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Complete
Health Care Benefits
for You and Your Family
The Trustees of your Health Services and Insurance Plan have worked hard
to provide you with a generous package of health benefits, designed to
fit your lifestyle. Your medical coverage through the Blue Cross Blue
Shield HealthMate Coast to Coast plan protects you whether you're on the
road or close to home. More than half a million physicians participate
in the Blue Cross Blue Shield network, so that even when you're traveling,
you'll have easy access to care and maximum coverage for services.
Through
HealthMate Coast to Coast, you and your eligible family members have comprehensive
medical benefits, including: wellness benefits for adults and children,
coverage for prescription drugs, hospitalization and surgery, extended
care, behavioral health and chemical dependency treatment.
And that's
not all Teamsters Local 251 Health Services and Insurance Plan
members also get coverage for dental, vision, hearing, weekly accident
and sickness, life insurance and much more.
Coverage
for Retirees
When designing your benefits program and making improvements, the Trustees
try to do what's best for the members; and that responsibility doesn't
end when you retire the Plan features a self-pay package of benefits
available to eligible retirees.
Eligibility
To establish eligibility for coverage, you must work at least 300 hours
in covered employment in a calendar quarter, called a "qualifying
period." When you work at least 300 hours in a qualifying period,
you are eligible for coverage for a three-month period called, called
the "eligibility period." The Fund Office will determine your
on-going eligibility on a quarterly basis. Your dependents are eligible
for benefits on the same date that your coverage begins.
A
Plan for Good
Health
The Trustees of your Plan want you and your family to stay healthy. That's
why the Plan provides free wellness programs, such as free health risk
appraisals, cholesterol screening, blood pressure readings and private
consultations about your health. You'll also get a bimonthly newsletter
containing health tips, information and news.
As part of
your HealthMate Coast to Coast coverage, you'll pay only $10 when you
use a BlueCard PPO provider for:
Routine
physical examinations for you and your covered family members;
Routine immunizations for your children, and
Well-woman annual examinations. Also, when you use a BlueCard PPO
provider, there is no copayment for wellness visits for newborns born
after January 1, 2001 through 15 months of age.
Legal
Services
The Trustees of your Plan have retained the services of attorneys so that
you and your eligible dependents may receive free legal help with a variety
of services, such as buying a home, preparing a will or handling insurance
company claims.
Important
Benefit Contact Information
You may always call the Fund Office at (401) 467-3323 if you have a question
about any of your benefits, but here are some other contacts to help you
get answers to your benefits questions quickly.
Important
Benefit
Contact Information
For
Questions
About . . . |
Contact
|
Phone
Number |
Website/E-mail
|
| Medical |
Blue
Cross Blue Shield of Rhode Island
HealthMate Coast to Coast
444 Westminster Street
Providence, RI
02903-3279 |
To
find participating providers:
1 (800) 810-BLUE
For preauthorization:
(401) 272-5670 or
1 (800) 635-2477
Customer Service:
(401) 459-5000 or
1 (800) 639-2227 |
For general information:
www.bcbsri.com |
|
Prescription Drugs |
Blue
Cross Blue Shield of Rhode Island
444 Westminster Street
Providence, RI
02903-3279 |
For
questions about your coverage or to find a participating pharmacy,
call:
(401) 459-5000 |
|
| Dental
|
Delta
Dental |
To
find a participating provider:
(401) 752-6100 |
www.deltadentalri.com
|
| Vision |
Davis Vision |
Customer Service:
1-800-584-2866 |
www.davisvision.com |
|
Hearing |
Sargent Rehabilitation Center
800 Quaker Lane
Warwick, Rhode Island
02818 |
(401)
861-6600 |
|
|
Life Insurance, Accidental Death and Dismemberment and Personal Accident
Coverage |
The Fund Office
1201 Elmwood Avenue
Providence, RI
02907-3799 |
Telephone:
(401) 467-3323
Fax:
(401) 467-9480 |
|
|
Weekly Accident and Sickness |
|
Legal Services |
|
Retiree Benefits |
Medical
Benefits
HealthMate Coast to Coast Protection
Your medical coverage is provided through HealthMate Coast to Coast from
Blue Cross Blue Shield of Rhode Island. Through HealthMate Coast to Coast,
you and your family have access to a large network of physicians and hospitals
at home and across the country. When you use the Preferred Provider Organization
BlueCard PPO participating providers will accept a pre-negotiated
amount, called an allowance, as payment in full for covered services.
