. The existing form which the Fund requires you and any such attorney to
complete includes this entire provision as set forth herein. The Fund may
modify this form at any time without further notice, in its sole and exclusive
discretion, and will provide you with a copy of any new or revised form to be
executed and returned to the Fund within ten (10) days of notification. The
Fund also may, in its sole and final discretion, require you, your dependent
and/or any such attorney, representative or agent to execute such other
documents the Fund deems necessary, helpful or appropriate to protect the
Fund’s rights under this provision. You may also be required to permit the
Fund to intervene in any proceeding, and you may be required to file a lien or
Consent to Lien, assignment or other such forms, to protect the Fund’s
interests.
The Fund may withhold or suspend payment of any or all
benefits in case a claim against any third party exists, pending reimbursement,
pending guaranteed recognition of the Fund’s reimbursement, or pending court
order, as the Fund may decide, in its sole and final discretion. If you, your
dependent, attorney, representative or agent fail or refuse to cooperate with
this provision and with the Fund’s right by disputing the Fund’s lien, failing
to advise the Fund of the status of the claim against the third party,
withholding necessary information, not executing the consent to lien form
described above, or in any other way the Fund will withhold, suspend and
exclude payment of any benefits which would otherwise be payable under the
Fund. This is a specific exclusion and limitation of the Fund, and is in
addition to any other legal rights, which the Fund may have, or any other
action the Fund may take to protect its rights.
You, your dependent, your attorney, or representative or
agent must advise the Fund as to the status of any claim against any third
party, including providing the Fund with information as to the third party,
insurers, lawsuits or any other data related to the claim or to the initiation
of the claim, every twelve (12) months thereafter, whenever a settlement is
proposed, and whenever requested by the Fund.
No claim against any third party may be settled or resolved,
and no payment may be accepted from any third party, without written consent
from the Fund. Unless and until the Fund has received full reimbursement, no
monies from or through a third party may be distributed to you, your dependent,
your attorney, representative or agent without the Fund’s written consent if
any monies are distributed to you or your attorney, they are to be held in
constructive trust, and these monies are, to the extent of benefits payable or
paid by the Fund, assets of this Fund and debt owed to the Fund, and will
promptly be repaid to the Fund. The Fund’s decision on whether to grant, or
withhold, its consent is a final and binding decision, made in the sole
discretion of the Fund’s Trustees.
The Fund may, by written notice given to you, require that
all other persons comply with this provision as well in order to secure the
Fund’s rights in the exercise of its sole and final discretion.
Full cooperation with this provision is a condition to
payment of any benefits under this Fund. In case of any failure of cooperation
or violation of this provision no benefits will be paid and, you, your
dependent, your attorney, your representative or your agent will be liable to
the Fund for full reimbursement of its lien, including costs, interest and
fees.
This provision covers not only you as participant, but your
dependents, spouses, attorney, representatives, agents and their heirs,
guardians, executors, successors and assignees.
No other liens may be superior to the Fund’s lien or rights
under this provision. The Fund may in its discretion and in an appropriate
case, agree to a reduction of its lien for the payment of a portion of
attorneys’ fees and costs of a legal proceeding, if all terms of this provision
have been and are being observed.
Any disputes arising under or in connection with this section,
including disputes over liens, their amount, reimbursement or withholding of
benefits, or reductions or compromises in the Fund’s lien shall, if not
resolved with the Fund Office, be settled in accordance with the procedure for
Claims and Appeals in this booklet, including review by the Board of Trustees.
This section describes the procedures for filing claims for
benefits from the United Teamster Fund. It also describes the procedure for
you to follow if your claim is denied in whole or in part and you wish to
appeal the decision.
A claim for benefits is a request for benefits made in
accordance with reasonable claims procedures. In order to file a claim for
benefits, you must submit a completed claim form. Simple inquiries about the
Fund’s provisions that are unrelated to any specific benefit claim and will not
be treated as a claim for benefits. In addition, a request for prior approval
of a benefit that does not require prior approval by the fund is not a claim
for benefits.
A claim form may be obtained from the Fund Office by calling
(718) 859-1624, (718) 842-1212 or (732) 882-1901. Benefits obtained from
providers who belong to the Magnacare network, do not require the submission of
a claim form. The provider will complete the paperwork for you.
