Summary of Benefits
Blue Cross Blue Shield is one of the largest P.P.O Plans in the Country and by utilizing it saves our members and the Health and Welfare Trust Fund a considerable amount of money. You may go on their website at www.bcbsfl.com to see what doctors and medical facilities are in the network or you may call their toll free number which is 1-800-320-7091. Our Group # is 64441001. You may also pick up a Provider Directory for South Florida at the Union Office.
NEBA is our Administrator for our Dental, Pension, 401(k) Plans, and the Disability and Life Insurance Claims. Their toll free number is 1-800-842-5899. Their website is www.nebainc.com. Click on Online Services.
The following is a list of some of the benefits that you may or may not be aware of. You may not be eligible for some of these benefits while you are under Cobra.
These benefits are for active working members only:
- If you become disabled due to illness or injury, you may qualify for E&S if you meet the requirements stated in the By-Laws Section 11 (7) thru (10).
- From our insurance you may be also entitled to $250 per week if injured off the job for 26 weeks. $250 for an on-the-job injury for the first week and $84 for additional 25 weeks. In both cases, you will get 100 hours towards your insurance per month. To help keep your insurance in effect, you will need to call the Union Hall for the forms that you and the doctor must complete. You are not eligible for this benefit while under Cobra.
- We have a $30,000 Life Insurance Policy, if deceased due to an accident, you will received $60,000. You are not eligible while you are under Cobra. We urge you to update your beneficiary card!
- We are here to help each and every member. Please let us know if we can be of assistance to you, whether it’s a ride to the doctor or anything else. WE CAN’T HELP YOU, IF WE ARE NOT AWARE THAT YOU NEED HELP.
- Don’t forget your BCBS card for your medications/prescriptions. Try to use generic prescriptions because this will help our insurance plan. Read more about this below.
- Please use our PPO Plan which is Blue Cross Blue Shield of Florida (Blue Choice Plan). By using Blue Cross-Blue Shield of Florida, you will save yourself and the Health and Welfare Trust Fund money when you go to a doctor in the BCBS network. Participant and/or Dependent pays a $45.00 fee per office visit (for primary care physicians, i.e; General Practitioner or Pediatrician only). All Specialists, other than General Practitioner, the Participant and/or Dependent the Plan is 70-30%. If a doctor or medical facility is not part of the BCBSFL Network, than the 50-50% Plan is used. BCBSFL’s website lists doctors and medical facilities in your area: www.bcbsfl.com (my blue service).
Medical Coverage Rates
- This Medical plan is effective each year effective January 1, while Dental insurance is effective May 1st.
- The Calendar Year deductible is $500 per person or $1,500 per family
- The doctor office visit co-pay $45 per visit (for primary care physicians only)
- Transplant Policy unlimited or no cap on procedures and drugs combined.
- The co-insurance percentage is:
- PPO service providers is 70%
- Non-PPO service providers is 50/50
The prescription drug co-pays are as follows:
- The Pharmacy Benefit Manager (PBM) is Prime Therapeutics at 1-888-849-7865 or www.bcbsfl.com Prime Therapeutics handles the prescription drug portion of our Blue Cross/Blue Shield Policy.
- Generic drug co-pay is $15.00 per prescription
- Name brand formulary drug co-pay is $35 per prescription
- Non-formulary drug co-pay is $65 per prescription
- Mail order (90-day prescription) generic drug co-pay is $30 per prescription
- Mail order (90-day prescription) name brand formulary drug co-pay $70 per prescription
- Mail order (90-day prescription) non-formulary drug co-pay is $130 per prescription
Dental Coverage – PPO with Guardian Dental – Effective June 1, 2017
- Customer Service – 1-888-600-1600
- Group #: 00538906
- Plan #: 00538906
- Up to $2,000. per eligible person in a family.
- Wisdom teeth are covered under dental program (NOT Major Medical)
- It is recommended to use the dental professionals within the Guardian Dental network
If ordering maintenance/continuing drugs (prescriptions needed for more than 30 days) the board of trustees encourages you to choose the mail order option .
Upon a member passing away, please have the Spouse and/or Member of the Family, call the Union Hall – 305-681-8596 immediately. The information needed is as follows:
- Date of death;
- Death Certificates – Please submit three (3) ORIGINAL death certificates WITH the cause of death (long form). This should be requested by the Funeral Home;
- A copy of the paid funeral invoice – This form has to be noted as PAID IN FULL. The person noted on this form will be receiving any money benefits paid by the United Association.
- Upon all the information received, regarding this passing member, NEBA and the United Association will be notified by the Union Hall. There is nothing for the family member to do, but call the Union Hall.