Frequently Asked Questions
Medical Benefits Questions
Some outpatient diagnostic imaging services need to be pre-certified or they are not covered (i.e. CT, PET Scan and MRI to name a few). Your provider should contact BlueCross BlueShield to begin the pre-certification process.
The medical deductible for Schedule of Benefits I is $500 per individual and $1500 per family.
For Schedule of Benefits I, maximum out-of-pocket (in network) is $5,000/person or $10,000/person (out of network). There is a cap limit of $10,000 aggregate per family in network and $20,000 aggregate per family out of network.
Yes, each time you or a family member go to the emergency room, you have a $100 co-pay. The $100 co-pay is waived only if you are admitted to the hospital from the emergency room.
Yes, 100% per eligible member and eligible dependent per calendar year.
Well-baby immunizations, school physicals, routine lab work, HPV vaccine, etc.
1. If a diagnosis appears to be injury related, you will receive an "Accident Letter" to determine if it is work comp or a third party liability claim.
2. Coordination of Benefits: It is necessary to have the primary insurance payment voucher along with the itemized bill from the provider. You will receive "Other Insurance Letter" of this is not received.
3. If you no longer have other insurance, you will need to provide a Certificate of Insurance from your former insurance showing when that coverage terminated.
For a newborn child, provide the Fund office a copy of the baby’s birth certificate and fully complete a new enrollment/beneficiary form.
For marriage, provide a copy of the marriage certificate and fully complete a new enrollment/beneficiary form.
For divorce, provide a copy of your divorce decree (showing who is responsible for dependent(s) health insurance) and complete a new enrollment/beneficiary form.
Insurance Card Questions
Present your Blue Cross Blue Sheild ID Card to Medical/Dental providers and a RX prescription card from Express Scripts for pharmacy.
Yes, call the Fund Office.
Dental
The dental deductible is $100/person ($300 family limit). Preventative exams, cleanings and bitewings are covered at 100% Effective January 1, 2012 and not subject to this deductible and are covered twice a year per person.
No, unless medically necessary for children under age 19.
Yes, request your dental provider to submit charges to the Fund office for processing a pre-treatment-estimate.
Vision
Routine vision benefits are covered directly through Vision Service Plan (VSP).
You can submit your claim directly to VSP for a refund. A VSP Out-of-Network Reimbursement Form can be downloaded from www.vsp.com or requested from the Fund office.