N.E.C.A. LOCAL UNION NO. 313 I.B.E.W. BENEFIT FUNDS

Transcription

1 N.E.C.A. LOCAL UNION NO. 313 I.B.E.W. BENEFIT FUNDS Fund Office: GEMGroup, Administrator, Rockwood Office Park, 501 Carr Road, Suite 220, Wilmington, DE Phone: (302) / (800) / Fax: (302) October 2016 RE: NECA Local Union No. 313 IBEW Health & Welfare, Pension & Deferred Income Plans ( Benefit Plans ) Dear Plan Participant: This is to inform you regarding certain updates and reminders with regard to your Benefit Plans as noted below. Addresses for GEMGroup Customer Service - Effective immediately, specific boxes have been implemented as a convenience to participants for addressing customer service inquiries with the Fund Administrator GEMGroup for the Benefit Plans. These boxes are listed below. Of course, participants can continue to call GEMGroup during normal business hours regarding any Benefit Plan issues but can now also communicate by if that is more convenient. Please include in your your full name, home address, telephone number and GEMGroup ID number. When appropriate, GEMGroup personnel may be able to respond back to your inquiry by return . In some cases, however, it may be necessary to speak with you directly by telephone for privacy and security reasons. Health & Welfare Plan Pension Plan Deferred Income Plan (Annuity) 313Health&Welfare@gemgroup.com 313Pension@gemgroup.com 313Annuity@gemgroup.com Vision Benefit Enhancements Effective September 1, 2016, National Vision Administrators (NVA) has implemented some enhancements to the vision benefits provided by the Health & Welfare Fund that may reduce your out-of-pocket cost, such as discounts for purchases you may make in addition to what the Benefit Plan covers. Enclosed for your reference is a brochure from NVA providing a full description of the Health & Welfare Plan s vision benefit program. Reminder: Utilizing Urgent Care Facilities in Lieu of the Emergency Room When Appropriate The Trustees would like to remind participants that when urgent care is needed, participants are strongly urged to utilize an urgent care facility instead of a hospital emergency room, whenever it would be considered an appropriate alternative. This reduces your outof-pocket cost since the copay amount is $10 at an urgent care facility instead of $100 at a participating hospital emergency room. This also reduces the Benefit Plan cost. On the reverse side of this notice is a description of Plan provisions for Emergency Outpatient Care for your reference. Also enclosed for your reference is a listing of the existing urgent care facilities that are currently in network with Aetna in the three counties in Delaware and in contiguous counties. Please note that the Aetna provider network changes periodically, so you should verify that the facility you are utilizing is in the Aetna network before services are rendered. You may verify this via the Aetna website at or by calling the member services number on the back of your ID card. Please retain this notice with your important papers for future reference. Sincerely, BOARD OF TRUSTEES Enclosures

2 Emergency Outpatient Care The Plan pays benefits for treatment in a hospital or emergency facility for: Accidental injury within 48 hours of the accident; Minor surgical procedures; Services required as a result of a serious and unexpected illness that requires immediate medical care. The benefit works as follows: If you are admitted as an inpatient at a participating Aetna hospital as a result of an emergency, the Plan pays 100% of the allowable charge (AC) after a $10 copay. If you are admitted as an inpatient at a non-participating Aetna hospital as a result of an emergency, you pay 20% of the Allowable Charge. In you are not admitted at a participating Aetna hospital as a result of an emergency, the Plan pays 100% of the Allowable Charge after a $100 copay. If you are not admitted as an inpatient at a non-participating Aetna hospital as a result of an emergency, you pay 20% of the Allowable Charge after a $100 copayment. In other words, if you are not admitted to the hospital as an inpatient after an emergency, you must make a $100 copay for an outpatient emergency visit at a participating Aetna hospital (the copay is reduced to $10 if you are admitted). If you visit an urgent care facility, your copay is $10. If such a visit is made at a non-participating Aetna hospital, you must pay 20% of the Allowable Charge plus a $100 copay (the copay is waived if you are admitted). In either case, you must meet the special X-ray and laboratory services deductible ($35), if applicable to your situation.

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