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Benefit Summary: Comprehensive Major Medical Plan

 

Building Trades Plan Benefit Summary for Active Employees and Dependents (also known as the Comprehensive Major Medical Plan)
Benefit Coverage
Calendar Year Deductible
PPO Providers $350 per person; $1,050 per family
Non-PPO Providers $700 per person; $2,100 per family
Note: Eligible expenses are cross applied to both the in-network and out-of-network deductibles.
Coinsurance
PPO Providers & all Emergency Care (Note: Emergency medical care received at a non-PPO hospital is paid at in-network coinsurance level.) Fund pays 80% of covered expenses after deductible. IHD will contact you if you have been admitted to a hospital to assist with coordinating your post-discharge care.
Non-PPO Providers Fund pays 60% of covered expenses after deductible
Calendar Year Medical Out-of-Pocket Maximum (Including the Deductible)
For non-Medicare retirees and dependents
PPO Providers $2,000 per person; $4,000 per family
Non-PPO Providers $7,500 per person or family
For Active Members
PPO Providers $3,750 per person or family
Non-PPO Providers $7,500 per person or family
Calendar Year Prescription Drug Out-of-Pocket Maximum
For non-Medicare retirees and dependents
PPO & Non-PPO Providers $4,600 per person; $9,200 per family
For Active Members
PPO Providers $2,850 per person; $9,450 per family
Non-PPO Providers Unlimited
Note: Any amount you pay toward eligible health care services and supplies you receive in-network and/or out-of-network will be cross applied to and accumulate toward your out-of-pocket maximum.
Lifetime Maximum for All Covered Expenses (Excluding Substance Abuse Treatment and Home Nursing Care) Unlimited
Adult Well Care*
Annual routine physical exam (including associated laboratory and radiology services) and adult immunizations (includes office visit expense) Fund pays 100% of covered expenses. Deductible does not apply.
Diagnostic sigmoidoscopy Fund pays 100% of covered expenses. Deductible does not apply. Once per 3 calendar years beginning at age 50.
Diagnostic colonoscopy (provided in accordance with American Cancer Society guidelines) Fund pays 100% of covered expenses. Deductible does not apply.
Additional covered preventive services for adults are listed in the June 1 Plan Changes Notice.
Adult Female Care*
Annual gynecological exam and pap smear (including office visit expense) Fund pays 100% of covered expenses. Deductible does not apply.
Mammography screening (1 baseline: age 35 to 40; annually: age 40+) Fund pays 100% of covered expenses. Deductible does not apply.
HPV testing Fund pays 100% of covered expenses. Deductible does not apply.
Bone density testing for osteoporosis $250; balance covered at 80%. Deductible does not apply.
Adult Male Well Care*
Annual prostate exam (including PSA test) Fund pays 100% of covered expenses. Deductible does not apply.
Child Well Care*
Routine new baby care for children less than age 2 (for hospital and office visits, laboratory, and radiology services) Fund pays 100% of covered expenses. Deductible does not apply.
Routine physical exam for children age 2 through 18 (for office visits, laboratory, and radiology services) Fund pays 100% of covered expenses. Deductible does not apply.
Necessary immunizations Fund pays 100% of covered expenses. Deductible does not apply.
HPV vaccine for girls and boys between the ages of 9 and 26 Fund pays 100% of covered expenses. Deductible does not apply.
Also see the Advisory Committee on Immunization Practices page on the Centers for Disease Control and Prevention website for additional immunization and vaccine information.
*Note: You must use PPO providers when receiving preventive, well-care services.
Chiropractic Care
PPO Providers Fund pays 80% of covered expenses after deductible
Non-PPO Providers Fund pays 60% of covered expenses after deductible
Calendar Year Maximum $500 per calendar year per person
Organ Transplant Benefit
Blue Distinction Providers Fund pays 100% of covered expenses
PPO Providers Fund pays 80% of covered expenses after deductible
Non-PPO Providers Not covered
Behavioral Health Treatment(pre-certification required)**
Lifetime Maximum for Substance Abuse Treatment Unlimited
Mental Health/Substance Abuse Outpatient Treatment PPO Providers: Fund pays 80% of covered expenses after deductible. Non-PPO Providers: Fund pays 60% of covered expenses after deductible
Mental Health/Substance Abuse Inpatient Treatment If pre-certified: Covered same as any other illness.

If not pre-certified: A $250 per confinement penalty will apply.

Outpatient Laboratory Program
Laboratory testing at any in-network facility (Lab One or Anthem Blue Cross Blue Shield PPO providers) Fund pays 100% of covered expenses. Deductible does not apply.
Laboratory testing at a non-PPO Provider Fund pays 60% of covered expenses after the deductible.
Member Assistance Program, provided by ComPsych
Member Assistance Program (MAP) Visits 1-5: Fund pays 100%; deductible does not apply. Visits 6 and up: The outpatient mental health/substance abuse benefit is paid.

**Either you or your provider must call ComPsych at 1-877-627-4239 to precertify inpatient hospital treatment for mental health and substance abuse. If you do not, you will be charged a $250 penalty fee. In an emergency, seek care immediately, then call your primary care doctor as soon as possible for further assistance and directions on follow-up care. Failure to make contact within seventy-two (72) hours of an emergency admission will result in application of the $250 penalty fee.