learning center

 

Overview of the Plan A and Plan B Benefit Plans

Medical
Plan A (current plan)
Plan B (new plan)
Maximum lifetime benefit
$1 million per individual
$1 million per individual
 
PPO Provider
Non-PPO Provider in PPO
Area
PPO Provider
Non-PPO Provider in PPO
Area
Annual deductible
$250 per individual;
$500 per family
per 
calendar year
$750 per individual;
$1,500 per family
per calendar year
$500 per individual
$1,000 per family
per calendar year
$1,000 per individual;
$2,000 per family
per calendar year
Hospital-inpatient
Per admission:
Fund pays 100%
of the first
$50,000
plus 85%
of the excess
charges with
an out-of-pocket
maximum of $2,000
(after deductible)
Per admission:
Fund pays 90%
of the first
$50,000
plus 75%
of the excess
charges with
an out-of-pocket
maximum of $7,000
(after deductible)
Per admission:
Fund pays 100%
of the first
$7,500
plus 85%
of the excess
charges with
an out-of-pocket
maximum of $5,000
(after deductible)
Per admission:
Fund pays 90%
of the first
$7,500
plus 75%
of the excess
charges with
an out-of-pocket
maximum of $7,000
(after deductible)
Hospital-Outpatient
Fund pays 100%
after $15
co-payment
Fund pays 80% 
of R & C fees
for most procedures
Fund pays 90%
after $15
co-payment
Fund pays 75%
of R & C fees
for most procedures
 Physician
Fund pays 100%
after $15
co-payment
In most cases,
Fund pays 80%
of R & C fees
Fund pays 90%
after $15
co-payment
In most cases,
Fund pays 75%
of R & C fees
Annual physical exam 
(must be at least one year old)
Fund pays 100% in network after $15 co-payment
(no deductible)
Fund pays 100% in network after $15 co-payment
(no deductible)
Well baby care
Paid same as other Plan A medical treatment
Paid same as other Plan B medical treatment
Emergency treatment
Fund pays 100%
after $75 penalty
for each emergency
medical treatment
(waived if admitted
to the hospital),
plus $15
co-payment
Fund pays 80% of R&C fees,
after $75 penalty for each
emergency medical
treatment (waived if
admitted to the
hospital)
Fund pays 100%
after $75 penalty
for each emergency
medical treatment
(waived if admitted
to the hospital),
plus $15
co-payment
Fund pays 75% of R&C fees,
after $75 penalty for each
emergency medical
treatment (waived if
admitted to the
hospital)
 
Medical
Plan A (current plan)
Plan B (new  plan)
Mental health care   Inpatient
   (25 days max per calendar year)
   Outpatient
   (24 visits max per calendar year)
Paid same as other Plan A inpatient care
 
For visits after first eight visits under the MAP,
Fund pays 100% after $15 co-payment per visit
Paid same as other Plan B inpatient care
 
For visits after first eight visits under the MAP,
Fund pays 100% after $15 co-payment per visit
Treatment of alcoholism or
substance abuse   Inpatient
   (25 days max per lifetime)
 
   Outpatient
   ($1,500 max per calendar year)
Paid same as other Plan A inpatient care

For visits after first eight visits under the MAP,
after $15 co-payment per visit, Fund pays 100%
of first $500 in covered charges and 80% of
remaining covered charges
Paid same as other Plan B inpatient care
 
For visits after first eight visits under the MAP,
after $15 co-payment per visit, Fund pays 100%
of first $500 in covered charges and 80% of
remaining covered charges
 
Dental
Plan A (current plan)
Plan B (new preventive plan)
Type I (Diagnostic and Preventive
Benefits: exams, cleanings, etc.)
PPO Provider
Non-PPO Provider in
PPO Area
PPO Provider
Non-PPO Provider in PPO
 
100%
100% of usual and
customary charges
100%
100% of usual and
customary charges
Type II (Restorative and Other
Basic Services: fillings and crowns,
etc.)
80%
80% of usual and
customary charges
None
Type III (Major Restorative
Services: crowns, dentures and
bridges, etc.)
50%
50% of usual and
customary charges
None
Annual maximum
None
None
Orthodontia
Lifetime maximum of $2,500. Available to age 19
None
 
Prescription Drugs
Plan A (current plan)
Plan B
Retail Pharmacy
You pay the following co-payment per
prescription for up to a 30-day supply:
  - Generic drug: $5
  - Preferred brand-name: $15
  - Non-preferred brand-name: $25
Same as Plan A
 

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Copyright © 2006 Massachusetts Laborers' Benefit Funds
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This information is intended only to provide highlights of the plans. In the event of any inconsistency between the information on this Web site and the official plan document, the terms of the official plan document, as interpreted by the Board of Trustees in its sole discretion, will control. All examples and projections included on this Web site are not a guarantee of future benefits under the plans. The benefit amounts are estimates only, based on the stated assumptions and are subject to change.

The Massachusetts Laborers' Benefit Funds reserve the right to amend, modify, or terminate all or part of any plan at any time.