Medical Summary Plan Description

 

Highmark Preventive Schedule - 2012

This schedule, based on recommendations from the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, the American Cancer Society January 2008 Colorectal Cancer Screening guidelines and items/services required under the Patient Protection and Affordable Care Act of 2010 (PPACA), is a reference tool for planning your family's preventive care. Your specific needs may vary according to your personal risk factors. Your doctor is always your best resource for determining if you're at an increased risk for a condition. If you have questions about your coverage, please call the toll-free Member Service number on your identification card.  2012 Highmark Preventive Schedule

Effective January 1, 2011 (as required by law)

  • The Plan will cover children up to the age 26 without regard to marital status, student status, financial dependency or other special requirements.  Should you have a child under the age of 26 who has been terminated under our plan, please contact the Fund Office.
  • The Plan will cover stepchildren up to the age 26 in the same manner as biological children.  If you have a stepchild / stepchildren that you want to add to the plan, please contact the Fund Office.

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.  If you have a different and unrelated disability, and return to work for one full day, you will then be entitled to a new benefit period.

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.