Important Changes for 2007
IMPORTANT
CHANGES COMMENCING IN 2007
These changes will impact your eligibility
status as well as your
Plan of Benefits.
Please read thoroughly.
MASSACHUSETTS LABORERS' HEALTH AND WELFARE FUND
14 NEW ENGLAND EXECUTIVE PARK * SUITE 200
P.O. BOX 4000, BURLINGTON, MASSACHUSETTS 01803-0900
TELEPHONE (781) 272-1000 OR (800) 342-3792 * FAX (781) 238-0703
August, 2006
IMPORTANT CHANGES FOR 2007
Dear Member and Family:
As you know, the Board of Trustees of the Massachusetts Laborers’ Health and Welfare Fund remains committed to the best interests and needs of all of our members, while maintaining the sound management of the Fund.
We are very pleased to announce several positive developments for 2007. These developments result from the savings expected to be realized from selecting Blue Cross Blue Shield of Massachusetts as the Fund’s new medical network provider, and other favorable considerations. The Fund is now able to offer members the possibility of coverage in one of two benefit plans, based on new eligibility rules.
Beginning on January 1, 2007:
It will be easier to obtain Health and Welfare Fund benefits because of the new eligibility rules.
- Two alternative benefit plans will be available to active members: Plan A (the current benefit plans) and Plan B (a modified set of benefit plans).
- The new eligibility rules described below will be used to determine your eligibility for either of these benefit plans.
First, summary information on the two benefit plans appears below.
Two Benefit Plans for Active Members
As of January 1, 2007, there will be two benefit plans for active members: Plan A and Plan B. Plan A will provide the current benefit plans. Plan B will provide different medical and dental plans, but will match Plan A in all other respects. The chart below shows the benefits included in Plan A, as compared to Plan B.
| Plan A | Plan B | |
| Benefits |
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For information regarding the benefits provided by Plan A and Plan B, please see the enclosed summary
“Overview of the Plan A and Plan B Benefit Plans.”
New Eligibility Rules
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.
Two Eligibility Requirements
Plan A – 1,000 hours within a 12-month Qualifying Period = coverage during a 6-month Eligibility Period
Plan B – 700 hours within a 12-month Qualifying Period = coverage during a 6-month Eligibility Period
First Qualifying/Eligibility Period Requirement
| Oct |
12- Month Qualifying Period |
| Nov | |
| Dec | |
| Jan | |
| Feb | |
| Mar | |
| Apr | |
| May | |
| Jun | |
| Jul | |
| Aug | |
| Sep | |
| Oct |
Collection Lag for Employer Contributions |
| Nov | |
| Dec | |
| Jan |
6-Month Eligibility Period |
| Feb | |
| Mar | |
| Apr | |
| May | |
| Jun |
Second Qualifying/Eligibility Period Requirement
| Oct |
12- Month Qualifying Period |
| Nov | |
| Dec | |
| Jan | |
| Feb | |
| Mar | |
| Apr | |
| May | |
| Jun | |
| Jul | |
| Aug | |
| Sep | |
| Apr |
Collection Lag for Employer Contributions |
| May | |
| Jun | |
| Jan |
6-Month Eligibility Period |
| Feb | |
| Mar | |
| Apr | |
| May | |
| Jun |
Hours Requirements
- Plan A provides coverage for members who accumulate 1,000 recorded hours of employment during a 12-Month Qualifying Period.
- Plan B provides coverage for members who accumulate 700 recorded hours of employment (but less than 1,000 hours) during a 12-Month Qualifying Period.
Example
Your eligibility during the 6-Month Eligibility Period beginning January 1, 2007 will depend on the number of recorded hours of employment you accumulated during the 12-Month Qualifying Period beginning on October 1, 2005 and ending on September 30, 2006. If you work 1,000 or more hours, you will be eligible for Plan A. If you work 700 hours but fewer than 1,000 hours, you will be eligible for Plan B.
Maintaining Your Eligibility
Once you gain eligibility, your eligibility will continue as long as you work at least 1,000 hours (Plan A) or 700 hours (Plan B) in a 12-Month Qualifying Period for the next 6-Month Eligibility Period.
A 2006 Change
Effective September 1, 2006, you will be liable for an additional $75 co-pay for each hospital emergency room visit, in addition to the $15 co-payment that applies for a hospital emergency room visit with a PPO provider. However, the $75 additional co-pay will be waived if the member or dependent receiving treatment is admitted to the hospital.
If you have any questions about any of these changes, please call the Fund Office.
Very truly yours,
Thomas P.V. Masiello
Administrator
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) |
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| 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 |
Paid same as other Plan B inpatient care |
| 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 |
