Plan Description

The Plan uses Blue Cross of California as the Preferred Provider Organization. Self-Funded PPO Plan’s health coverage meets the minimum value standard for the benefits it provides. The Affordable Care Act establishes a minimum value standard of 60% (actuarial value) benefits of a health plan.

Hearing Aid Benefit

The Plan pays for an initial examination by a physician no more than once in a 24-month period, and a hearing aid examination also no more than once in a 24-month period, up to $85.00 each. The Plan pays 80% of the cost of a hearing aid and provides a maximum benefit of $2,500 per year over any 5-year period.

Eligibility Requirements

Active Employees and Retirees who are not eligible for Medicare.

rxedo

Prescription Program

The prescription drug program is a $5/10% copayment program. For each prescription, the Participant’s copayment will be $5 or 10% of the cost of the prescription, whichever is higher, and the difference between brand and generic, if a brand is dispensed when a generic is available. To be eligible for prescription drug benefits, Participants must use either the RxEDO mail-order program or the RxEDO retail network of pharmacies. The prescription drug program is a $5/10% copayment program. For each prescription, the Participant’s copayment will be $5 or 10% of the cost of the prescription, whichever is higher, and the difference between brand and generic, if a brand is dispensed when a generic is available. To be eligible for prescription drug benefits, Participants must use either the RxEDO mail-order program or the RxEDO retail network of pharmacies. 

The RxEDO pharmacy network includes over 67,000 participating pharmacies nationwide and includes all major chain pharmacies. 

The Board of Trustees has implemented an integrated mail/retail prescription drug and formulary program through Rx Education & Design Organization, Inc (RxEDO – pronounced Re-do) as your new Prescription Benefit Partner. RxEDO utilizes many of the same pharmacies and services that you are already accustomed to; therefore you should see very few changes to your plan.

Claims Procedures

You may use the Plan’s claim form for any claim or you may use your provider’s own form. In order to speed up the processing of your claims, the Trustees suggest you use the following procedure when using the Plan’s forms:

  • Part I must be completed and signed by the member. If the claim resulted from an accident, please give complete information including the date, time and place.
  • The attending physician must either complete Part II of the Plan’s claim form or attach his own form or an itemized statement which contains an ICDA code. The Plan does not require a claim form completed by a lab technologist, radiologist, or consulting physician who assisted in or performed, a procedure which is billed by your attending physician.
  • A new claim form is required for each accident. If more than one family member has a claim related to an accident or other occurrences, a separate claim form is required for each family member.
  • Please identify all subsequent bills with your Local Union or your policy number.
  • An authorized representative may submit a claim on behalf of a claimant.
  • For a claim involving urgent care, a healthcare professional with knowledge of your medical condition may act as the authorized representative of the claimant.