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Benefit Changes
Effective June 1 and July 1, 2007
The Board of
Trustees of the Central Pennsylvania Teamsters Health & Welfare Fund
announces benefit changes to the Health & Welfare Plans. The benefits
have been changed to provide participants with coverage that remains
competitive with other Teamsters Funds as well as with other health
benefit plans in the region.
The following is
intended as a summary of the benefits changes only. Please note there
are separate summaries of benefit changes for both active and retired
participants. Look under the “Summary of Benefits” link on this
website for a summary of all benefits (including the benefits listed
below) for each plan. Contact the Fund Office if you have additional
questions.
Active Participants
in Plans 13, 14 and 16 (for those Participants under Plans 14 and 16
that have the Optional coverage referred to in each section below):
Benefits Effective
June 1, 2007:
Immunization
Benefits:
Effective June 1, 2007, all immunizations
recommended by the Centers for Disease Control for your eligible
children (through age 23 for full-time students) will be covered. If
you use a participating provider, the Fund will pay the network amount
in full. If you use a non-network provider, the Fund will pay benefits
equal to the lesser of the UCR or the billed amount. You will be
responsible for any amounts over the UCR schedule. Previously, the
Fund only paid immunizations for children under age 6 as stated above.
For children age 6 and over, the Fund paid up to a maximum combined
benefit of $25 towards the immunization and office visit.
Transplant Benefits:
Effective June 1, 2007, transplant benefits have been improved. The
Fund will now pay a maximum of $300,000 for costs related to
transplants occurring on or after June 1, 2007, as measured from the
date of the transplant surgery, through six weeks from the date of
surgery. Thereafter, the patient’s claims will be payable under the
medical provisions of the Plan (including prescription,
hospitalization, physician office visit, etc.). Previously, the Fund
applied a $200,000 cap on all costs related to a specific
transplant, regardless of when they were incurred.
Wheelchair
Benefits:
Effective June 1, 2007, the Trustees have removed the $400 wheelchair
cap. The Fund previously set the maximum amount payable for a
wheelchair at $400, subject to Major Medical deductible and
co-insurance for durable medical equipment. Keep in mind that the Fund
will continue to pay benefits for only one wheelchair per lifetime and
is subject to any applicable co-pays and deductibles under Major
Medical.
Chiropractor Visit
Benefits:
Effective June 1, 2007, the Trustees increased the benefits for
chiropractic visits. The Fund will now pay a maximum of $25 per visit
for up to 20 visits per Benefit Year per eligible family member.
The maximum benefit was increased to $500 per person per year.
Previously, the Fund limited payments to $25 per person per visit to
an annual maximum of $400 per family per year.
Dental Benefits:
For services rendered on or after June 1, 2007, the annual benefit
maximum for each eligible family member has been raised from $750 to
$1,000 for Plan 13. Under Plans 14 and 16, if you have dental coverage under
Option A, your annual benefit maximum for each eligible family member
will increase from $750 to $1,000; under Option B, that cap is
increased from $600 to $800; and under Option C, the cap is increased
from $450 to $600.
In addition, the
Fund has worked with Delta Dental to revise the payment schedule for
those patients electing to use non-Delta Dental providers. The
Trustees have updated the reimbursement schedule for non-Delta Dental
providers for most services. Remember, however, that you receive the
greatest dental benefit by using a Delta Dental provider.
Orthodontic
Benefits:
Effective June 1, 2007 (for eligible dependent children 18 years of
age and under), the orthodontic benefit maximum will be raised from
$2,000 to $3,000 if you use a Delta Dental provider. The increased
benefit amount applies to braces placed on or after June 1, 2007.
If you use a
non-Network provider, the benefit maximum remains at $2,000.
