Medical Benefits
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Schedule of Benefits
To help members take control of their health and ensure their dependents are in the best of health, the Fund will pay 100% of the cost of qualified preventive services, such as an annual routine physical exam. The Fund offers members a “dual option” medical benefits program that includes a Platinum Plan and a Gold Plan. The Platinum Plan has lower out of pocket expenses compared to the Gold Plan and is available only to those members who complete the annual WellTeam screening. If you are unsure as to what applies to you and/or your dependents, please call Member Services at 800-523-2846, option #1.
| Find a Horizon Provider
(continue as guest)
|
Find an Aetna Provider | |||
|---|---|---|---|---|
| Medical | ||||
| Horizon BCBS PPO PLATINUM | Horizon BCBS PPO GOLD | Aetna EPO PLATINUM | Aetna EPO GOLD | |
| PCP Visit | $20 Copay | $30 Copay | $15 Copay | $25 Copay |
| Specialist Visit | $30 Copay | $40 Copay | $25 Copay | $35 Copay |
| Emergency | $100 Copay | $100 Copay | $100 Copay | $100 Copay |
| Urgent Care | $50 Copay | $50 Copay | $50 Copay | $50 Copay |
| In-Network Deductible & Coinsurance | $200 deductible per person, $400 per family, and 10% coinsurance up to $500 per person | $450 deductible per person, $900 per family, and 10% coinsurance up to $750 per person | $50 deductible per person, $100 per family, and 10% coinsurance up to $250 per person | $300 deductible per person, $600 per family, and 10% coinsurance up to $500 per person |
| Out-of-Network Deductible & Coinsurance | $450 deductible per person, $900 per family, and 20% coinsurance up to $1500 per person | $950 deductible per person, $1900 per family, and 20% coinsurance up to $2250 per person | NOT COVERED | NOT COVERED |
| Death Benefits | ||||
| Death of Member | $20,000 | |||
| Death of Spouse | $1,500 | |||
| Death of Dependent Child in accordance with age as follows: | ||||
| Over 14 days, but less than six months | $300 | |||
| Six months, but less than two years | $600 | |||
| Two years, but less than three years | $1,200 | |||
| Greater than three years | $1,500 | |||
| Accidental Death and Dismemberment Benefits (Members Only) | ||||
| Loss of Life | $20,000 | |||
| Both hands or both feet | $20,000 | |||
| Sight of both eyes | $20,000 | |||
| One hand and one foot | $20,000 | |||
| One hand and sight of one eye | $20,000 | |||
| One foot and sight of one eye | $20,000 | |||
| One hand or one foot | $10,000 | |||
| Sight of one eye | $10,000 | |||
| Unlike other plan benefits which are self-insured, these Death and Dismemberment Benefits are provided through a group life policy insured by Dearborn National. | ||||
| Weekly Benefits | ||||
| $250 per week | $50 per workday | |||
| If you work for a New Jersey Employer covered under the New Jersey Temporary Disabilities Law, you will receive 1/2 (half) of the disability payment indicated above. Disability benefits will commence on the first work day if the disability results from an accident or hospitalization. Benefits will commence on the sixth work day is the disability is a result of a sickness or pregnancy. Weekly disability benefits are payable for a maximum of 26 weeks. The Fund will pay you weekly disability benefits upon the initial denial of a worker’s compensation claim if you execute a Fund approved subrogation agreement. | ||||
Teladoc
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- member.Teladoc.com/registration
- 1-800-Teladoc (835-2362)
- Teladoc.com/mobile
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Mental Health Services
The Fund recognizes the challenges of balancing work with the circumstances of everyday life. Through Total Care Network (TCN), members have access to a broad network of licensed professionals that provide counseling, information and treatment resources to assist with substance abuse and mental health care needs. TCN provides a confidential behavioral health program to support both members and eligible dependents.
Mental and behavioral health services are administered through TCN, not Horizon or Aetna. If a member chooses an out-of-network behavioral health provider, he/she will be responsible for any balance charged by the provider. For support with mental or behavioral health matters or to find a provider, call TCN at 800-298-2299 or 215-425-8140.
| TCN Mental Health/Substance Abuse | ||||
|---|---|---|---|---|
| Horizon BCBS PPO PLATINUM | Horizon BCBS PPO GOLD | Aetna EPO PLATINUM | Aetna EPO GOLD | |
| IN-NETWORK (Out-patient) | $20 copay | $30 copay | $20 copay | $30 copay |
| IN-NETWORK (In-patient) | $200 deductible per person, $400 per family, and 10% coinsurance up to $500 per person | $450 deductible per person, $900 per family, and 10% coinsurance up to $750 per person | $50 deductible per person, $100 per family, and 10% coinsurance up to $250 per person | $300 deductible per person, $600 per family, and 10% coinsurance up to $500 per person |
| OUT OF NETWORK (In-Patient & Outpatient) | $450 deductible per person, $900 per family, and 20% coinsurance up to $1500 per person | $950 deductible per person, $1900 per family, and 20% coinsurance up to $2250 per person | $450 deductible per person, $900 per family, and 20% coinsurance up to $1500 per person | $950 deductible per person, $1900 per family, and 20% coinsurance up to $2250 per person |
Discount Outpatient Imaging and Laboratory Program
To help reduce or even eliminate out of pocket costs for diagnostic testing, the Fund has partnered with Health Care Solutions (HCSC) to provide members with an alternative solution for non-emergency outpatient diagnostic testing needs, diabetic testing care and sleep apnea products.
- HCSC Alternative Outpatient Radiology Testing Program
- HCSC Alternative Outpatient Laboratory Testing Program
- HCSC CPAP Program
- HCSC Diabetic Supply Program
Contact HCSC at 800-655-8125
Genetic Testing
Better health with a little help from your genes
In an ongoing commitment to member health, Teamsters has partnered with Color to help you personalize your health with genetic insights.
Discover what your genes say about your risk for common hereditary cancers and heart conditions, as well as how your body processes certain medications. With Color, you’ll also get access to board-certified genetic counselors so you can better understand and act on your results.
This benefit is available to members and up to one adult dependent.
Its Simple!
Step 1
Provide a saliva sample at home and send it back to the Color lab.
Step 2
In just a few weeks, view your results securely online.
Step 3
Meet with a genetic counselor or clinical pharmacist to start creating a personalized plan designed to prevent or detect disease.
Gym Reimbursement
The Fund understands that starting or staying with an exercise routine is not easy. We also know that when members exercise regularly, they’ll be healthier and feel better. Fit Teamster is a voluntary program that rewards members for being motivated in having overall good physical health. Members can earn up to $200 a year for just staying fit!
Download the form for details and to submit for reimbursement
Rothman Orthopaedics Fast-Track
We’re proud to have Rothman Orthopaedics as our partner! More importantly, we’re proud that our members can be seen quickly, and with the utmost care and attention by medical practitioners who are experts in their fields.
When you are injured, waiting is the hardest part! That’s why we created this fast-track program in conjunction with Rothman Orthopaedics exclusively for our members and their families.
Make an Appointment
Frequently Asked Questions (FAQ)
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