What benefits does the Fund provide to retired members and/or their dependents?

If you are no longer actively employed due to retirement or a disability, you may be eligible for retiree benefits. The level and type of benefit coverage is based on whether you are eligible for Medicare coverage. To learn more, refer to retiree benefits information in the Member Benefits section and select the “Retiree” filter.

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What benefits does the Fund provide to active members and their dependents?

The Fund offers a comprehensive benefits package including:
- - Medical
  - Prescription Drug
  - Dental
  - Vision
  - HRA
  - Member Assistance Program (MAP)
  - Weekly Disability
  - Life and AD&D Insurance
  - Free & Clear Quit For Life® Program (smoking cessation benefit)
To learn more, refer to Member Benefits.

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Eligibility Questions

How do I become eligible for active Plan benefits?

If you are a bargaining unit employee, you become eligible for active Plan benefits based on the amount in your Dollar Bank. You become eligible for benefits after the minimum required amount has been credited to your Dollar Bank (without self-payment).

Refer to Eligibility for complete details on the requirements that apply to all active employees.

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How do I become eligible for retiree Plan benefits?

To be eligible for retiree benefits, you must:
- Retire from the industry (due to age or disability) under a qualified pension plan;
- Be at least age 57 1/2;
- Have been eligible for Plan benefits for at least 48 of the most recent 60 months, or for 96 of the most recent 120 months; and
- Have been eligible for Plan benefits at the time of retirement.
When you become eligible for retiree benefits, coverage is also available for your spouse and dependent children, if they were eligible for coverage at the time of your retirement.

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How can I find out if my dependent is eligible for Plan coverage?

In order for your dependents to be covered under the Fund, they must meet certain eligibility requirements. Refer to Eligibility for details.

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At what age is my child no longer eligible for coverage?

Refer to Eligibility for information on dependent eligibility.

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I’m retiring, can I continue my benefits?

To be eligible for retiree Plan benefits, you must:
- Retire from the industry under a qualified pension plan;
- Be at least age 57 1/2;
- Have been eligible for benefits for at least 48 of the most recent 60 months, or for 96 of the most recent 120 months; and
- Have been eligible for Plan benefits at the time of retirement.
When you become eligible for retiree benefits, coverage is also available for your spouse and dependent children, if they were eligible for coverage at the time of your retirement.

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I’m leaving covered employment, can I continue my benefits?

Yes, you may be able to continue coverage through COBRA. In most situations, if you want to continue coverage under COBRA, you must contact the Fund Office within 60 days from the date you and/or your dependent’s eligibility would otherwise end.

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What happens if my coverage lapses and I return to work?

If you leave covered employment and later return to work, you must again meet the initial eligibility requirements. Contact the Fund Office at 1-304-525-0331 or 1-888-466-9094 for more information.

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I’m getting married, what do I need to do?
- - Notify the Fund Office of your marriage by calling 1-304-525-0331 or 1-888-466-9094, or send an email to the Fund Office.
  - Complete a new Enrollment Form.
  - Submit a copy of your marriage certificate to the Fund Office.
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COBRA

What benefits will I have under COBRA?

If you elect COBRA Continuation Coverage, the Plan will provide Medical, Prescription Drug, Dental, Vision, and Life Insurance benefits coverage that is identical to that provided to employees and their dependents.

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If I continue benefits by making self-payments directly to the Fund, can I also get COBRA coverage?

No. Any period of time in which you continue your coverage by making self-payments directly to the Fund will be counted to reduce the continuation period you would be eligible for under COBRA.

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How much are the COBRA premiums?

The Fund Office will notify you of the cost of your COBRA Continuation Coverage when it notifies you of your right to coverage. The cost for COBRA Continuation Coverage is determined by the Board of Trustees on a yearly basis and will not exceed 102% of the cost to provide this coverage. The cost for extended disability coverage (from the 19th month through the 29th month) is an amount determined by the Trustees, not to exceed 150% of the cost to provide coverage.

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How long can I be covered under COBRA?

