Medical Benefits

Plumbers’ Welfare Fund, Local 130, U.A.

Eligibility

Less Restrictive Initial Eligibility Requirements

Section 2.2 of the Active Plan pertaining to Initial Eligibility is revised to remove the requirement that new employees must have at least 250 hours worked in two consecutive Contribution Quarters before coverage begins. Effective January 1, 2017, employees are only required to accumulate 300 hours to earn Initial Eligibility and the Participant would become eligible for benefits on the 1st day of the following month after accumulating the 300 hours. The Participant would be eligible for the remainder of that Benefit Quarter, as well as the next Benefit Quarter. Afterwards, the Participant would need to work 250 hours in the Contribution Quarter in order to maintain eligibility under the corresponding Benefit Quarter.

For example, if a Member begins working in Covered Employment and works 300 hours by April 15, coverage will begin May 1 and run through the June, July and August 2017 Benefit Quarter. To continue coverage, the Participant will need 250 hours in the Contribution Quarter of April, May, and June to continue coverage in the Benefit Quarter of September, October and November.  An eligible Participant becomes covered the first day of the Benefit Quarter under the Welfare Fund after completing at least 250 hours in each of the two (2) consecutive Contribution Quarters with a Contributing Contractor.

Deductible

There is a $200.00 per person calendar year deductible with a per family maximum of $600.00 as of June 1, 2011. Not all of the benefits listed below are subject to this deductible. As of June 1, 2012, there is no longer a $25.00 co-pay for office visits. The $150.00 co-pay for emergency room visits is still in effect.

Additional Limit on Non – PPO Providers

In addition to the limits noted above, the Fund will recognize only up to 70 percent of the reasonable and customary charges for covered expenses with doctors, hospitals, and other providers that are not part of the Blue Cross Blue Shield PPO networks. Charges above this amount will not be covered by the Fund and will be the responsibility of the Participant or Dependent.

Dental Benefits

Dental benefits are subject to a separate $50.00 deductible with a maximum deductible of $150 per family unit. After the deductible is met, the Plan pays up to 100% of the reasonable cost of routine dental oral examinations and 80% of other covered dental services, up to an annual maximum benefit of $4,000 unless the patient is under the age of 18 then there is no limit. The Welfare Fund uses Delta Dental as the administrator of the dental benefits and both the Welfare Fund and Participants 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.  Find a Delta Dental Provider by clicking on the link.

Orthodontic Benefits

The Welfare Fund pays 80% of reasonable charges up to a maximum lifetime limit of $4,500.

Vision Benefits

The Welfare Fund pays up to $40 for a general eye examination, $40 for contact lens fitting and follow-up exam and $350 for prescription glasses, frames, and lenses. The vision benefits are administered through EyeMed and Participants and dependents can receive discounts by using EyeMed providers. For further information about EyeMed providers please contact the Fund Office. Find an EyeMed Provider by clicking on the link.

Health Reimbursement Arrangement (HRA)

A Health Reimbursement Arrangement (HRA) is a supplemental way to help you pay for out of pocket medical expenses that you are required to pay under the terms of the Plumbers’ Welfare Fund, Local 130 U.A. (Plan) and the Internal Revenue Code 213(d).

Items you can reimburse through the HRA include:

  • Annual deductibles per person
  • Co-payments for medical expenses & prescription drugs
  • Cobra and Self-Pay premiums.

Debit cards available to use for HRA-eligible expenses.

Starting June 1, 2015, debit cards reflecting your HRA account balance will be issued to all eligible Plan participants. The debit cards will be administered through TASC DirectPay system. The amount available through your card will reflect the current unused credits to your HRA. You will not receive a card until you have earned initial eligibility under the Plan. Additionally, if you lose eligibility under the Plan, you generally will not be able to access allocations to the HRA made with respect to hours worked after your loss of eligibility until such time as you regain eligibility. Once you lose eligibility you will not be able to use your debit card but you will be able to submit paper claims for dates of service prior to losing eligibility under the Plan, (However, you can continue to access HRA contributions allocated with respect to hours worked before you lost eligibility by submitting paper claims). If you lose active eligibility and elect COBRA, you will continue to accrue additional credits to your HRA account and will have immediate access to those contributions. (Your rights, if any, to COBRA under the HRA will be explained in the COBRA Election Notice that is provided following a loss of eligibility.)

For more information, contact the customer care group at (608) 243-8277 or Toll Free at (877) 933-3539.

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Schedule of Medical Benefits Click Here