The following information must be completed in order for
your request for benefits to be a claim.
·
Participant name
·
Patient name
·
Patient Date of Birth
·
SSN of participant
·
If treatment is due to accident, accident details
The following information will be provided by your doctor or
dentists:
·
Date of Service
·
CPT-4 (the code for physician services and other health care
services found in the Current Procedural Terminology, Fourth Edition, as
maintained and distributed by the American Medical Association)
·
ICD-9 (the diagnosis code found in the International
Classification of Diseases, 9th Edition, Clinical Modification as
maintained and distributed by the U.S. Department of Health and Human
Services)
·
Billed charge
·
Number of Units (for anesthesia and certain other claims).
Federal taxpayer identification number (TIN) of the provider.
·
Billing name and address
When you present a prescription to a pharmacy to be filled
out under the terms of this Fund, or a voucher to an optical provider, that
request is not a “claim” under these procedures. However, if your request for
prescription or optical services is denied, in whole or in part, you may file a
claim and appeal regarding the denial by using these procedures.
Claims must be filed within 90 days following the date the
charges were incurred. If it was not reasonably possible to file the claim
within such time, failure to file claims within the time required shall not
invalidate or reduce any claim. However, in that case, the claim must be
submitted as soon as reasonably possible and in no event later than one year
from the date the charges were incurred.
Services obtained from providers who belong to the Magnacare
network do not require the submission of a claim form. The provider will
complete the paperwork for you. Your claim will be considered to have been
filed as soon as it is received at the appropriate Health Organization.
An authorized representative, such as your legal spouse, may
complete the claim form for you if you are unable to complete the form yourself
and have previously designated the individual to act on your behalf. A form
can be obtained from the Fund Office to designate an authorized
representative. The Fund may request additional information to verify that
this person is authorized to act on your behalf. A health care professional
with knowledge of your medical condition may act as an authorized representative.
The claims procedures for comprehensive medical benefits
will vary depending on whether your claim is for a Pre-Service Claim, an
Urgent Care Claim, a Concurrent Care Claim, or a Post-Service
Claim. The procedures will also vary for Life Insurance Claims,
Dependent Life Insurance Claims and Accidental Death and Dismemberment Claims.
Read each section carefully to determine which procedure is applicable to your
request for benefits.
A Pre-Service Claim is a claim for a benefit for
which the Fund requires approval of the benefit (in whole or in part) before
medical care is obtained. Prior approval of services is required for:
·
treatment of alcohol and drug addiction;
·
the use of operating room facilities at a hospital for a surgical
procedure in the case of an emergency. (The hospital must contact the Fund
Office prior to such treatment);
·
durable medical equipment;
·
certain prescribed medications.
If you improperly file a Pre-Service Claim, the
appropriate health organization will notify you as soon as possible but not
later than 5 days after receipt of the claim, of the proper procedures to be
followed in filing a claim. You will only receive notice of an improperly
filed Pre-service claim if the claim includes:
·
your name;
·
your specific medical condition or symptom; and
·
a specific treatment, service or product for which approval is
requested;
Unless the claim is re-filed properly, it will not
constitute a claim.
For properly filed Pre-Service Claims, you will be
notified of a decision within 15 days from receipt of the claim unless
additional time is needed. The time for response may be extended up to 15
days if necessary due to matters beyond the control of the Fund. You will
be notified of the circumstances requiring the extension of time and the date
by which a decision is expected to be rendered.
If an extension is needed because the Fund needs additional
information from you, the extension notice will specify the information needed.
In that case you and/or your doctor will have 45 days from receipt of the
notification to supply the additional information. If the information is not
provided within that time, your claim will be denied. During the period in
which you are allowed to supply additional information, the normal period for
making a decision on the claim will be suspended. The deadline is suspended
from the date of the extension notice until either 45 days or the date you
respond to the request (whichever is earlier). The Fund then has 15 days to
make a decision on a Pre-Service Claim and notify you of the
determination.
An Urgent Care Claim is any claim for medical care or
treatment with respect to which the application of the time periods for making
pre-service claim determinations:
·
could seriously jeopardize the life or health of the claimant or
the ability of the claimant to regain maximum function, or
·
in the opinion of a physician with knowledge of the claimant’s
medical condition, would subject the claimant to severe pain that could not be
adequately managed without the care or treatment that is the subject of the
claim.
