Massachusetts Laborers

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Eligibility


Medical & Weekly Accident and Sickness Benefits


Dental Plan Benefits


Vision Plan Benefits


Prescription Drug Plan


COBRA


Life Insurance & Disability


Retiree/Self-Pay Benefits

Medical & Weekly Accident and Sickness Benefits

Medical Benefits
Maximum Lifetime Benefit	Plan A and Plan B: $1 million per individual
Annual Deductible	Plan A PPO Provider: $250 individual; $500 family Plan A Non-PPO Provider in PPO Area: $750 individual; $1,500 family Plan B PPO Provider: $500 individual; $1,000 family Plan B Non-PPO Provider in PPO Area: $1,000 individual; $2,000 family
Annual Deductible If you move from Plan A to B during a calendar year (or vise versa)	If you move from Plan A to Plan B, or vice versa, during a calendar year, your payments 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 $500 individual 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.
Medical Preferred Provider Organization (PPO)	- BlueCross BlueShield of Massachusetts is the PPO provider except for those services covered by the Wellness Corporation. - The Wellness Corporation/Member Assistance Program (MAP) pre-authorizes: - mental health and substance abuse services - complementary care
Find a Doctor	To find a doctor or to confirm that your current doctor participates in the BlueCross BlueShield PPO Network you can: 1. Call 1-800-810-BLUE (1-800-810-2583) 2. Access their Web site at http://www.bcbs.com/
Hospital Pre-Authorizations	You must contact BlueCross BlueShield for pre-authorization for certain services. If you fail to comply with the requirements for non-emergency hospital admission, the penalty could range from a $250 reduction in the amount paid by the Fund to a complete denial of the claim. See the Summary Plan Description for complete details. If you require inpatient and/or outpatient services for substance/alcohol abuse, nervous/mental illness, or complementary care you must have the service pre-authorized by The Wellness Corporation (1-800-522-6763).
Member Assistance Program (MAP)	Provided by The Wellness Corporation, MAP can help you with family difficulties, marital stress, child and adolescent concerns, illness of a family member, financial pressure, job stress, or alcohol and drug abuse. These services must be pre-authorized or your claim will be denied. Contact MAP at 1-800-522-6763.
What the Plan Covers	Click here for a benefits overview. Complete details are available in the Summary Plan Description.
Filing a Claim	If you go to a provider in the BlueCross BlueShield PPO Network, there is no need to file a claim. Your provider will file it on your behalf directly with BlueCross BlueShield. Important Note: The provider must include the “UEM” prefix when submitting claims on your behalf. If your provider has to file an inpatient and/or outpatient claim for substance/alcohol abuse, nervous/mental illness, or complementary care, you must have the service pre-authorized by The Wellness Corporation/MAP. Your provider should submit the claim to the Fund Office at the following address: The Massachusetts Laborers’ Health and Welfare Fund P.O. Box 4000 Burlington, MA 01803-0900
Weekly Accident and Sickness Benefit (for members only) can help replace lost income when an injury or illness prevents you from working.
Benefit	Provides a payment up to $39 a day or $273 per week for up to 13 weeks.
Eligibility	If you become totally disabled and unable to work because of: - any injury not arising out of or in the course of your employment; - any disease not entitling you to benefits under any Workers’ Compensation, occupational disease law, or similar legislation; or - any injury or disease not entitling you to automobile insurance wage continuation payments.
When Payments Start	If the disability is the result of an accident, payment starts the first day of disability. If the disability is the result of illness, payment starts the eighth day of disability. If the disability is related to pregnancy, payment starts the eighth day of disability.
Length of Payments	If you meet the eligibility requirements, you will receive up to 13 weeks for any one continuous period of disability that is due to the same or related cause(s). Refer to the Summary Plan Description for complete details.
Filing a Claim	You and your doctor must FULLY complete a Provider’s Green Claim Form and return that completed form to the Fund Office within 90 days of the date your disability began. If you and your doctor do not FULLY complete the claim form, it will be rejected.
Summary Plan Description

BACK

BlueCross BlueShield

Express Scripts

Davis Vision

Delta Dental of Massachusetts

The Wellness Corporation

Centers for Medicare & Medicaid Services (CMS)

Web MD

American Medical Association

Massachusetts Laborers' District Council

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.