You may continue your Medical, Prescription Drug, Dental, Vision, and Life Insurance benefits for 18 months, 29 months, or 36 months, if applicable. Click here for full details about COBRA Continuation Coverage.

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Medical Questions

Is there a program to help me after a hospital stay?

Yes. The Transition Care Program and a Care Assist Program are for participants who have been admitted to the hospital. This program helps you navigate the post-discharge health care system and stay healthy to avoid hospital readmission. They will contact you if you have been admitted to a hospital to assist with coordinating your post-discharge care. Or, if you know you are going to be admitted, call the Transition Care Line at 1-800-554-0281 to arrange for assistance in advance.

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What type of services does the Transition Care Program and a Care Assist Program provide?

Services include:
- - General assistance with post-discharge needs. Navigation Specialists are available to answer questions and provide support.
  - Schedule medical appointments. They can schedule your follow-up doctor visits, as well as facilitate communication and coordinate care with your providers.
  - Locate health care providers. If you need care your provider doesn’t offer, they can locate appropriate alternate providers.
  - Coordinate delivery of medical records. You can have your medical records delivered to your doctor for follow-up appointments.
  - Assist with community resources. They can connect you with community resources to facilitate your care and recovery.
  - Coordinate prescription fills. Discharged patients often require one or more medications. They can help get your prescriptions filled and see that you receive them.
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What are my medical benefits?

If you are a regular, active member, your medical plan is determined by the contribution paid by your employer as required by your collective bargaining agreement. Your medical benefits are provided under either the Building Trades Plan (also known as the Comprehensive Major Medical Plan) or the Flexible Choice Plan.

If you are a member of the CW/CE classification, your medical plan is the Flexible Choice Plan.

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Can somone act on my behalf when I need medical care?

You can appoint an authorized representative by following the Fund’s policy as outlined in the March 1 Notice.

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Does the Fund offer access to a PPO network?

Yes. The Fund contracts with Highmark Blue Cross Blue Shield in order to provide members with access to the BCBS PPO network. To locate a network doctor, hospital or facility, go to www.highmarkbcbswv.com or call 1-800-810-2583.

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How can I find a network doctor or hospital?

To locate a Highmark Blue Cross Blue Shield doctor, hospital or facility, go to www.highmarkbcbswv.com or call 1-800-810-2583.

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What percentage of my medical expenses will the Plan cover?

Generally, after the deductible, the Plan covers 80% of covered medical expenses for PPO providers and all emergency medical care and 60% for non-PPO providers. Note: Emergency medical care received at non-PPO hospitals is covered as in-network care at 80%. For a summary of medical benefit coverage, refer to Medical Benefits.

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What are the Plan’s medical deductible and out-of-pocket maximum amounts?

Each year the Plan covers a portion of eligible expenses after you satisfy the calendar year deductible. Refer to the Benefit Summary for each medical plan for details. Generally, charges applied to the in-network deductible will also apply to the out-of-network deductible and vice versa. The out-of-pocket maximum includes the deducible expense. Amounts applied to the in-network out-of-pocket maximum will also apply to the out-of-network out-of-pocket maximum and vice versa. In addition, once you reach the out-of-pocket maximum, the Plan covers 100% of eligible expenses for the remainder of the calendar year.

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HEALTHY LIFE Program

What is the HEALTHY LIFE Program?

HEALTHY LIFE is a voluntary program for Fund members and their covered spouses that significantly reduces the amount you pay for medical benefits in exchange for taking preventive steps to safeguard your health.
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What do I have to do?

You and your covered spouse must each complete a physical exam every two years, by November 30, to be eligible for HEALTHY LIFE. During the exam, your doctor will measure your height and weight, blood pressure, resting pulse rate, and waist circumference. You’ll give a blood sample to test your cholesterol, triglycerides, and blood sugar and blood count. Your doctor will also ask about your use of nicotine and request a urine sample to test for kidney disease. You will not be tested for drug use during your exam. There is no enrollment required to complete the HEALTHY LIFE.