Whether your claim is an Urgent Care Claim is
determined by the Fund applying the judgment of a prudent layperson who
possesses an average knowledge of health and medicine. Alternatively, any
claim that a physician with knowledge of your medical condition determines is
an Urgent Care Claim within the meaning described above, shall be
treated as an Urgent Care Claim.
If you improperly file an Urgent Care Claim, the
appropriate Health Organization will notify you as soon as possible but not
later than 24 hours after receipt of the claim, of the proper procedures
to be followed in filing a claim. Unless the claim is refiled properly, it
will not constitute a claim.
If you are requesting pre-certification of an Urgent Care
Claim, the time deadlines are different. The Fund will respond to you with
a determination by telephone as soon as possible taking into account the
medical exigencies, but not later than 72 hours after receipt of the
claim by the Fund. The determination will also be confirmed in writing.
If an Urgent Care Claim is received without
sufficient information to determine whether or to what extent benefits are
covered or payable, the appropriate Health Organization will notify you [and
your doctor] as soon as possible, but not later than 24 hours after
receipt of the claim, of the specific information necessary to complete the
claim. You and/or your doctor must provide the specified information within 48
hours. If the information is not provided within that time, your claim will be
denied.
Notice of the decision will be provided no later than 48
hours after receipt of the specified information or the end of the period given
for you to provide this information, whichever is earlier.
At the end of this Summary Plan Description is a
list of the Fund’s Health Organizations.
A Concurrent Claim is a claim that is reconsidered
after an initial approval was made and results in a reduction, termination or
extension of a benefit. (An example of this type of claim would be an
inpatient hospital stay originally certified for five days that is reviewed at
three days to determine if the full five days is appropriate.) In this situation
a decision to reduce, terminate or extend treatment is made concurrently with
the provision of treatment.
A reconsideration of a benefit with respect to a Concurrent
Claim that involves the termination or reduction of a
previously-approved benefit (other than by plan amendment or termination) will
be made by the appropriate Health Organization as soon as possible, but in any
event early enough to allow you to have an appeal decided before the benefit is
reduced or terminated.
Any request by a claimant to extend approved Urgent
Care treatment will be acted upon by the appropriate health organization within
24 hours of receipt of the claim, provided the claim is received at least 24
hours prior to the expiration of the approved treatment. A request to extend
approved treatment that does not involve urgent care will be decided according
to pre-service or post-service timeframes, whichever applies.
The following procedure applies to Post-Service Claims.
A Post-Service Claim is a claim that is not a Pre-Service Claim
(for example, a claim submitted for payment after health services and treatment
have been obtained).
·
Obtain a claim form.
·
Complete the employee’s portion of the claim form.
·
Have your Physician either, complete the Attending Physician’s
Statement section of the claim form and submit the completed HCFA health
insurance claim form, or submit an HIPAA-compliant electronic claims
submission.
·
Attach all itemized Hospital bills or doctor’s statements that
describe the services rendered.
Check the claim form to be certain that all applicable
portions of the form are completed and that you have submitted all itemized
bills. By doing so, you will speed the processing of your claim. If the claim
forms have to be returned to you for information, delays in payment will
result.
You do not have to submit an additional claim form if your
bills are for a continuing disability and you have filed a claim within the
past calendar year period. Mail any further bills or statements for any Medical
or Hospital services covered by the Fund to the appropriate Health Organization
as soon as you receive them. Ordinarily, you will be notified of the decision
on your Post-Service Claim within 30 days from the Fund’s receipt
of the claim. This period may be extended one time by the Fund for up to 15
days if the extension is necessary due to matters beyond the control of the
Fund. If an extension is necessary, you will be notified before the end of the
initial 30-day period, of the circumstances requiring the extension of time and
the date by which a decision will be rendered.
If an extension is needed because the Fund needs additional
information from you, the extension notice will specify the information
needed. In that case you will have 45 days from receipt of the
notification to supply the additional information. If the information is not
provided within that time, your claim will be denied. During the period in
which you are allowed to supply additional information, the normal period for
making a decision on the claim will be suspended. The deadline is suspended
from the date of the extension notice until either 45 days or until the date
you respond to the request (whichever is earlier). The Fund then has 15
days to make a decision on a Post-Service Claim and notify you of
the determination.
