Tuesday, October 20, 2020

Your Health Care Benefits

Your Health Care Benefits

The Board of Trustees is pleased to welcome you to the new website for the Plumbers Local 55 Cleveland Trust Fund. Within this website, you will now have access 24 hours a day, 7 days a week to commonly requested forms, useful links, and frequently asked questions regarding your benefits provided by the Plan. As always, please feel free to contact the Benefit Office at (216) 503-1184 or toll-free at (844) 344-2715 if you have any additional questions or concerns.


Important Updates to Coverage for Testing and Treatment of COVID-19 provided by MMO

There are three important items we want to bring to your attention regarding coverage for testing and treatment of COVID-19. Because you are a fully insured group, you are automatically opted in to these coverage updates.

The changes will be effective retroactively to January 27, 2020, the date the US Department of Health and Human Services declared the national public health emergency.

1. Per the Families First Coronavirus Response Act signed into law by President Trump on March 18, 2020, testing for COVID-19 is covered with no member cost sharing. Testing covers the cost of the test, as well as the cost of the provider visit, which could include a telehealth (telemedicine), urgent care or emergency room visit, to determine whether the COVID-19 testing is required, and the visit to administer the test.

2. The Ohio Department of Insurance (ODI) issued Bulletin 2020-05. This bulletin mandates that fully insured and non-ERISA, self-funded groups cover all treatment related to COVID-19 diagnoses as emergency services, effective March 20, 2020. This means services must be covered at the in-network benefit level regardless of whether the healthcare professional or facility is in our network.

3. For our fully insured plans, Medical Mutual is waiving member cost sharing for all treatment related to COVID-19, including hospitalizations and ground ambulance transfers for individuals with a positive COVID-19 diagnosis, through May 31, 2020. In addition, Medical Mutual will permanently cover FDA-approved medications and vaccines when they become available.


Medical and Prescription Benefits

Your medical and prescription benefit network for Active and Non-Medicare Retirees is provided by MMO and for Medicare Retirees is provided by Aetna. To get the most out of your benefits, it is best to use a provider that participates in the MMO or Aetna networks. To locate a participating provider or for questions regarding benefits and claims, please contact MMO (800) 382-5729 or Aetna (800) 872-3862. You may also click on the MMO or Aetna link on the right side of the page to connect to their website.

Vision Benefits

Your vision benefit network is provided by VBA. Using a participating provider that accepts the VBA 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 VBA at (800) 432-4966 or click on the VBA link on the right side of the page to connect to their website.