The Comprehensive Medical Benefit covers a wide range of medical expenses and provides financial protection when you and your family need medical care.
Both the Active and Pre-Medicare Retiree Plans of Benefits work similarly. Generally, after you pay an individual deductible (up to a family limit), the Plan and you share the cost of medical expenses. The Plan pays:
For more information, including your deductibles, the percentages the Plan pays and annual limits, refer to the section titled Your Medical Benefits of your Summary Plan Description (SPD).
Your Prescription Drug Benefit features a retail pharmacy program and a mail-order program. The retail pharmacy program is for short-term prescriptions (up to a 34-day supply). The mail-order program is for long-term prescriptions (up to a 90-day supply).
For more information on this benefit, see the section titled The Prescription Drug Benefit of your Summary Plan Description (SPD).
The Dental Expense Benefit will pay a percentage of covered expenses depending on the type of services you receive. The percentages are as follows:
|Preventative and Diagnostic||100%|
|Restorative and Prosthodontics||80%|
Benefits are paid each year up to the individual annual maximum of $1,000. This maximum does not apply to preventive services for children under the age of 19. Benefits for Orthodontic services are paid up to the lifetime orthodontic maximum of $1,000, and are only available to covered Dependents under age 19. See the section titled Dental Expense Benefit (if shown on your schedule of benefits) of your Summary Plan Description (SPD) for more information.
When you use VSP providers (in-network), many of your services are provided at no cost to you. Even when you go to a non-VSP provider (out-of-network), you will continue to receive the $200 per person annual allowance.
See the section titled Vision Care Benefit (If Shown On Your Schedule of Benefits) of your Summary Plan Description (SPD) for more information.
Yes. The hearing aid benefits applies to active and retired employees not enrolled in Medicare only.
You are eligible for a hearing aid benefit of up to $2,500 per ear, once every 36 months. You must go through EPIC Hearing Healthcare. EPIC will refer you to a hearing care professional for a free basic hearing exam.
If you need a more extensive hearing exam, it is covered under the Medical Benefit, subject to the deductible and coinsurance.
If you need hearing services or just suspect you do, call EPIC at 1-866-956-5400.
A formulary is a list of drugs that are preferred by your Plan. This list includes a wide selection of drugs that is preferred because it offers you choice while helping keep the cost of your prescription drug benefit affordable.
For more information about your formulary, visit www.express-scripts.com or call the number on your pharmacy ID card.
Once you retire and start making self-payments toward retiree coverage, you cannot regain eligibility in the Active Plan, even if you return to work. Your retiree coverage under the Plan will end if you stop making self-payments, even if you return to work.
For more information about returning to work after you retire, see your Summary Plan Description.
© Iron Workers Tri-State Welfare Fund. The information on this Web site presents selected highlights of the Iron Workers Tri-State Welfare Fund. The actual Plan provisions of the Plan are in the Plan’s legal document. In the event of a conflict between the wording on the site and the legal documents, the legal documents will govern. The Trustees reserve the right to amend, modify, or discontinue all or part of the Plan at any time.