Medical Summary Plan Description

Please note there have been several changes to the Summary Plan Description(SPD) from when it was initially printed. Below is information and links to amendments to the Medical Plan. Please call the Fund Office for any questions.

Change in routine physicals

Effective April 1, 2009, active members and early retirees and their eligible dependents can get a routine physical once per year rather than every two years. This improvement will be administered through Highmark.

Smoking Cessation

Effective April 1, 2009, there will be a smoking cessation benefit administered through the Fund Office. There will be a $700 lifetime maximum. Reimbursements will be at 100%. Physician visits, medication treatments, nicotine replacement therapy and counseling will be covered. Over-the-counter medications will not be covered. This benefit would apply only to active members and early retirees and their eligible dependents.

Sick Pay provision change

Be advised that the Board has approved a change in one provision affecting our sick pay benefit. Our sick pay benefit is $200.00 per week for a maximum of fifteen weeks. In addition, disability credits are issued which assist a member in maintaining medical coverage. Before this change, successive periods of disability had to be separated by at least 200 hours of employment, unless the disability arose from different and unrelated causes. We are retaining the 200 hour requirement between the first and second period of disability but there will now be a 1000 hour employment requirement after a second period of disability.

Change in annual prescription maximum for active members and early retirees and their eligible dependents

Retroactive to January 1, 2009, the annual prescription cap increased to $5,000 with the excess of eligible charges over $5,000 covered at 50%.

Active and retiree eligibility requirements

Eligibility for retirees changed on effective benefit period starting April 1, 2006. Eligibility requirements can be found in the eligibility page on this website. Retirees can read the plan amendment notice.

Understanding Medicare Drug Coverage

read this announcement, which explains how the Medical Drug Coverage works, summarizes standard Medicare Prescription Drug Coverage and other resources for more information.

Change in orthotic benefits

Effective April 21, 2005, All members eligible for the orthotic benefit under durable medical equipment (page 42 of the medical handbook). Please be advised that, effective immediately, there will be a $400.00 cap per calendar year on the orthotic benefit provided by our Plan.

Inpatient hospital deductible

Effective April 1, 2004, The inpatient hospital deductible for active members and early retirees will be $400 once per family per year rather than $200 once per family per year.

Prescription plan changes

Effective April 1, 2004, Our prescription program will move to a three tier program with three levels of copays. Read more... 

Oral surgery benefits eliminated

Effective April 1, 2004, The plan will no longer provide the oral surgery benefit outlined on pages 40 and 41 of your benefit handbook. Voluntary dental care benefits are available.

Vision care benefits eliminated

Effective April 1, 2004, The plan will no longer provide a vision care benefit. The vision care benefit was outlined on page 44 of your handbook. Voluntary vision care benefits are available.

Flu, Meningitis and pneumonia immunizations

Effective April 16, 2003, the Medical Board voted to add coverage through Highmark Blue Cross Blue Shield for Flu, Meningitis and Pneumonia Immunizations. This benefit is now available to active members and non-Medicare retirees.

Change in filing durable medical equipment claims

Effective August 2003, As you know, individuals in groups 51242-00, 02, 04, 06, 08 and 70 have coverage for durable medical equipment. Coverage is 80% of the usual and customary fee. For many years, these claims were processed through the Fund Office. On January 1, 2002, you were advised that these claims should be submitted direct to Highmark Blue Cross Blue Shield. We were under the impression that the 80% reasonable benefits maximum amount paid by Highmark would be accepted by most providers and that they would bill you for only the additional 20% not covered by the Plan. This would have saved money for you and the Plan. However, we have found that this is not the case, and Effective immediately, all claims for durable medical equipment should again be submitted directly to the Fund Office as you did prior to January 1, 2002.

Change in filing claims

Effective January 1, 2002 payments for office visits, counseling and durable medical equipment will be be processed through Highmark BlueCross BlueShield rather than through the Fund Office. Read more...