Medical Benefits

The Fund offers two distinct benefit programs – a self-insured version of the BCBS Blue Card™ PPO program, as well as a self-insured version of Aetna’s EPO program. The Blue Card™ PPO program is a preferred provider program with both in-network and out-of-network benefits. The Aetna EPO program has no out-of-network benefits.

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Weekly Disability Claim Form

COB Declaration of Health Coverage

(Versión en español)

Dental Claim Form

Change of Address

(Versión en español)

Gym Reimbursement Form

HIPAA Authorization

(Versión en español)

Beneficiary and Census Form

(Versión en español)

Weekly Disability Continuation Form

Application for Handicapped Coverage

Member Kit

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 (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 must enroll in order to add eligible dependents to the account

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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 or Aetna, and 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. 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	Aetna EPO PLATINUM	Aetna EPO 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 Aetna Plan	No Out of Network Benefit Available as per Aetna 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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