Your employer pays the cost of this coverage. It is NOT a deduction from your hourly wage, but a contribution over and above your hourly wage. There are no premium payments made by you or any of your eligible dependents for this coverage while you meet the eligibility requirements. If you fail to meet these requirements, you will be allowed to pay to continue your coverage. It’s possible that you will not be eligible for benefits three months from the date that you begin working.
Availability of benefits is based on employment. If the Fund Office receives contributions for 135 hours worked during one month, you will be eligible for benefits for one month, but three months ahead. For example, if 135 hours are reported for June, you will be eligible for benefits in September.
Prior to the start of your eligibility, you will be sent notification from the Fund Office as well as more detailed information regarding the benefits summarized below. These benefits are available for you and your family when medically necessary and not the result of a work related accident.
After you have met the yearly deductible of $150 per person or $300 per family, we pay 80% of the plan allowance for:
- doctor visits
- preventive services and wellness benefits for children
- annual pap smear
- annual mammogram for women age 35 or over
- annual physical exam for members and their spouses
- diagnostic laboratory and pathology tests
- surgeons' fees in or out of the hospital
- emergency medical care expenses
- anesthesiologists' charges
- equipment such as splints, braces and crutches
- chiropractic care and physical therapy
- inpatient and outpatient mental health benefits including alcohol/substance abuse with prior approval
The first $7000 of covered expenses is paid at 100% of the allowance (no deductible) per spell of illness with the remaining covered expense paid at 80% of the allowed amount. This includes outpatient hospital stays as well.
Prescription Drug Program
When you use your card at a participating pharmacy, you pay $10 for generic drugs, $25 for preferred drugs and $35 for non-preferred for a 34 day supply. Most grocery store pharmacies and drug store pharmacies are participating pharmacies. Purchasing your maintenance medication (medication that you take on an on-going basis, such as blood pressure medicine or insulin) by mail order costs $20 for generic, $50 for preferred and $70 for non-preferred for a 90 day supply.
Employee Assistance Plan
8 free confidential counseling sessions to discuss problems regarding:
- substance abuse
- legal concerns
- additional psychiatric benefits available with required referral from EAP provider
The plan pays up to 100% Network (80% Non-network) of the allowance for basic services such as:
- exams (once every six months)
- cleaning (once every six months)
- fluoride treatments (once each 12 months)
The plan pays up to 80% Network (80% Non-network) of the allowance for basic services such as:
- oral surgery
Additionally, the Plan pays 80% Network (50% Non-network) of the allowance for major services such as:
- inlays and crowns
- removable bridges
There is a maximum reimbursement of $2,000 per person per year. Orthodontics are not covered.
The Plan pays 100% of the allowance for a complete vision service (exam, frames and lenses) once every two years if you use a participating provider.
Hearing aid allowance every three years.
Death, Disability and Dismemberment Benefits
These benefits are available only to the employee -- not to the dependents. The Plan pays:
- $25,000 death benefit for active employees
- $6,000 death benefit for retired employees
- Short term disability benefits are payable for thirteen weeks at the rate of 50% of gross pay to a maximum of $260 per week. An additional thirteen weeks is also available at 40% of gross pay up to a maximum of $210 per week.
- Supplemental Worker's Compensation Accident Benefits ensure that you receive the same benefits regardless of where the accident occurs.
Electrical Welfare Trust Fund
Local calls: (301) 731-1050