If an extension is needed because the Fund needs additional
information from you, the extension notice will specify the information
needed. In that case you will have 45 days from receipt of the notification to
supply the additional information. If the information is not provided within
that time, your claim will be denied. During the period in which you are
allowed to supply additional information, the normal period for making a
decision on the claim will be suspended. The deadline is suspended from the
date of the extension notice until either 45 days or until the date you respond
to the request (whichever is earlier). Once you respond to the Fund’s request
for the information, you will be notified of the Fund’s decision on the claim
within 30 days.
A Life Insurance Claim is a claim made by your
beneficiary on the occasion of your death. A Dependent Life Insurance Claim
is a claim made by you on the occasion of the death of your dependent.
The following procedure applies to claims for the Life
Insurance Benefit or Dependent Death Benefit:
·
You or your beneficiary, as applicable, must obtain a claim form
from the Fund Office.
·
Complete the claim form.
·
Attach proof of death form (original certificate of death).
·
Return the completed claim form and all necessary documentation
to the Fund Office.
For Life Insurance and Dependent Life Insurance, the
Fund will make a decision on the claim and notify you or your beneficiary
within 90 days. If the Fund requires an extension of time due to matters
beyond its control, it will notify you of the reason for the delay and when the
decision will be made. This notification will occur before the expiration of
the 90-day period. A decision will be made within 90 days of the time the Fund
notifies you of the delay. If an extension is needed because additional
information is needed from you, the extension notice will specify the
information needed. Until you supply this additional information, the normal
period for making a decision on the claim will be suspended.
You will be provided with written notice of a denial of a
claim (whether denied in whole or in part). This notice will state:
·
The specific reason(s) for the determination.
·
Reference to the specific provision(s) on which the determination
is based.
·
A description of any additional material or information necessary
to perfect the claim, and an explanation of why the material or information is
necessary.
·
A description of the appeal procedures (including voluntary
appeals, if any) and applicable time limits.
·
A statement of your right to bring a civil action under ERISA
Section 502(a) following an adverse benefit determination on review.
·
If an internal rule, guideline or protocol was relied upon in
deciding your claim, you will receive either a copy of the rule or a statement
that was relied upon and it will be available upon request at no charge.
·
If the determination was based on the absence of medical
necessity, or because the treatment was experimental or investigational, or
other similar exclusion, you will receive an explanation of the scientific or
clinical judgment for the determination applying the terms of the Fund to your
claim, or a statement that it is available upon request at no charge.
·
For Urgent Care Claims, the notice will describe the
expedited review process applicable to Urgent Care Claims. For Urgent
Care Claims, the required determination may be provided orally and followed
with written notification within 3 (three) days.
·
For Urgent Care Claims and Pre-Service Claims, you
will receive notice of the determination even when the claim is approved.
If your claim is denied in whole or in part, or if you
disagree with the decision made on a claim, you may ask for a review. Your
request for review must be made in writing to the Fund Office within 180 days
after you receive notice of denial, whether in whole or part. For a request of
a review of Life Insurance or, Dependent Life Insurance benefits, the request
must be made within 60 days after you receive notice of denial, whether in
whole or part. Appeals involving Urgent Care Claims may be made orally
by calling the appropriate health organization at the number listed in this
booklet.
The review process works as follows:
·
Upon your written and notarized request, you have the right to
receive copies of all documents, records, and other information relevant to
your claim, free of charge. A document, record or other information is
relevant if it was relied upon by the Fund in making the decision; it was
submitted, considered or generated (regardless of whether it was relied upon);
it demonstrates compliance with the Fund’s administrative processes for
ensuring consistent decision making; or it constitutes a statement of plan
policy regarding the denied treatment or service.
·
Upon request, you will be provided with the identification of
medical or vocational experts, if any, that gave advice to the Fund on your
claim, without regard to whether their advice was relied upon in deciding your
claim.
·
A different person will review your claim than the one who
originally denied the claim. The reviewer will not give deference to the
initial adverse benefit determination. The decision will be made on the basis
of the record, including such additional documents and comments that may be
submitted by you.
