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International Union of Operating Engineers: Local 399
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Summary of Medical Benefits

 


Effective May 1, 2019
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Medical Benefits     

Preferred Provider Network

BlueCross BlueShield Labor Lease Program

     
Deductible            $300 per person per calendar year
    $1200 per family per calendar year
     
     
Major Medical Coinsurance   90% PPO         70% Non-PPO
     
Plan Maximum (Medical Claims)   Unlimited
     
Additional Copayment   $100 outpatient emergency room
     

Adult Wellness

(Age/frequency guidelines apply)

 

 

 

 

 

 

Annual Routine Exam

Immunizations

Mammogram

Gynecological exam with related testing:

PSA with related exam

Colonoscopy

     

Pre-Certification Requirement

   Call Med-Care Management

   1-800-367-1934

 

 

 

 

 

Hospitalizations

Outpatient surgical procedures performed in a

surgical facility or a hospital

Physical, occupational, speech therapy

IV Therapy

Home care, medical equipment & supplies

 

     

Plan Exclusions

(See Summary Plan Description for 

complete list)

 

 

 

 

Out of network surgical faclities

Speech or other therapy for develpmental delay

Treatment of Infertility


Click here to view the full list of plan exclusions

 

 

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For additional details, please click below to view/download a copy of the
2019 Summary Plan Description Book

 

2019 Summary Plan Description Book

 

 

Contact Elite Adminstration Customer Service at

(312) 243-1265 for information regarding

your claims payment status

 

 

Contact Numbers:

 

H&W Fund Office

(312) 372-9870

Press Option 3


H&W Dedicated Fax Number:

(312) 842-0291

 

Click here for H&W staff contact list

For questions or issue on Medical Coverage,

please contact Elite Adminstration at (312) 243-1265

 

For questions or issue on Dental Coverage,

please call Delta Dental at (800) 323-1743

 

For questions on Prescriptions,

Please contact OptumRx (800) 788-4863

 

For questions regarding Vision Coverage,

please call VSP at (800) 877-7195

 

If you are a member needing assistance, please call 

or email the Health & Welfare Fund Office Staff.