YOUR HEALTH CARE PLAN
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Plan Overview
Active electrical workers, non-bargaining unit staff and retirees, learn about your benefits coverage, co-pays, deductibles, and more for your Medical, Prescription, Behavioral/Mental Health, Dental, Vision/Hearing and other benefits.
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- Medical Plan
- Dental Plan
- Vision/Hearing Plans
- Behavioral/Mental Health Plan
- Prescription Plan
- Other Plans
MEDICAL: Benefit Plan Overview
| Active Electrical Workers:Standard Plan | Active Electrical Workers:"H" Plan | Non-Bargaining Unit:Office Plan | Retirees:Pre-Medicare | Retirees:Medicare Eligible | |
|---|---|---|---|---|---|
| Copay | 0 | 0 | 0 | 0 | Medicare Supplemental Coverage Only |
| Deductible | $150 pp/ $300 family | $150 pp/ $300 family | $150 pp/ $300 family | $150 pp/ $300 family | Medicare Supplemental Coverage Only |
| Coinsurance | 80% EWTF/ 20% member | 80% EWTF/ 20% member | 80% EWTF/ 20% member | 80% EWTF/ 20% member | Medicare Supplemental Coverage Only |
| Annual Exams & Labs | 100% Coverage; No Cost Sharing | 100% Coverage; No Cost Sharing | 100% Coverage; No Cost Sharing | 100% Coverage; No Cost Sharing | Medicare Supplemental Coverage Only |
| Out of Pocket Max | $8,000/year | N/A | $8,000/year | $8,000/year | Medicare Supplemental Coverage Only |
| Annual Benefit Maximum | NO | NO | NO | NO | Medicare Supplemental Coverage Only |
| Lifetime Benefit Maximum | <$1,000,000: No limit >$1,000,000: 50% Reduced Benefit | <$100,000: No limit >$100,000: 50% Reduced Benefit | <$1,000,000: No limit >$1,000,000: 50% Reduced Benefit | <$1,000,000: No limit >$1,000,000: 50% Reduced Benefit | Medicare Supplemental Coverage Only |
| In Network & Out of Network Coverage? | BOTH | In-Network ONLY | BOTH | BOTH | Medicare Supplemental Coverage Only |
| Referral Required for Specialist? | NO | NO | NO | NO | Medicare Supplemental Coverage Only |
| Pre-Authorization Required? | NO | NO | NO | NO | Medicare Supplemental Coverage Only |
| COVERAGE: | |||||
| Medical (office visits, doctor charges, etc) | YES | YES | YES | YES | Medicare Supplemental Coverage Only |
| Well Woman | YES | YES | YES | YES | Medicare Supplemental Coverage Only |
| Routine Physicals | YES | YES | YES | YES | Medicare Supplemental Coverage Only |
| Lab & X-rays | YES | YES | YES | YES | Medicare Supplemental Coverage Only |
| Chiropractice Care, Physical Therapy, & Speech Therapy | YES | YES | YES | YES | Medicare Supplemental Coverage Only |
| Hospitalization & Surgery | YES | YES | YES | YES | Medicare Supplemental Coverage Only |
| Maternity & Gynecological Care | YES–Maternity for Member/Spouse Only | YES–Maternity for Member/Spouse Only | YES–Maternity for Member/Spouse Only | YES–Maternity for Member/Spouse Only | Medicare Supplemental Coverage Only |
| Emergency Room | YES | YES | YES | YES | Medicare Supplemental Coverage Only |
DENTAL: Benefit Plan Overview
Active Electrical Workers:Standard Plan Active Electrical Workers:"H" Plan Non-Bargaining Unit:Office Plan Retirees:Pre-Medicare Retirees:Medicare Eligible
Annual Benefit Maximum Non-Ortho–Dependents < 18 yrs old: $ 0 Non-Ortho Member/Spouse: $3,000 N/A Non-Ortho– Dependents < 18 yrs old: $ 0 Non-Ortho Member/Spouse: $3,000 Non-Ortho–Dependents < 18 yrs old: $ 0 Non-Ortho Member/Spouse: $3,000 Non-Ortho–Dependents < 18 yrs old: $ 0 Non-Ortho Member/Spouse: $3,000
Pre-Authorization Required? Treatment Plan > $600 Only N/A Treatment Plan > $600 Only Treatment Plan > $600 Only Treatment Plan > $600 Only
COVERAGE:
Preventive Services In Network: 100%
Out of Network: 80%N/A In Network: 100%
Out of Network: 80%In Network: 100%
Out of Network: 80%In Network: 100%
Out of Network: 80%
Basic Dental Services In Network: 80%
Out of Network: 80%N/A In Network: 80%
Out of Network: 80%In Network: 80%
Out of Network: 80%In Network: 80%
Out of Network: 80%
Major Dental Services In Network: 80%
Out of Network: 50%N/A In Network: 80%
Out of Network: 50%In Network: 80%
Out of Network: 50%In Network: 80%
Out of Network: 50%
Orthodontia Member, Spouse, & Dependent Children: 50% up to $3,000 N/A Member, Spouse, & Dependent Children: 50% up to $3,000 Member, Spouse, & Dependent Children: 50% up to $3,000 Member, Spouse, & Dependent Children: 50% up to $3,000
VISION & HEARING: Benefit Plan Overview