·
If your claim was denied on the basis of a medical judgment (such
as a determination that the treatment or service was not medically necessary,
or was investigational or experimental), a health care professional who has
appropriate training and experience in a relevant field of medicine will be
consulted.
·
Pre-Service Claims
You will be sent a notice of decision on review within 30
days of receipt of the appeal by the appropriate health organization.
·
Urgent Care Claims
You will be sent a notice of a decision on review within 72
hours of receipt of the appeal by the appropriate health organization.
·
Post-Service Claims
You will be sent a notice of the decision on review by the Health
Organization within 30 days of the receipt of a request for review. If you are
dissatisfied with the outcome, you may file an appeal within 180 calendar days
from the date of the notice denying your first request for review. The request
for an appeal must be made in writing to the Board of Trustees.
·
Post-Service Claims
Ordinarily, decisions on appeals involving Post-Service Claims
will be made at the next regularly Scheduled meeting of the Board of Trustees
following receipt of your request for review. However, if your request for
review is received within 30 days of the next regularly Scheduled meeting, your
request for review will be considered at the second regularly Scheduled meeting
following receipt of your request. In special circumstances, a delay until the
third regularly Scheduled meeting following receipt of your request for review
may be necessary. You will be advised in writing in advance if this extension
will be necessary. Once a decision on review of your claim has been reached,
you will be notified of the decision as soon as possible, but no later than 5
days after the decision has been reached.
The decision on any review of your claim will be given to
you in writing. The notice of a denial of a claim on review will state:
·
The specific reason(s) for the determination
·
Reference to the specific plan provision(s) on which the determination
is based
·
A statement that you are entitled to receive reasonable access to
and copies of all documents relevant to your claim, upon request and free of
charge
·
A statement of your right to bring a civil action under ERISA
Section 502(a).
·
If an internal rule, guideline or protocol was relied upon by the
Fund, you will receive either a copy of the rule or a statement that it is
available upon request at no charge.
·
If the determination was based on medical necessity, or because
the treatment was experimental or investigational, or other similar exclusion,
you will receive an explanation of the scientific or clinical judgment for the
determination applying the terms of the Plan to your claim, or a statement that
it is available upon request at no charge.
You may not start a lawsuit to obtain benefits until after
you have requested a review of your benefit claim and a final decision has been
reached, or until the appropriate time frame described above has elapsed since
you filed a request for review and you have not received a final decision or
notice that an extension will be necessary to reach a final decision. No
lawsuit may be started more than 180 days after the end of the year in which
medical or dental services were provided.
The Employee Retirement Income Security Act of 1974 (ERISA)
requires that participants in employee benefit plans receive certain
administrative information about their funds and the people who run them. The
Fund is subject to those rules and this section will tell you more about Plan
operations.
The Fund’s formal name is the United Teamster Fund.
The Board of Trustees and/or its duly authorized designee(s)
have the exclusive right, power and authority, in their sole and absolute
discretion, to administer, apply and interpret this booklet, the Trust
Agreement and any other Fund documents, and to decide all matters arising in
connection with the operation or administration of the Fund or Trust. Without
limiting the generality of the foregoing, the Board of Trustees and/or its duly
authorized designee(s) shall have the sole and absolute discretionary authority
to:
·
Take all actions and make all decisions with respect to the
eligibility for, and the amount of, benefits payable under the Fund.
·
Formulate, interpret and apply rules, regulations and policies
necessary to administer the Fund in accordance with the terms of the Fund.
·
Decide questions, including legal or factual questions, relating
to the calculation and payment of benefits under the Fund.
·
Resolve and/or clarify any ambiguities, inconsistencies and
omissions arising under the Fund, including this booklet, the Trust Agreement
or other Fund documents.
·
Process and approve or deny benefit claims.
·
Determine the standard of proof required in any case.
All determinations and interpretations made by the Board of
Trustees and/or its duly authorized designee(s) shall be final and binding upon
all participants, beneficiaries and any other individuals claiming benefits
under the Fund. The Board of Trustees may delegate any other such duties or
powers as it deems necessary to carry out the administration of the Fund.
The Board of Trustees also reserves the right in its sole
and absolute discretion to amend or terminate the Fund at any time and for any
reason. Continuation of benefits is not guaranteed. Neither you, nor your
beneficiaries nor any other person has or will have a vested or nonforfeitable
interest in the Fund.