HEALTHY LIFE eligibility lasts for two years. For example, if you completed your HEALTHY LIFE requirements in 2019, you are eligible for HEALTHY LIFE savings starting January 2020 and you do not need to complete the requirements again until 2021. If you complete the requirements in 2020, you do not need to complete them again until 2022.
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Can anyone participate?

The HEALTHY LIFE Program is for members and their covered spouses who are in the Building Trades Plan. If you are married, your spouse must participate in order for your family to be eligible for the HEALTHY LIFE Children do not have to complete the physical exam or tests for a family to be eligible for the incentives.
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What is the deadline for completing the HEALTHY LIFE exam?

You and your covered spouse must each complete a physical exam every two years, by November 30, in order to be eligible for the incentives that go into effect on the following January 1.
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Does the November 30 deadline apply if I’m a new member?

If you are a first year hire, you and your spouse will have until November 30 of the following year to complete your physical exams. Your HEALTHY LIFE savings will go into effect the plan year after you meet the requirements.
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Do I have to pay for the physical exam?

As long as you go to an in-network provider, the Fund covers the cost of preventive exam services at 100%. During your visit, ask your doctor to code the visit as a preventive visit. If your provider sends you out of the office for lab work, you should confirm that the lab is part of the network as well.
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What should I expect during the exam?

Your doctor will measure your height, weight, blood pressure, resting pulse rate, waist measurement and your use of nicotine, among other things. You may want to use this reference card as a guide and to help track your results. You will not be tested for drug use during your physical exam. Test results are not used for employment decisions or to determine eligibility for benefits.
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Why is the Fund launching this program?

The Fund believes that preventive care is so important and so simple, they want to reward members who take steps to safeguard their health. The health screenings and tests you receive during a physical exam can help detect early signs of some serious health concerns. In fact, should a health concern be identified, early detection is critical to successful treatment and prognosis as well as lower health care costs in the future.
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What if I don’t want to participate?

The HEALTHY LIFE Program is voluntary. If you and/or your spouse choose not to participate, you will not be eligible for the savings and you will pay a greater portion of your health care costs.
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Will my employer or union see a copy of my results?

The privacy of your personal health information is very important. Your employer and union do not have access to your health information or your decision to participate in the HEALTHY LIFE Program. The aggregate data provided to the Fund is what triggers your qualification for the Program’s enhanced benefits.
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Can I go to my own doctor?

The Fund covers the cost of preventive exam services at 100% if you visit an in-network provider. To confirm if your provider participates in the network, you can call 1-800-810-2583 or visit www.highmarkbcbswv.com and click on “Find a Doctor or Pharmacy.” If your doctor sends you out of the office for lab work, confirm that the lab is also part of the network.

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Do I have to fill out any forms?

There are no forms to fill out or return. The Fund will track participation through the claims process.
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Can my kids participate?

While it is recommended, and a good practice, for your children to get their annual exams, they are not required to participate in the HEALTHY LIFE program for you to be eligible for the incentives.
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How long do the better benefits last?

HEALTHY LIFE benefits last for two years, which means if you and your covered spouse each complete the exam and tests by November 30, 2019, you will be eligible for the HEALTHY LIFE incentives from January 1, 2020 through December 31, 2021.
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What happens at the end of this two-year period?

At the end of this two-year period, you will be required to complete another physical exam in order to continue saving.
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Prescription Drug Questions

I’m retired. Am I eligible to receive prescription drug benefits?

Yes. If you are retired and not eligible for Medicare, you and your dependents will be eligible to receive the same prescription drug coverage as active participants.

If you are Medicare-eligible and enrolled in the Fund’s Medicare Advantage Plan, prescription drugs are covered. The prescription drug plan has a secondary level of coverage through Sav-Rx. The two prescription drug plans work together to provide the greatest level of benefits. For example, if a medication is not covered by the Medicare Advantage Plan, it should be covered by the Sav-Rx plan.

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How can I find a network pharmacy?

To find a Sav-Rx retail pharmacy, call 1-866-233-IBEW (4239) or go to www.savrx.com (you will need to enter “IBEWD4” for the group number).

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Who should I call if I have a question about my prescription drug benefits, the Fund or Sav-Rx?

