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New Preferred Provider Organization Network

July 2006

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

July, 2006

Dear Member and Eligible Dependents:

Effective September 1, 2006, the Board of Trustees of the Massachusetts Laborers’ Health and Welfare Fund is pleased to announce that members and their eligible dependents will have access to a new Preferred Provider Organization (PPO) health care network for covered services under a new arrangement with Blue Cross Blue Shield of Massachusetts. This new PPO network arrangement will not affect your current plan of benefits , and will enable you to access an extensive nationwide network of providers through the preferred provider network of any Blue Cross Blue Shield Plan.

It is important to emphasize that HealthCare Value Management (HCVM), your current PPO network, will be discontinued as of August 31, 2006. However, it is anticipated that most of your current providers will also participate with the local Blue Cross Blue Shield Plan’s PPO network within your state, so you should experience little disruption in receiving your ongoing “in-network” benefits.You may also continue to receive your health care from any provider and your out-of-network benefits will remain the same, as discussed in your Summary Plan Description. If you receive care from a provider that is in your current HCVM Network, but not in the new Blue Cross Blue Shield PPO Network on or after September 1, 2006, your provider will be considered “out-of-network.”

To receive the highest benefit level (in-network benefits) under your Plan, you need to choose providers who participate in the Blue Cross Blue Shield PPO Provider network. Blue Cross Blue Shield offers many types of plans with different networks of providers. There are some Blue Cross Blue Shield providers who do not participate in the PPO network. If you seek care from a Blue Cross Blue Shield provider who is not part of the PPO network of providers, services will be considered out-of network, and will be paid at out-of-network benefit levels.

The network is responsible for selecting qualified professionals to provide approved MEDICAL services. The selection of the health care professionals and service providers that you use, however, is solely your responsibility. The Trustees take no responsibility for the qualification or actions of any individual provider of care, goods or services. Also note that the network providers may provide care that is not covered by the Plan; consult your Summary Plan Description for a description of your benefits.

To Locate a Blue Cross Blue Shield PPO Provider in your State

You may utilize the services of any of the Blue Cross Blue Shield Plan’s Preferred Providers as “in-
network” providers. For example, if you are a Massachusetts resident, you will more than likely utilize a
Massachusetts-based provider, however, you could also use the services of any of the Blue Cross Blue Shield preferred providers nationwide. To locate a PPO provider of any state, simply call Blue Cross Blue Shield at 1-800-810-BLUE (1-800-810-2583) or simply access their website at www.BCBS.com, or starting in September, 2006, visit our website www.MLBF.org.

Since there are always changes occurring with the professional services network, it is strongly suggested that you ask a provider if they are participating members of your specific state Blue Cross Blue Shield


Preferred Provider Organization, or access the Blue Cross Blue Shield website to obtain a provider’s current network status prior to receiving care.

New Medical Identification Cards

For this new Blue Cross Blue Shield PPO network arrangement you will be receiving a new identification card. Be sure to show this new card to all health care providers at the time of service, whether in-network or not. This is vital to insure that your medical expenses are sent directly from the provider to the Blue Cross Blue Shield Plan servicing your area. When you next see a health care provider that you are now using, please be sure to point out that your network has changed and that you have a new identification number: "UEM" followed by your Blue Cross Blue Shield identification number. It is extremely important that your provider include the “UEM” prefix when submitting claims on your behalf to the local Blue Cross Blue Shield Plan. For this reason, you must show the provider your new identification card when receiving health care services.

Claims Submissions

YOUR HEALTH CARE PROVIDER MUST SUBMIT ALL CLAIMS TO YOUR BLUE CROSS BLUE SHIELD OFFICE. The only exceptions are inpatient and/or outpatient claims incurred for substance/alcohol abuse and nervous/mental illness, and complementary care benefits: biofeedback, homeopathy, massage therapy, naturopathy, nutrition and Oriental medicine. As a reminder, all of the above identified benefits must be precertified, and all concurrent substance/alcohol abuse claims and all nervous/mental illness claims must be reviewed for utilization and case management by the Wellness Corporation before the claim can be processed by the Fund office. The Wellness Corporation telephone number is 1-800-522-6763. Those claims must be mailed to the Massachusetts Laborers’ Health and Welfare Fund, P. O. Box 4000, Burlington, Massachusetts 01803-0900.

Under the new network arrangement, Blue Cross Blue Shield will review all other concurrent claims for utilization review and case management, instead of the Wellness Corporation.

Other Benefits

There are no changes to any of the following benefits or how you receive them from providers:

  • Pharmacy Benefits
  • Dental Benefits
  • Vision Benefits
  • MAP Program

If you have any questions and need further clarification of this Preferred Provider Organization Network, contact the Fund office directly at 1-800-342-3792.

Very truly yours,

Board of Trustees
Massachusetts Laborers’ Health and Welfare Fund


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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.