Carpenters Health and Welfare Trust Fund carrier options under the medical plan include Kaiser HMO coverage or the Indemnity PPO plan.
Benefits through the Kaiser HMO network require all covered services be provided, or referred by, Kaiser. To elect Kaiser, you must live within their service area. The Indemnity Medical plan is a Preferred Provider Plan (PPO) that provides self-funded medical benefits to Participants. The PPO network is arranged through Anthem Blue Cross. Participants maximize their benefits by using Anthem PPO providers.
Payment of Benefits
Services are subject to Plan deductibles and annual out of pocket limits.
Services received at a Kaiser facility, will be covered in accordance with the Evidence of Coverage after applicable copayments are made.
Under the Indemnity Plan, covered services are paid based on the type of service rendered, whether or not the provider was a PPO provider and which Plan you are enrolled in. Generally speaking, after meeting the calendar year deductible of $128 per person/per year, most PPO services are paid at 90% (Plan A or Plan R) or are paid at 80% (Plan B or Flat Rate Plan).
In addition to medical and dental benefits, Participants are also eligible for additional benefits through the Health & Welfare Fund that include:
- Vision benefits
- Member Assistance Program (MAP)
- Life Insurance
If you elect coverage under the Indemnity Medical plan, your prescription benefits are provided by Express Scripts and vision benefits are provided by Vision Service Plan (VSP). If you elect coverage under Kaiser, your prescription and vision benefits are also with Kaiser.