You can call Sav-Rx at 1-866-233-IBEW (4239)

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Vision Questions

Does the Fund offer access to a vision network?

Yes. The Fund provides vision care exam benefits for you and your family through an arrangement with VSP.

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Are my spouse and/or children eligible for vision coverage?

Yes. Vision care benefits are available to you and your family.

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Does the Plan cover vision exam services that are not provided by a network provider?

Yes. However, you may be responsible for the difference between the amount applicable under the VSP plan and the amount actually charged for the exam by the non-VSP network provider. Refer to Vision Benefits page for more information.

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Are eye exams free?

The Building Trades Medical Plan and the Flexible Choice Medical Plan each cover one exam per year, if performed by an VSP provider.

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I need to find an optometrist in my area. What should I do?

To locate a participating VSP provider, visit vsp.com or call 1-800-877-7195.

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If I retire, will I still have coverage for vision care?

Yes, but only if you are not eligible for Medicare. When you become eligible for Medicare, you will have coverage for certain vision expenses under Medicare Part B.

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Dental Questions

Does the Fund offer access to a dental network?

Yes. The Fund works with Delta Dental of Ohio to administer your dental benefit plan. This means you’ll have access to two networks of providers who have agreed to accept negotiated, discounted fees for their services. The Delta Dental network is comprised of the Delta Dental PPO, which offers a smaller network of providers but has deeper discounts; and the Delta Dental Premier, which offers a larger number of participating providers but lower discounts. When you seek care from a dentist in either network, you’ll see a significant savings on your dental bill and out-of-pocket payments.

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How do I know if my dentist is in the network?

To see if your dentist participates in one of the Delta Dental Networks, visit www.deltadentaloh.com and follow these instructions:

1. Click the “Find a Dentist” link in the upper right corner or the green button at the bottom of the page.

2. Click the “Delta Dental PPO or Premier Network” link.

3. Select the “Delta Dental PPO” button or the “Delta Dental Premier” button (you have access to both networks), and enter your city and state or zip code.

4. You can filter your search results by distance, dental specialty, languages spoken, gender or extended hours. You may also search for a dentist by name.

5. Click “Search for a Dentist” to view your results.

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How do I save money by visiting a dentist in the network?

You save money because network dentists have agreed to accept negotiated, discounted rates for their services. To see an example of how you can save by going in-network, go to the Dental Benefits page.

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What is the calendar year maximum?

The calendar year maximum is the most the Plan will pay for your dental benefits in any given year.

If you are in the Building Trades Plan or the Flexible Choice Plan and you stay in network, your calendar year maximum is $900. If you choose to see an out-of-network dentist, Delta Dental’s discounted rates do not apply and your calendar year maximum will drop to $750 and, you will be responsible for any amount over the maximum non-participating dentist fee.

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Will I have to pay a deductible for dental care?

There is no deductible for preventive services. The Fund pays 100%, up to the reasonable and customary charge, for preventive services you receive, such as oral exams and routine cleanings. However, a calendar year deductible does apply for non-preventive services if you are enrolled in the Building Trades Plan (also known as the Comprehensive Major Medical Plan) . Dental benefits under the Flexible Choice Plan cover preventive care services only (i.e., there is no coverage for non-preventive services). Refer to Dental Benefits.

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Are my spouse and/or children eligible for dental coverage?

Yes.

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Are dental exams and cleanings free?

Yes. The Plan covers dental exams and cleanings 100% twice in a calendar year, subject to the reasonable and customary charge.

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If I retire, will I still have coverage for dental care?

Yes, but only if you are not eligible for Medicare. When you become eligible for Medicare, you will have coverage for certain dental expenses under Medicare Part B.

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HRA Questions

How is the HRA funded?

Your employer contributes toward an HRA on your behalf for each hour you work. This contribution is part of the negotiated employer hourly contribution to the Plan.

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What happens to the money left over in my account at the end of the year?

Any unused HRA balance is rolled over from year to year, so it is possible to use these accumulated funds to pay for larger expenses you may have in the future, including self contributions.

