Medical Benefits

Welfare Fund - Technical Engineering Division

Deductible

There is a $500.00 per person calendar year deductible with a per family maximum of $1,500.00. Not all of the benefits listed below are subject to this deductible.

Schedule of Benefits

The table below represents both In-network and Out-of-network benefits. The Welfare Fund has access to the Blue Cross Blue Shield network of hospitals, physicians, and other providers. Using a Blue Cross Blue Shield provider can substantially limit the expenses for Covered Employees, dependents, and the Welfare Fund.

Benefit	In-Network	Out-of-Network
Pre-Admission Hospital Tests	Paid in full	Paid in full
In-patient Hospital Room & Board (per stay)	$450 per day up to max of $100,000	$350 per day up to max of $100,000
In-hospital services	100% of 1st $1,500.00 90% of next $50,000	80% of first $50,000
In-hospital doctor visits Normal	$150.00 for 1st visit $100.00 per additional visit	Same as In-network
In-hospital doctor visits Intensive Care	$275.00 for 1st visit $150.00 per additional visit	Same as In-network
In-hospital doctor visits Consulting Physician	$150.00 each visit	Same as In-network
Surgical Benefits	Paid in full	Paid under surgical schedule
Assistant Surgeon	20% of allowed surgical charge	Same as In-network
Organ Transplants	Subject to Plan maximums applicable to a specific transplant. Advance Trustee approval is required for transplants	Same as In-network
Hospice Care	Up to $400.00 per day Max of $74,000.00 for any period	Same as In-network
Wellness	100% up to $500.00	Same as In-network
Smoking Cessation	50% up to $200.00 lifetime max	Same as In-network
Substance Abuse	$350.00 per day lifetime max of $40,000.00	Same as In-network
Outpatient including home health care	100% of 1st $1,000.00 Next $5,000.00 paid at 80%	Additional limit of 80% of reasonable and customary charges
Cancer	$20,000.00 lifetime max	Same as In-network
Hearing Aids	Up to $1,500.00 once every 5 years per ear	Same as In-network
Hearing Exams	$125.00 per exam once every 12 months	Same as In-network
Prescription Drugs	Generic drugs with a co-pay $5.00. Name brand drugs a co-payment of either $10.00 or $20.00
Eye Care	$40 for exam $200 for vision materials (Glasses/Contacts) Once per year	Same as In-network

Dental Benefits

Dental benefits are subject to a separate $10.00 deductible with a maximum deductible of $30 per family unit. After the deductible is met, the Plan pays up to 100% of the reasonable cost of routine dental oral examinations and 50% of other covered dental services, up to an annual maximum benefit of $1,500, maximum family benefit of $4,500. The Welfare Fund uses Delta Dental as the administrator of the dental benefits and both the Welfare Fund and covered Employees can receive savings as a result of using providers within the Delta Dental network. For further information about Delta Dental, please contact the Fund Office.

Orthodontic Benefits

The Welfare Fund pays 75% of reasonable charges up to a maximum lifetime limit of $2,500.

Important Notice: This website provides only a brief explanation of the Health and Welfare Plan under the Welfare Fund – Technical Engineering Division, Local 130, U.A. and is not a summary plan description. If there are any inconsistencies between this explanation and the Plan document, the Plan document shall control. Also, please refer to the Summary Plan Description for additional information about the benefits available and procedures of the Welfare Fund – Technical Engineering Division, Local 130, U.A. or contact the Tech Welfare Fund Office .