Through
the BlueCard PPO, routine office visits are covered in full after a $10
copayment. You are also fully covered for hospitalization and surgery.
However, you are free to use any doctor you choose. When you visit non-BlueCard
providers, you are generally covered at 80% of the allowance for most
services after meeting an annual deductible of $200 and paying any applicable
copayment. Non-BlueCard providers may bill in excess of the allowable
amount.
Need
to find a participating pharmacy?
Most
pharmacies in the Rhode Island area participate in the prescription
drug network. Contact Customer Service at (401) 459-5000 to receive
a list of participating pharmacies.
|
Prescription
Drugs
Through
the Blue Cross Blue Shield National Prescription Drug network you pay
20%
of the cost
for prescription drugs. You may use the mail
order service to have your maintenance medication (drugs you take on an
on-going basis) sent to your home, or you may have your prescriptions
filled at a participating pharmacy.
Once your
20% coinsurance for prescription drugs totals $300 in a calendar year,
Blue Cross Blue Shield will pay the entire cost of your prescription drugs
for the remainder of the year.
Your
Medical Benefits at-a-Glance
|
Medical Care |
| BlueCard
PPO |
You
Pay |
Non
PPO |
|
| Annual
out-of-pocket maximum |
$0
|
$3,000
per family |
| Annual
deductible |
$0 |
$200
per person |
|
Office visits |
$10 copayment |
$10
copayment plus 20% of the allowance |
| Hospitalization
and inpatient medical/surgical care |
$0 |
20% of the allowance |
|
Physical exams |
$10
copayment |
$10
copayment plus 20% of the allowance |
Behavioral
health and chemical dependency
Inpatient |
$0 |
20%
of the allowance |
|
Outpatient |
$15
copayment |
$15
copayment plus 50% of the allowance |
Dental
Benefits
Your dental coverage is provided through Delta Dental. The Trustees have
selected Delta Dental because more than 100,000 dentists participate in
the Delta Dental network nationwide. Show your ID card at a participating
Delta Dental provider to receive discounted rates for dental services.
With Delta
Dental, your preventive, diagnostic, and restorative care is covered in
full. This includes oral exams and cleanings, x-rays, extractions, fillings,
and root canal work. For other services, such as orthodontia, bridges,
dentures, implants and periodontics, you pay 50% of the Delta Dental rate
for services.
For dental
care outside of the Delta Dental network, you must pay for the services
in full and apply for reimbursement. If the non-Delta Dental provider
charges more than the Delta Dental rate, you must pay the difference,
as well as your coinsurance, if applicable.
Your
Dental Benefits at-a-Glance
| Dental
Care |
| Delta
Dental Provider |
You
Pay |
Non
Network Provider |
|
| Annual
maximum benefit |
$1,200
|
$1,200
|
| Annual
deductible |
$0 |
$0
|
| Preventive,
diagnostic and restorative |
$0 |
The
difference between non-network rate and Delta Dental's rate |
| Periodontics,
Implants and Prosthodontics |
50%
of the Delta Dental rate |
50%
plus the difference between non-network rate and Delta Dental's rate
|
| Orthodontics
up to $1,800 per person per lifetime |
50%
of the Delta Dental rate |
50%
plus the difference between non-network rate and Delta Dental's rate |
Vision
Benefits
Your vision benefits are provided through Davis Vision. When you visit
a Davis Vision provider, you and your eligible dependents are eligible
for an eye exam, glasses and contact lenses once every 12 months.
Your
Vision Benefits at-a-Glance
|
Every twelve months (to the day) you and/or your eligible dependents
are entitled to one of the options listed below when you visit a Davis
Vision provider: |
| Eye
Exam |
$0 |
| Eye
Exam + Eyeglasses |
$0 |
|
Eye Exam + Two Pairs of Eyeglasses |
$35 copayment |
| Eye
Exam + Contact Lenses |
$25 copayment |
|
Eye Exam + Eyeglasses + Contact Lenses |
$60
copayment |
Hearing
Care Benefits
You and your dependents are eligible for a hearing exam once every 12
months and a hearing aid once every 36 months. You may also be eligible
for an allowance of $1,500 to use toward the purchase of a digital hearing
aid. All hearing care benefits are payable through the Sargent Rehabilitation
Center.
Life,
Accident and Disability Insurance
The Trustees of the Teamsters 251 Health Services and Insurance Plan want
you and your family to be protected in the event that something happens
to you. The Plan provides life insurance coverage, accident coverage for
you and your dependents, and disability benefits in case you are injured
or sick and cannot work.

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