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Should I save my receipts?

You are strongly encouraged to save all your receipts and any Explanation of Benefits (EOBs) from other group medical coverage you may have. There is a chance that American Benefit Corporation may ask for a copy at some point. In fact, if you want, you can mail or fax your receipts to American Benefit Corporation immediately after using your HRA Debit Card. The system will be updated so that when the change is processed, the substantiation required, including EOBs, will already be recorded and no follow-up will be necessary. You can mail you receipts to American Benefit Corporation, HRA Department, 3150 US Route 60, Ona, WV 25545 or fax to 304-525-6005.

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Can I check the status of my transactions online?

You can track your current account balance and pending transactions through the HRA Debit Card site.

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How do I get reimbursement from my HRA?

Please refer to Health Reimbursement Arrangement page and the Health Reimbursement Arrangement SPD for information.

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Dollar Bank Questions

What’s my dollar bank balance?

You can review your dollar bank balance by logging in to the Member Dashboard from the home page.

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How long until my balance is exhausted?

Log in to the Member Dashboard from the home page to determine when your dollar bank will be exhausted, assuming no additional contributions are paid by an employer.

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Claim Questions

Where should I go to review the status of a medical claim?

You can review the status of your claim and get information about your out-of-pocket costs by logging in to the Member Dashboard.

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How can I find out how much I have accumulated toward my medical deductible or out-of-pocket limits?

You can get information about your medical deductible and your out-of-pocket costs by going to the Member Dashboard Login.

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Where should I go to review the status of a dental claim?

You can review the status of your claim and get information about your out-of-pocket costs by going to the Member Dashboard Login.

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What happens if my claim is denied?

If your claim is denied, you have a right to appeal your claim. You must file your appeal within certain time frames. For details on the claims appeal process, refer to your medical plan’s Summary Plan Description on the Forms & Documents page or contact the Fund Office at 1-304-525-0331 or 1-888-466-9094.

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How do I file a claim?

How you file a claim depends upon the type of service you receive (medical, prescription drug, dental, vision, etc.). Claim forms for each plan are available on the Forms & Documents page.

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How do I apply for Weekly Disability benefits?

Please refer to Weekly Disability Claims for information.

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Mental Health/Substance Abuse Questions

Which providers should I use for mental health and/or substance abuse treatment?

Lyra Health is the network provider for mental health and substance abuse treatment. The network is nationwide and consists of professional therapists, coaches, and physicians. To find a provider, call Lyra Health at 1-877-363-0489.

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How can I find a therapist that handles mental health and/or substance abuse problems?

The Lyra Health network consists of professional therapists, counselors, and physicians. To find a provider, call Lyra Health at 1-877-363-0489.

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Does the Plan cover outpatient treatment for mental health and/or substance abuse?

Yes, the Plan covers outpatient treatment for mental health and substance abuse. However, before receiving treatment, you must contact Lyra Health for a referral. If you fail to obtain an in-network referral from Lyra Health, your future claims will be paid at the out-of-network benefit level. To get a referral to an in-network provider, call Lyra Health at 1-877-363-0489.

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Does treatment for mental health and/or substance abuse have to be pre-approved?

Yes, inpatient mental health and substance abuse treatment must be pre-authorized through Lyra Health. You must contact Lyra Health before a hospital admission, except in the case of an emergency. If your hospitalization is emergent, you must call Lyra Health within 72 hours of the hospital admission. Failure to obtain the required pre-authorization may result in penalties. To pre-authorize your care, call American Health Holding at 1-866-898-9354.

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How do I get a referral to an in-network mental health and/or substance abuse provider?

To get a referral to an in-network provider, call Lyra Health at 1-877-363-0489.

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When do I call for inpatient mental health and/or substance abuse treatment?

You must contact Lyra Health before a hospital admission, except in the case of an emergency. If your hospitalization is emergent, you must call Lyra Health within 72 hours of the hospital admission. Failure to obtain the required pre-authorization may result in penalties. To pre-authorize your care, call American Health Holding at 1-866-898-9354..

