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International Union of Operating Engineers: Local 399
handw.jpg2017 Summary of Benefits Coverage Document now Available

Summary of Medical Benefits

 


Effective February 1, 2015
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Medical Benefits     

Preferred Provider Network

BlueCross BlueShield Labor Lease Program

     
Deductible            $300 per person per calendar year
    $1200 per family per calendar year
     
     
Major Medical Coinsurance   90% PPO         70% Non-PPO
     
Plan Maximum (Medical Claims)   Unlimited
     
Additional Copayment   $100 outpatient emergency room
     

Adult Wellness

(Age/frequency guidelines apply)

 

 

 

 

 

 

Annual Routine Exam

Immunizations

Mamogram

Gynecological exam with related testing:

PSA with related exam

Colonoscopy

     

Pre-Certification Requirement

   Call Med-Care Management

   1-800-367-1934

 

 

 

 

 

Hospitalizations

Outpatient surgical procedures performed in a

surgical facility or a hospital

Physical, occupational, speech therapy

IV Therapy

Home care, medical equipment & supplies

 

     

Plan Exclusions

(See Summary Plan Description for 

complete list)

 

 

 

Out of network surgical faclities

Speech or other therapy for develpmental delay

Treatment of Infertility

Hearing-Aids

 

 

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For additional details, please click below to view/download a copy of the
2015 Summary Plan Description Book

 

2015 Summary Plan Description Book

 

 

Contact Elite Adminstration Customer Service at

(312) 243-1265 for information regarding

your claims payment status

 

 

Contact Numbers:

 

H&W Fund Office

(312) 372-9870

Press Option 3


H&W Dedicated Fax Number:

(312) 842-0291

 

Click here for H&W staff contact list

For questions or issue on Medical Coverage,

please contact Elite Adminstration at (312) 243-1265

 

For questions or issue on Dental Coverage,

please call Delta Dental at (800) 323-1743

 

For questions on Prescriptions,

Please call Caremark at (888) 727-0504

 

For questions regarding Vision Coverage,

please call VSP at (800) 877-7195

 

If you are a member needing assistance, please call 

or email the Health & Welfare Fund Office Staff.