| Active Electrical Workers:Standard Plan | Active Electrical Workers:"H" Plan | Non-Bargaining Unit:Office Plan | Retirees:Pre-Medicare | Retirees:Medicare Eligible | |
|---|---|---|---|---|---|
| Allowance | Vision–$150 glasses/$100 contacts Hearing–$3,000 first hearing aid; $1,000 second hearing aid | N/A | Vision–$150 glasses/$100 contacts Hearing–$3,000 first hearing aid; $1,000 second hearing aid | Vision–$150 glasses/$100 contacts Hearing–$3,000 first hearing aid; $1,000 second hearing aid | Vision–$150 glasses/$100 contacts Hearing–$3,000 first hearing aid; $1,000 second hearing aid |
| Vision | YES | NO | YES | YES | YES |
| Hearing | YES | NO | YES | YES | YES |
BEHAVIORAL/MENTAL HEALTH: Benefit Plan Overview
| Active Electrical Workers:Standard Plan | Active Electrical Workers:"H" Plan | Non-Bargaining Unit:Office Plan | Retirees:Pre-Medicare | Retirees:Medicare Eligible | |
|---|---|---|---|---|---|
| Copay | 0 | 0 | 0 | 0 | Medicare Supplemental Coverage Only |
| Deductible | $150 pp/$300 family | $150 pp/$300 family | $150 pp/$300 family | $150 pp/$300 family | Medicare Supplemental Coverage Only |
| Coinsurance | EAP: 8 Free Counseling Sessions/Year Inpatient: 100% up to $7,000; After $7,000, 80% EWTF / 20% member Outpatient: 80% EWTF/20% member | EAP: 8 Free Counseling Sessions/Year No Inpatient/Outpatient Coverage | EAP: 8 Free Counseling Sessions/Year Inpatient: 100% up to $7,000; After $7,000, 80% EWTF / 20% member Outpatient: 80% EWTF/ 20% member | EAP: 8 Free Counseling Sessions/Year Inpatient: 100% up to $7,000; After $7,000, 80% EWTF / 20% member Outpatient: 80% EWTF/ 20% member | |
| Out of Pocket Max | $8,000/year | $8,000/year | $8,000/year | $8,000/year | Medicare Supplemental Coverage Only |
| Lifetime Benefit Maximum | <$1,000,000: No limit >$1,000,000: 50% Reduced Benefit | <$1,000,000: No limit >$1,000,000: 50% Reduced Benefit | <$1,000,000: No limit >$1,000,000: 50% Reduced Benefit | <$1,000,000: No limit >$1,000,000: 50% Reduced Benefit | Medicare Supplemental Coverage Only |
| In Network & Out of Network Coverage? | Both | EAP only | Both | Both | Both |
| Pre-Authorization Required | NO | N/A | NO | NO | BHS Navigation Required |
| COVERAGE: | |||||
| Employee Assistance Plan (EAP) | YES–Contact BHS for Benefit | YES–Contact BHS for Benefit | YES–Contact BHS for Benefit | YES–Contact BHS for Benefit | Medicare Supplemental Coverage Only |
| Substance Abuse & Mental Health | YES–Contact BHS for Benefit | NO | YES–Contact BHS for Benefit | YES–Contact BHS for Benefit | Medicare Supplemental Coverage Only |
PRESCRIPTION: Benefit Plan Overview
| Active Electrical Workers:Standard Plan | Active Electrical Workers:"H" Plan | Non-Bargaining Unit:Office Plan | Retirees:Pre-Medicare | Retirees:Medicare Eligible | |
|---|---|---|---|---|---|
| Regular Copay | Generic Drug: $10 Brand (Formulary) Drug: $25 Non-Formulary Drug: $35 | N/A | Generic Drug: $10 Brand (Formulary) Drug: $25 Non-Formulary Drug: $35 | Generic Drug: $10 Brand (Formulary) Drug: $25 Non-Formulary Drug: $35 | Generic Drug: $10 Brand (Formulary) Drug: $25 Non-Formulary Drug: $35 |
| Mail Order Maintenance Copay | Generic Drug: $20 Brand (Formulary) Drug: $50 Non-Formulary Drug: $70 | N/A | Generic Drug: $20 Brand (Formulary) Drug: $50 Non-Formulary Drug: $70 | Generic Drug: $20 Brand (Formulary) Drug: $50 Non-Formulary Drug: $70 | Generic Drug: $20 Brand (Formulary) Drug: $50 Non-Formulary Drug: $70 |
| Annual Benefit Maximum | NO | N/A | NO | NO | N/A |
| Lifetime Benefit Maximum | Immuno Therapy subject to Medical Lifetime Max | N/A | Immuno Therapy subject to Medical Lifetime Max | Immuno Therapy subject to Medical Lifetime Max | N/A |
| In Network & Out of Network Coverage? | BOTH | NO | BOTH | BOTH | BOTH |
| Pre-Authorization Required? | Non-Formulary Drugs Only | N/A | Non-Formulary Drugs Only | Non-Formulary Drugs Only | Non-Formulary Drugs Only |
| COVERAGE: | |||||
| Presciption Drugs | YES | NO | YES | YES | YES |
OTHER BENEFITS COVERAGE
| Active Electrical Workers:Standard Plan | Active Electrical Workers:"H" Plan | Non-Bargaining Unit:Office Plan | Retirees:Pre-Medicare | Retirees:Medicare Eligible | |
|---|---|---|---|---|---|
| Death Benefit | $50,000 Member Only | 0 | $50,000 Member Only | $12,000 Retiree Only | 0 |
| Accidental Dismemberment & Loss of Sight | YES | NO | YES | NO | NO |
| Weekly Accident & Sickness Benefit | YES | NO | YES | NO | NO |
| Supplemental Occupational Benefit | YES | NO | YES | NO | NO |