Effective July 1,
2007:
Death and
Accidental Death and Dismemberment Benefits: Previously, under Plan 13 and Plans 14 and 16 Option A, the Fund paid
$25,000 each for death and accidental death and dismemberment
benefits. Effective July 1, 2007, the death and accidental death and
dismemberment benefit has been raised to $35,000 for Plan 13 and for
Plans 14 and 16 Option A. Benefits under Plans 14 and 16 Option B have been raised to
$20,000 and to $10,000 under Option C. In addition, the benefits
payable upon the death of a child were raised from $1,000 to $2,000.
The benefits payable upon the death of a spouse remain at $2,000.
Emergency Room –
New Co-payment:
The Trustees have learned that many Participants and their families
use a hospital emergency room for services that they should receive
from their family physician. Unfortunately, an ER physician cannot
give the patient the same level of service and follow-up that is
available from a family physician. Moreover, the cost of emergency
room services is often four times as much as the same (or better)
service from a family physician. Therefore, effective July 1,
2007, there will be a Fifty Dollar ($50) co-payment for emergency room
visits. However, if the patient is admitted to the hospital
immediately following emergency room care, the co-payment will be
waived.
For Retired
Plans R-4 and R-5:
Benefits
Effective June 1, 2007:
Immunization
Benefits:
Effective June 1, 2007, all immunizations
recommended by the Centers for Disease Control for your eligible
children (through age 23 for full-time students) will be covered. If
you use a participating provider, the Fund will pay the network amount
in full. If you use a non-network provider, the Fund will pay benefits
equal to the lesser of the UCR or the billed amount. You will be
responsible for any amounts over the UCR schedule. Previously, the
Fund only paid immunizations for children under age 6 as stated above.
For children age 6 and over, the Fund paid up to a maximum combined
benefit of $15 towards the immunization and office visit.
Wheelchair
Benefits:
Effective June 1, 2007, the Trustees have removed the $400 wheelchair
cap. The Fund previously set the maximum amount payable for a
wheelchair at $400, subject to Major Medical deductible and
co-insurance for durable medical equipment. Keep in mind that the Fund
will continue to pay benefits for only one wheelchair per lifetime and
is subject to any applicable co-pays and deductibles under Major
Medical.
Chiropractor Visit
Benefits:
Effective June 1, 2007, the Trustees increased the benefits for
chiropractic visits. The Fund will now pay a maximum of $15 per visit
for up to 17 visits per Benefit Year per eligible family member.
Previously, the Fund limited payment to an annual maximum of $200
per family per year, at a maximum per visit fee of $15.
Benefits Effective
July 1, 2007:
Emergency Room –
New Co-payment:
The Trustees have learned that many Participants and their families
use a hospital emergency room for services that they should receive
from their family physician. Unfortunately, an ER physician cannot
give the patient the same level of service and follow-up that is
available from a family physician. Moreover, the cost of emergency
room services is often four times as much as the same (or better)
service from a family physician. Therefore, effective July 1,
2007, there will be a Fifty Dollar ($50) co-payment for emergency room
visits. However, if the patient is admitted to the hospital
immediately following emergency room care, the co-payment will be
waived.
For Retired Plan
R-2:
Benefits Effective
June 1, 2007:
Immunization
Benefits:
Effective June 1, 2007, all immunizations
recommended by the Centers for Disease Control for your eligible
children (through age 23 for full-time students) will be covered. If
you use a participating provider, the Fund will pay the network amount
in full. If you use a non-network provider, the Fund will pay benefits
equal to the lesser of the UCR or the billed amount. You will be
responsible for any amounts over the UCR schedule. Previously, the
Fund only paid immunizations for children under age 6 as stated above.
For children age 6 and over, the Fund paid up to a maximum combined
benefit of $15 towards the immunization and office visit.
Emergency Room –
New Co-payment: Plan
R-2 provides emergency room treatment coverage for accidents but not
for illnesses. Effective July 1, 2007, there will be a Fifty Dollar
($50) co-payment for emergency room visits for accidents. If the
patient is admitted to the hospital immediately following the
emergency room visit for treatment of an accident, the co-payment will
be waived.
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