In the event of the Fund’s termination, the Board of
Trustees will apply the monies in the Fund to provide benefits or otherwise
carry out the purpose of the Fund in an equitable manner until the Fund assets
have been disbursed. In no event will any part of the Fund assets revert to
the employers or to the Union. The Board of Trustees consists of an equal
number of employer and Union representatives.
The Board of Trustees is the Fund’s Sponsor and
Administrator.
The “employer identification number” assigned to the Fund by
the Internal Revenue Service is 13-5549593. The Plan identification number
assigned to the Fund by the Board of Trustees is 501.
Records are kept on a “Fund Year” basis. The Fund Year is
from May 1st to the following April 30th.
The Fund is known as a “welfare” fund under federal law. It
provides medical benefits, prescription drug benefits, dental benefits, visions
benefits, life insurance, and accidental death and dismemberment benefits.
Legal process may be served upon any Fund Trustee or the
Fund Administrator at:
United Teamster Fund
2137-2147 Utica Avenue
Brooklyn, NY 11234
Phone (718) 859-1624
The Fund was established and is maintained as a result of
collective bargaining agreements between employers and unions. A copy of the
collective bargaining agreement signed by your employer and union may be
obtained upon written request to the Fund Office, and is available for
examination during normal business hours at the Fund Office. In addition, a
complete list of the bargaining units participating in the Fund may be obtained
upon written request to the Fund Office and is available for examination by
participants and beneficiaries during normal business hours at the Fund
Office. The Fund Office may charge a reasonable amount for copies.
Participants and beneficiaries may also receive from the
Fund Office, upon written request, information as to whether a particular
employer or employee organization is participating in the Fund and, if the
employer or employee organization is participating, its address.
The benefits described in this booklet are provided through
employer contributions or COBRA premiums. The amount of employer contributions
and the employees on whose behalf contributions are made are determined by the
provisions of the applicable collective bargaining agreements.
All assets are held in trust by the Board of Trustees for
the purpose of providing benefits to covered participants, either through the
direct payment of benefits or the payment of premiums to entities that insure
these benefits, and defraying reasonable administrative expenses.
All benefits under the Fund are paid out of the Fund’s
assets. This means they are “self-funded.” The Fund has entered administrative
contracts with various entities to assist in administering the Fund. Contact
information for all providers are at the end of this booklet.
If a court or a state administrative agency has issued an
order with respect to the provision of health care coverage for any of the
participant’s children, the Administrator or its designee will determine if the
court or state administrative agency order is a Qualified Medical Child Support
Order (QMSCO) as defined by Federal law, and that determination will be binding
on all parties. The state administrative agency order must be issued through
an administrative process established by state law and must have the force and
effect of state law under the applicable state law.
An order is not a QMCSO if it requires the Fund to provide
any type or form of benefit or any option that the Fund does not otherwise
provide, or if it requires an individual employee who is not covered by the
Fund to provide coverage for a Dependent Child, except as required by a state’s
Medicaid-related child support laws.
If an order is determined to be a QMSCO, and if the
participant is covered by the Fund, the Administrator or its designee will so
notify the parents and each child, and advise them of the Fund’s procedures
that must be followed to provide coverage to the child. However, no coverage
will be provided for any child under a QMSCO unless the applicable employee
contributions for that child’s coverage are paid, and all of the Fund’s
requirements for coverage of that child have been satisfied.
For additional information regarding the QMSCOs and the
procedures for payment of claims under them, see Claims Information.
As a participant in the United Teamster Fund, you are
entitled to certain rights and protections under the Employee Retirement Income
Security Act Of 1974 (ERISA). ERISA provides that all participants and
eligible dependents shall be entitled to:
·
Examine, without charge, at the Fund Office and at other
specified locations, such as work locations and union halls, all documents
governing the Fund, including summary plan descriptions, collective bargaining
agreements signed by the participant’s employer and a copy of the latest annual
report (Form 5500 series).
·
Obtain, upon written request to the Administrator, copies of
documents governing the operation of the Fund, including collective bargaining
agreements, and copies of the latest annual report (Form 5500 series) and an
updated summary plan description. The Administrator may make a reasonable
charge for the copies.
