Medical Benefits
Medical Benefits
The Fund offers two distinct benefit programs, both are self-insured versions of the BCBS Blue Card™ PPO program. The Blue Card™ PPO program is a preferred provider program with both in-network and out-of-network benefits. The Blue Card™ PPO In-Network Only program has no out-of-network 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, Horizon PPO and Horizon PPO In-Network Only, 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) |
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|---|---|---|---|---|
| Medical | ||||
| Horizon BCBS PPO PLATINUM | Horizon BCBS PPO GOLD | HORIZON-IN-NETWORK ONLY PLATINUM | HORIZON-IN-NETWORK ONLY 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 ***This benefit is for 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 ***This benefit is for members ONLY*** | ||||
| $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. | ||||
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- member.Teladoc.com/registration
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Behavioral Health Services
The Fund recognizes the challenges of balancing work with the circumstances of everyday life. Members, through their primary insurance carrier (Horizon has 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. To assist members in a more impactful way, the Fund has brought on a Behavioral Health Advocate for those members seeking care. This advocate is here specifically to guide our members through the maze of all things Behavioral Health and Substance Abuse. PLEASE NOTE: We know how serious your care is to you. 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 your Behavioral Health Advocate at (888) 561-2299 or (856) 382-2497.
| Behavioral Health and Substance Abuse | ||||
|---|---|---|---|---|
| Horizon BCBS PPO PLATINUM | Horizon BCBS PPO GOLD | Horizon PPO IN-NETWORK ONLY PLATINUM | Horizon PPO IN-NETWORK ONLY GOLD | |
| IN-NETWORK (Out-patient) | $20 copay | $30 copay | $15 copay | $25 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 | No Out of Network Benefit Available as per Horizon PPO In-Network Only Plan | No Out of Network Benefit Available as per Horizon PPO In-Network Only Plan |
*** Specialized agreements can be enacted on the patient’s behalf only when the practitioner and/or practice agrees to the Fund’s proposed rate agreement and considers it as payment in full.
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
Cancer Screening & Prevention
Your Color benefit, now including at-home cancer screenings, in addition to private genetic testing.
Color’s confidential and free service helps you better detect cancer early so you can lead a healthier
life. Get free at-home cancer screening, easy access to in-person services like mammograms and
colonoscopies, private genetic testing, and support from a team of cancer experts with Color.
This benefit is available to all members and their spouses at no cost.
Here is What You Get (For Free!)
- At-home screenings for colorectal, cervical, and prostate cancers
- At-home genetic testing + counseling to assess an increased family-inherited cancer risk, plus
genetic ancestry and traits - Scheduling for mammograms, colonoscopies, and other screenings with in-network providers
- A dedicated care advocate who will do whatever it takes to help you get your screenings done
- Same-day/next-day phone or video visits with doctors and genetic counselors with deep
expertise in cancer care
Get More Details Here
If you need help at any part of the process, give Color a call at (844) 352-6567 between 6am and 5pm 7 days a week or email them at support@color.com.
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
Frequently Asked Questions (FAQ)
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