Benefit Summary: Building Trades Medical Plan
A snapshot of health coverage for active members.
How your plan works. Amounts shown are what you pay per calendar year.
| In-Network
HEALTHY LIFE Incentive |
In-Network
No Incentive |
Out-of-Network | |
| Deductible | |||
|
$550 | $750 | $1,100 |
|
$1,650 | $2,250 | $3,300 |
| Note: Your in-network and out-of-network eligible expenses cross-apply and accumulate toward both your in-network and out-of-network deductible requirement. | |||
| Out-of-Pocket Maximum: Medical | |||
|
$4,750 | $6,500 | $9,500 |
|
$4,750 | $6,500 | $9,500 |
| Out-of-Pocket Maximum: Prescription Drug | |||
|
$1,650 | Not applicable | |
|
$8,800 | Not applicable | |
| Out-of-Pocket Maximum: Combined Medical and Prescription Drug | |||
|
$6,400 | $8,150 | Not applicable |
|
$13,550 | $15,300 | Not applicable |
| Note: Your in-network and out-of-network eligible expenses cross-apply and accumulate toward your in-network out-of-pocket maximum. | |||
| Coinsurance | 80% | 70% | 60% |
| 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 (one every three Calendar Years, beginning at age 50) | Fund pays 100% of covered expenses. Deductible does not apply. | ||
| 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 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 (for people age 60 and older) | Fund pays 100% of covered expenses. 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 26 (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. | |||
| 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 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 | ||
| $10,000 allowance applies for transportation and lodging prior to, during, and after the transplant procedure for the patient and one family member or companion if a Blue Distinction Facility is used. | |||
| Behavioral Health Treatment (pre-certification required)* | |||
| Lifetime maximum for substance abuse treatment | Unlimited | ||
| Mental health/substance abuse outpatient treatment |
|
||
| Mental health/substance abuse inpatient treatment | Covered same as any other illness. | ||
| Outpatient Laboratory Program | |||
| Laboratory testing at any in-network facility (Lab One or Highmark 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 Lyra Health | |||
| Member Assistance Program (MAP) | Visits 1-8: Fund pays 100%; deductible does not apply. Visits 9 and up: The outpatient mental health/substance abuse benefit is paid. | ||
*Pre-certification through American Health Holding is required for hospitalization, skilled nursing, surgery or inpatient hospital treatment for mental health and substance abuse. 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.
**You must use PPO providers when receiving preventive, well-care services.
***Coinsurance level reflects HEALTHY LIFE compliance. If you do not participate in HEALTHY LIFE, the Plan will pay 70% coinsurance and you will pay 30% coinsurance.
Regular Retiree Medical Coverage (Non-Medicare-Eligible Retirees)
When you retire, your medical and prescription drug coverage has different out-of-pocket maximum amounts, as shown in the table below. Otherwise, you and your covered dependents are eligible for the same medical, prescription drug, dental, vision, life insurance, and AD&D insurance coverage you had as an active participant until you (or your dependents) become eligible for Medicare. When you retire, but before you turn age 65, you can access any credits (amounts) in your HRA, but you are not able to contribute any new amounts to that account.
| In-Network | Out-of-Network | |
| Out-of-Pocket Maximum: Medical Plan* | ||
|
$3,000 | $9,500 |
|
$6,000 | $9,500 |
| Out-of-Pocket Maximum: Prescription Drugs* | ||
|
$4,600 | Not applicable |
|
$9,200 | Not applicable |
| Out-of-Pocket Maximum: Combined Medical and Prescription Drugs* | ||
|
$7,600 | Not applicable |
|
$15,200 | Not applicable |
| * Per calendar year | ||
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