·
Receive a summary of the Fund’s annual financial report. The
Trustees are required by law to furnish each participant with a copy of this
summary annual report, upon written request.
You may continue health coverage for yourself, spouse or
dependents if there is a loss of coverage under the Fund as a result of a
“qualifying event”. You or your dependents may have to pay for such coverage.
Review the rules in this summary plan description on COBRA continuation
coverage rights.
You will be provided a certificate of creditable coverage,
free of charge when you: lose coverage under the Fund, become entitled to
COBRA, when your COBRA continuation coverage ceases, if you request it before
losing coverage, or if you request it up to 24 months after losing coverage.
Without evidence of creditable coverage, you may be subject to a preexisting
condition exclusion for 12 months (18 months for late enrollees) after your
enrollment date in your coverage.
In addition to creating rights for participants, ERISA
imposes duties upon the people who are responsible for the operation of the
employee benefit Plan. The people who operate the Fund are called
“fiduciaries.” Fiduciaries have a duty to act prudently and in the interest of
you and other participants and beneficiaries. No one, including your employer,
your union, or any other person, may fire you or otherwise discriminate against
you in any way to prevent you from obtaining a benefit or exercising your
rights under ERISA.
If your claim for a benefit is denied or ignored, in whole
or in part, you have a right to know why this was done, to obtain copies of
documents relating to the decision, and to appeal any denial, all within
certain time Schedules.
Under ERISA, there are steps you can take to enforce the
above rights. For instance, if you request a copy of the Fund’s documents or
the latest annual report and do not receive them within 30 days, you may file
suit in a federal court. In such a case, the court may require the
Administrator to provide the materials and pay you up to $110 a day until you
receive the materials, unless the materials were not sent because of reasons
beyond the control of the Administrator.
If you have a claim for benefits that is denied or ignored,
in whole or in part, you may file suit in a state or federal court. In
addition, if you disagree with the Fund’s decision or lack thereof concerning
the qualified status of a medical child support order, you may file suit in
federal court. If it should happen that fiduciaries misuse the Fund’s money,
or if you are discriminated against for asserting your rights, you may seek
assistance from the U.S. Department of Labor, or you may file suit in a
federal court. The court will decide who should pay court costs and legal
fees. If you are successful, the court may award you your order the person you
have sued to pay these costs and fees. If you lose, the court may order you to
pay these costs and fees, for example, if it finds your claim is frivolous.
If you have any questions about the Fund, you should contact
the Fund Office. If you have any questions about this statement or about your
rights under ERISA, or if you need assistance in obtaining documents from the
Administrator, you should contact the nearest Office of the Employee Benefits
Security Administration (formerly the Pension and Welfare Benefits
Administration), U.S. Department of Labor, listed in your telephone directory,
or:
Division of Technical Assistance and Inquiries
Employee Benefits Security Administration
U.S. Department of Labor
200 Constitution Avenue, N.W.
Washington D.C, 20210.
You may also obtain certain publications about your rights
and responsibilities under ERISA by calling the publications hotline of the
Employee Benefits Security Administration.
|
BENEFIT
|
HEALTH ORGANIZATION
|
TYPE OF FUNDING
|
|
Medical/Hospital
|
Magnacare
825 East Gate Boulevard
Garden City, New York 11530
(T) 516-282-8000
(F) 516-228-7743
|
Self-funded. The Fund pays the cost of benefits, which
are administered by Magnacare and provides pre-certification and case
management services.
|
|
Prescription Drugs
|
Prescription Drugs
Express Scripts Inc.
Mail Pharmacy Service
P. O. Box 66773
St. Louis, Missouri 63166-6773
|
Self-funded. The Fund pays the cost of benefits, which
are administered by Express Scripts.
|
|
Vision
|
United Teamster Fund
2137-2147 Utica Avenue
Brooklyn, New York 11234
General Vision Service
Comprehensive Professional System
Vision Screening
National Optical Services
New County
|
Self-funded. The Fund provides and administers benefits.
|
|
Life Insurance
|
United Teamster Fund
2137-2147 Utica Avenue
Brooklyn, New York 11234
718-859-1624
|
Self-funded. The Fund provides and administers benefits.
|