The Boards of Trustees of the Ohio and IKORCC Funds are pleased to announce that effective January 1, 2025, the IKORCC Fund has merged into the Ohio Fund. To reflect our unity, the Ohio Fund has been renamed the Central Midwest Regional Council of Carpenters Welfare Fund (CMRCC Fund)
Effective January 1, 2023, medical claims will be processed through the Level Care Health Program – a program specifically developed for United Brotherhood of Carpenter sponsored Funds. Through Level Care Health, we have been able to secure better pricing and terms for our Fund.
Here is some important information regarding this program. Please read carefully:
1. Change in Blue Cross Network: Effective January 1, 2023, Independence Blue Cross (Independence) will replace Anthem Blue Cross as your medical network provider, and medical claims will be paid by Independence Administrators (IA) instead of BeneSys.
o You do not have to change doctors or other providers! Due to the Blue Cross Blue Shield network, the same doctors, hospitals, and other providers that are in-network with Anthem are in-network with Independence!
o There are no changes in your benefits. Your copayments, deductibles, and other coverages are not changing.
2. Your Benefit Cards
o Medical: Independence Blue Cross Blue Shield medical ID cards have a new look. After January 1, 2024, replacement cards and new dependent cards will display the Blue Cross Logo as well as the Independance Sheild. Digital copies of your new Independence card can be found on your member portal.
o Dental/Vision: These benefits are not changing! You will not receive a new dental/vision drug card. Do not discard your current dental/vision card, as you will continue to use it after January 1, 2023.
o Prescription Drugs: These benefits are not changing! You will not receive a new prescription drug card. Do not discard your current prescription drug card, as you will continue to use it after January 1, 2023.
3. Change in Telemedicine: Effective January 1, 2023, Independence Blue Cross (Independence) program MDLIVE will replace Anthem Blue Cross LIVE Health Online as your telemedicine provider
o With telemedicine from MDLIVE, you have 24/7 access to a board-certified doctor for non-emergency medical conditions.
o Text IBXTPA to 635-483 to chat with Sophie, a virtual assistant who will help you sign up
o Download the MDLIVE app on your smartphone
o Visit mdlive.com/ibxtpa
o Call 1-888-956-6411
Effective January 1, 2024 TELADOC will replace MDLIVE as your telemedicine provider.
Teladoc is a program that allows Covered Persons to contact a Physician online (with a webcam) or through a smartphone 24 hours a day, 7 days a week, for non-emergency issues.
Teladoc is accessible at www.TeladocHealth.com via telephone at: 1-800-835-2362. Visits through Teladoc are covered 100% (in-network only).
- General Medical
- Behavioral Mental Health
- Dermatology
Get a Second Opinion from a Cleveland Clinic Specialist without Leaving Home With Virtual Second Opinions by Cleveland Clinic.
The Ohio Carpenters' Health Fund is now offering Virtual Second Opinions through the Cleveland Clinic. With Virtual Second Opinion Services, you can have your diagnosis and treatment plan, or that of a family member, reviewed by a Cleveland Clinic Specialist without travel or red tape. It’s easy, 100% confidential, and available at no cost to you. All you need is a phone, tablet, laptop or desktop system.
GET STARTED BY FOLLOWING THE LINK BELOW:
https://www.clinicbyclevelandclinic.com/central-midwest-carpenters/
How It Works
Use the link above and follow the prompts. You will explain your medical diagnosis, treatment plan, etc., to a Nurse Care Manager who will match you to the right expert specialist. The Cleveland Clinic will collect your medical records, including lab samples, scans and more. In about two weeks, you will receive a detailed report with your specialist’s opinion and chat live with him or her to ask questions and learn more.
The Clinic's patient liaison phone number +1 (844) 777-0788
This Convenient, No-Cost Benefit Can Help if You Are:
Diagnosed with a serious condition, such as cancer
About to make a major decision about a medical next step, such as surgery
Considering a treatment that involves risk or has significant consequences
Dealing with a condition or chronic illness that isn't improving or is getting worse
Confused about or struggling with a medical diagnosis and treatment plan
Express Scripts Prescription Information:
IMPORTANT NOTE FOR THOSEALREADY RECEIVING COVERAGE FOR WEIGHT LOSS DRUGS:
As of October 1, 2024, if you would not have qualified for coverage under the new criteria when you began taking the drug, you will no longer be approved for coverage. Here are two examples of how this will work:
Example 1: On June 1, 2024, Participant A had a BMI of 31 and was approved for weight loss drug coverage. As of October 1, assuming Participant A’s BMI is under 32, Participant A will not be eligible for continued coverage unless Participant A otherwise meets the new criteria.
Example 2: On June 1, 2024, Participant B had a BMI of 33 (baseline BMI) and was approved for weight loss drug coverage. As of October 1, Participant B has a BMI of 31 and, assuming all other coverage requirements are met, will be eligible for continued coverage because Participant B’s baseline BMI meets the new criteria.
Coverage is also subject to the following conditions:
(a) Prior authorization is required for coverage to begin and then at least once per year in subsequent years. For each prior authorization after initial approval, have or maintain a 5% weight loss from initial weight.
(b) Enrollment and engagement with Omada, a virtual health program, provided by Express Scripts, the pharmacy benefits manager (PBM). Omada helps members create healthier habits to achieve long-lasting results. To continue coverage of a weight loss medication, you must meet the following requirements each month:
(1) Use the Omada app four times a month, by doing lessons or engaging with your health coach, peer group or online community.
(2) Weigh in four times a month using the smart scale provided by Omada.
Enroll in Omada, register or log in to esrx.com/healthsolutions on or after October 1, 2024, to get your Access Code. Then sign up at omadahealth.com/esi or download the Omada mobile app.
If you want your weight loss GLP-1 medication to be covered by your plan, ask your doctor to visit the Express Scripts online portal at esrx.com/PA or call Express Scripts at 800.417.1764 to arrange for a review on or after October 1, 2024. If your doctor doesn’t visit esrx.com/PA or call and get approval, you’ll be responsible for the full cost.
Summary of Health Care Benefits
Medical Benefits
Your medical benefit network is provided by Independence Blue Cross. To get the most out of your medical benefits, it is best to use a provider that participates in the Independence Blue Cross network. To locate a participating provider or for questions regarding benefits and claims, please contact Independence at 1-833-242-3330.
Dental Benefits
Your dental benefit network is provided by Delta Dental. Using a participating provider that accepts the Delta Dental network will ensure that you get the most out of your dental benefits provided by the Plan. To locate a participating provider or for questions regarding your dental benefits and claims, please contact Delta Dental at (800) 524-0149 or click on the Delta Dental link on the right side of the page to connect to their website.
Prescription Benefits
Your prescription coverage is provided by Express Scripts. For information about participating pharmacies, benefit information or to request additional ID cards, please contact Express Scripts at (800) 716-2932.
Vision Benefits
Your vision benefit network is provided by VSP. Using a participating provider that accepts the VSP network will ensure that you get the most out of your vision benefits provided by the Plan. To locate a participating provider or for questions regarding your vision benefits and claims, please contact VSP at (800) 877-7195 or click on the VSP link on the right side of the page to connect to their website.