I.B.E.W. LOCAL UNION #130 HEALTH & WELFARE MEDICAL INSURANCE PLAN

EMPLOYER PAID!!

ALL EMPLOYEES, SPOUSES & THEIR DEPENDENTS HAVE PPO MEDICAL CLAIMS WHICH ARE PAID AT 90% OF U&C OR REPRICED AMOUNT, WHICHEVER IS LESS, ONCE THE ANNUAL $300.00 DEDUCTIBLE IS SATISFIED. AFTER THE PLAN PAYS $15,000.00 ON PPO CLAIMS. THE BALANCE WILL BE PAID AT 100% OF U&C OR REPRICED AMOUNT, WHICH EVER IS LESS, UP TO THE $500,000.00 LIFETIME MAXIMUM.

NON PPO MEDICAL CLAIMS ARE PAID AT 75% OF U&C AFTER THE ANNUAL $300.00 DEDUCTIBLE HAS BEEN SATISFIED. NON PPO CLAIMS NEVER GO INTO 100%. (LIFETIME MAXIMUM $500,000.00)

NERVOUS AND MENTAL DISORDERS INPATIENT LIFETIME MAXIMUM IS $500,000.00. OUTPATIENT ANNUAL MAXIMUM IS $1,200.00 (OR 30 VISITS AT $80.00 EACH PAID AT 50%).

ALCOHOL AND SUBSTANCE ABUSE INPATIENT ANNUAL MAXIMUM IS $5,000.00. SUBSTANCE ABUSE OUTPATIENT ANNUAL MAXIMUM IS $1,200.00 (OR 30 VISITS AT $80.00 EACH PAID AT 50%).

ALL HOSPITAL EMITS AND SURGICAL PROCEDURES ARE SUBJECT PRE-ADMISSION AUTHORIZATION AND CONCURRENT HOSPITAL REVIEW. CALL THE PLAN'S UTILIZATION REVIEW MANAGER. CALL AMERICAN LIFECARE AT 1-800-749-2298.

HOSPITAL AND MEDICAL CHARGES INCURRED BUT NOT APPROVED BY UTILZATION REVIEW AS MEDICALLY NECESSARY WILL BE SUBJECT TO REDUCED CO-INSURANCE RATES OF 60%.

EMPLOYEES ONLY RECIEVE A $5,000.00 LIFE INSURANCE POLICY. ACCIDENTAL DEATH AND DISMEMBERMENT ADDITIONAL $5000.00 POLICY, IF THEY ARE COVERED UNDER HEALTH AND WELFARE AT THE TIME OF DEATH.

THE EMPLOYER PROVIDED PLAN COVERS YOU, YOUR SPOUSE AND ALL ELIGIBLE DEPENDENTS.

INITIAL ELIGIBILITY REQUIREMENTS ARE $480.00 OF EMPLOYER CONTRIBUTIONS. TO MAINTIAN COVERAGE, YOU MUST EARN $240.00 OF EMPLOYER CONTRIBUTIONS MONTHLY OR SELF-PAY DIFFERENCE.

Make your own free website on Tripod.com