Health & Welfare

Please be aware that the Fund will not cover medical services rendered as a result of driving with a blood alcohol limit at or in excess of the applicable limit; as coincident with your ingesting an illegal substance (except for medically necessary substance abuse benefits); or coincident with your participation in an illegal activity, regardless of whether the activity can be characterized as a misdemeanor or felony.

Please refer to your Summary Plan Description for a description of exclusions.

The Health and Welfare Fund does not cover participants or their eligible dependents for illnesses or injuries that arise as a result of performing non-covered employment for wage or profit. Any time such service is rendered for wage or profit, there are no benefits (i.e. medical, short-term disability, etc.) payable by the Fund. Non-covered employment means any employment for which contributions are not made to the Fund. Unfortunately, in the past, there have been cases where an individual was performing odd jobs, i.e. painting, roofing, etc. for which they received payment. The individual was injured while performing the job and as a result, all bills and short-term disability benefits were denied. If you or your spouse intend to render services or be self-employed in any capacity for which a wage or profit is received, you must have the appropriate liability coverage to cover any injuries or illnesses which arise as a result of performing such services.

The Trustees of the Central Pennsylvania Teamsters Health & Welfare Fund (“Fund”) believe that it is each person’s responsibility to become knowledgeable about his or her medical conditions, the available treatments and the physicians and hospitals providing treatment for these conditions. There are many sources of information, including those that can be accessed through the Internet. The Trustees urge you to review the information you gather critically and carefully.

The Fund’s website offers links to a number of websites that can offer general information. The PHC4 link will provide you with access to reports developed by the Pennsylvania Health Care Cost Containment Council, an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of health care, and increasing access for all citizens regardless of ability to pay. The PHC4 reports rank hospitals and providers on the outcomes of several kinds of procedures. The information given by these websites is general information and not medical advice and is not intended as a substitute for medical care provided by a physician. In addition, no information in the PHC4 report is intended to encourage or discourage a patient from receiving services from any particular physician or hospital. Because of that, the Trustees and the Fund assume no responsibility for any decision you may make arising out of the use, misuse, interpretation or application of any information or other material provided on this site.

http://www.phc4.org/

Pre-certification is required for all non-emergency hospital admissions and surgery and most out-patient surgeries. MRI’s, CAT Scans and PET Scans do not require pre-certification. Please call the Fund Office if you have questions regarding the necessity of pre-certification in a particular situation.

Plan medical advisors make the final pre-certification determination. American Health Holding (AHH) reviews pre-certification requests for the Plan’s medical benefits.

If you are using a Network physician, it is the doctor’s responsibility to contact the Fund Office and follow its instructions to obtain pre-certification. If you use a non-Network provider, it is your responsibility to contact the Fund Office and follow its instructions to obtain pre-certification.

If you have emergency surgery, you or your provider must notify the Fund Office within 2 business days after treatment/hospitalization.

Please note: Pre-certification approval does not automatically mean that a claim will be approved. The Trustees reserve the right to deny benefits if subsequent information leads the Plan’s professional advisors to conclude that the treatment was not medically necessary.

To pre-certify, you must call the Fund Office at 610-320-5500, toll-free in PA at 1-800-422-8330 or toll-free nationwide at 1-800-331-0420.