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.
** All of the benefits noted on the following pages are subject to the eligibility schedule set forth in the Summary Plan Description
| Find a Horizon Provider | 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 | $250 deductible per person, $500 per family, and 10% coinsurance up to $500 per person | $500 deductible per person, $1000 per family, and 10% coinsurance up to $750 per person | $100 deductible per person, $200 per family, and 10% coinsurance up to $250 per person | $350 deductible per person, $700 per family, and 10% coinsurance up to $500 per person |
| Out-of-Network Deductible & Coinsurance | $500 deductible per person, $1000 per family, and 20% coinsurance up to $1500 per person | $1000 deductible per person, $2000 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. | ||||
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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) | $250 deductible per person, $500 per family, and 10% coinsurance up to $500 per person | $500 deductible per person, $1000 per family, and 10% coinsurance up to $750 per person | $100 deductible per person, $200 per family, and 10% coinsurance up to $250 per person | $350 deductible per person, $700 per family, and 10% coinsurance up to $500 per person |
| OUT OF NETWORK (In-Patient & Outpatient) | $500 deductible per person, $1000 per family, and 20% coinsurance up to $1500 per person | $1000 deductible per person, $2000 per family, and 20% coinsurance up to $2250 per person | $500 deductible per person, $1000 per family, and 20% coinsurance up to $1500 per person | $1000 deductible per person, $2000 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
In our ongoing commitment to member health, the Fund has partnered with Color Genomics to offer eligible members free access to Color’s confidential genetic testing program. This program provides customized resources, such as education, genetic testing and counseling, and ongoing support services for participating members who are identified to be at risk. Color’s test checks your DNA for hereditary cancer risk, hereditary heart disease, and medication response to help you become more aware of your risk so you can make better decisions about your health moving forward.
Members can claim their kits at www.color.com/go/teamsters. This program is voluntary and completely confidential. Test results will not be shared with the Fund or your employer. Questions about genetic testing or support with claiming your kit, call Color at 844-352-6567 or email Color 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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