02. What is my in-network deductible?
03. What is my out-of-network deductible?
04. How do I request a new card (medical, dental or prescription drug)?
05. Will my coverage continue once I stop working?
06. How do I find a provider in the network?
07. What is the chiropractic benefit?
08. Does the Plan cover weight loss programs or the cost of a fitness club membership?
09. What is my copay?
10. Do I have to pay the balance on my bill from my doctor?
11. What is the physical therapy benefit?
12. What is the inpatient benefit?
13. Is a pre-certification required for an inpatient admission?
14. What kind of details do I have to provide about an accident?
15. What is the durable medical equipment benefit?
16. What is the status of my claim?
01. How is my eligibility determined?
Your eligibility to participate in Plan A or Plan B for each 6-month Eligibility Period will depend on the number of recorded hours of employment you accumulate with one or more contributing employers within a period of 12 consecutive months as follows:
- Plan A-1,000 recorded hours within a 12-month Qualifying Period = coverage during a 6-month Eligibility Period
- Plan B-700 recorded hours within a 12-month Qualifying Period = coverage during a 6-month Eligibility Period
02. What is my in-network deductible?
|
Plan A |
Plan B |
||
|
PPO Provider |
Non-PPO Provider in |
PPO Provider |
Non-PPO Provider in |
| $250 per individual | $750 per individual | $500 per individual | $1,000 per individual |
| $500 per family | $1,500 per family | $1,000 per family | $2,000 per family |
See question 3 below for information on how your deductible changes if you move from Plan A to Plan B, or vice versa, during a calendar year.
03. What is my out-of-network deductible?
If you move from Plan A to Plan B, or vice versa, during a calendar year, the payments you make toward your deductible will accumulate. For example:
- If you have met the individual $250 calendar-year PPO Provider deductible for Plan A and then switch to Plan B for the next six-month Eligibility Period, you must pay an additional $250 to meet the individual $500 calendar-year PPO Provider deductible for Plan B.
- If you have met the individual $500 calendar-year PPO Provider deductible for Plan B and then switch to Plan A for the next six-month Eligibility Period, you automatically meet the $250 individual calendar-year PPO Provider deductible for Plan A.
04. How do I request a new card (medical, dental or prescription drug)?
05. Will my coverage continue once I stop working?
06. How do I find a provider in the network?
07. What is the chiropractic benefit?
Under Plan A and Plan B, the Fund will pay 80% of the provider’s charge, up to a maximum benefit of $50 per visit, with a limit of 30 visits per calendar.
Complete details are available in the Summary Plan Description.
08. Does the Plan cover weight loss programs or the cost of a fitness club membership?
While the Plan covers gastric bypass surgery (pre-authorization by BlueCross BlueShield is required), it does not cover weight-loss programs or the cost of a fitness club.
Complete details are available in the Summary Plan Description.
09. What is my copay?
If you use a PPO Provider your copayment is $15.
10. Do I have to pay the balance on my bill from my doctor?
11. What is the physical therapy benefit?
12. What is the inpatient benefit?
Please refer to the “Eligible Medical Expenses” chart in the Summary Plan Description for Plan A and Plan B coverage.
13. Is a pre-certification required for an inpatient admission?
14. What kind of details do I have to provide about an accident?
15. What is the durable medical equipment benefit?
Both Plans provide a benefit for the purchase or rental of certain durable medical equipment for up to $5,000 renewable annually. You must contact BlueCross BlueShield for pre-authorization prior to purchasing any equipment.