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Benefit Summary: Building Trades Medical Plan

 

For Active Members

Building Trades Medical Plan Benefit Summary for Active Employees and Dependents (also known as the Comprehensive Major Medical Plan)
Benefit Coverage*
With HEALTHY LIFE Incentive Without HEALTHY LIFE Incentive
Calendar Year Deductible
PPO Providers $350 per person; $1,050 per family $550 per person; $1,650 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. Fund pays 70% 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 $5,550 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 $1,650 per person; $8,800 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 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.
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
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 Covered same as any other illness.
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.

*Pre-certification through American Health is required for hospitalization, skilled nursing or surgery.

**You must use PPO providers when receiving preventive, well-care services.

***Either you or your provider must call ComPsych at 1-877-627-4239 to pre-certify 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.