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Smoking Cessation Questions

Are my children eligible for the smoking cessation benefit?

Only your adult dependents are eligible to participate in the Free & Clear Quit For Life® Program. Click here for more information about the Fund’s smoking cessation benefit or visit www.freeclear.com.

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I need help to quit smoking. How many times can I speak with a counselor?

Services through the Free & Clear Quit For Life® Program include up to five coaching calls from a Quit Coach. These services are provided at no cost to you. Click here for more information about the Fund’s smoking cessation benefit or visit www.freeclear.com.

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Does the Plan’s smoking cessation benefit cover the cost of prescription drugs?

The Free & Clear Quit For Life® Program is provided at no cost to you, but coverage does not include costs for prescription drugs. The program does include (among other things) non-prescription Nicotine Replacement Therapy (such as the patch, gum, or lozenges) upon recommendation of a Quit Coach. Prescription smoking cessation products will be subject to the copayments and limitations outlined in the Prescription Drug Benefit Summary.

Click here for more information about the Fund’s smoking cessation benefit or visit www.freeclear.com.

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Make the Most of Your Prescription Plan

Benefit Tips

Frequently Asked Questions

General Questions

Eligibility Questions

COBRA

Medical Questions

HEALTHY LIFE Program

Prescription Drug Questions

Vision Questions

Dental Questions

HRA Questions

Dollar Bank Questions

Claim Questions

Mental Health/Substance Abuse Questions

Smoking Cessation Questions

General Questions

What benefits does the Fund provide to retired members and/or their dependents?

What benefits does the Fund provide to active members and their dependents?

Eligibility Questions

How do I become eligible for active Plan benefits?

How do I become eligible for retiree Plan benefits?

How can I find out if my dependent is eligible for Plan coverage?

At what age is my child no longer eligible for coverage?

I’m retiring, can I continue my benefits?

I’m leaving covered employment, can I continue my benefits?

What happens if my coverage lapses and I return to work?

I’m getting married, what do I need to do?

COBRA

What benefits will I have under COBRA?

If I continue benefits by making self-payments directly to the Fund, can I also get COBRA coverage?

How much are the COBRA premiums?

How long can I be covered under COBRA?

Medical Questions

Is there a program to help me after a hospital stay?

What type of services does the Transition Care Program and a Care Assist Program provide?

What are my medical benefits?

Can somone act on my behalf when I need medical care?

Does the Fund offer access to a PPO network?

How can I find a network doctor or hospital?

What percentage of my medical expenses will the Plan cover?

What are the Plan’s medical deductible and out-of-pocket maximum amounts?

HEALTHY LIFE Program

What is the HEALTHY LIFE Program?

What do I have to do?

Can anyone participate?

What is the deadline for completing the HEALTHY LIFE exam?

Does the November 30 deadline apply if I’m a new member?

Do I have to pay for the physical exam?

What should I expect during the exam?

Why is the Fund launching this program?

What if I don’t want to participate?

Will my employer or union see a copy of my results?

Can I go to my own doctor?

Do I have to fill out any forms?

Can my kids participate?

How long do the better benefits last?

What happens at the end of this two-year period?

Prescription Drug Questions

I’m retired. Am I eligible to receive prescription drug benefits?

How can I find a network pharmacy?

Who should I call if I have a question about my prescription drug benefits, the Fund or Sav-Rx?

Vision Questions

Does the Fund offer access to a vision network?

Are my spouse and/or children eligible for vision coverage?

Does the Plan cover vision exam services that are not provided by a network provider?

Are eye exams free?

I need to find an optometrist in my area. What should I do?

If I retire, will I still have coverage for vision care?

Dental Questions

Does the Fund offer access to a dental network?

How do I know if my dentist is in the network?

How do I save money by visiting a dentist in the network?

What is the calendar year maximum?

Will I have to pay a deductible for dental care?

Are my spouse and/or children eligible for dental coverage?

Are dental exams and cleanings free?

If I retire, will I still have coverage for dental care?

HRA Questions

How is the HRA funded?

What happens to the money left over in my account at the end of the year?

Should I save my receipts?