Monday, August 3, 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 and Pipefitters Union Local 525 Health and Welfare 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 Trust Fund Office at (702) 415-2199 or (844) 763-3228 if you have any additional questions or concerns.

Medical Benefits

There are basically two types of Medical Plans available to the Plumbers and Pipefitters Local 525 Health & Welfare Trust Fund participants, PPO or EPO. The options are described briefly below. Detailed information regarding each plan can be obtained on this website or by calling the Trust Fund office at (702) 415-2199 or (844) 763-3228.

Your medical benefit network is provided by Anthem Blue Cross Blue Shield. To get the most out of your benefits, it is best to use a provider that participates in the Anthem network.  If you are covered under the EPO Plan, you MUST use an Anthem provider or services will NOT be covered.  To locate a participating provider, please log into www.Anthem.com or call the Trust Fund office for assistance. Remember: for the best benefits, when accessing care you should always use an Anthem provider.  For primary care services, EPO Participants MUST use the Collective Union Health clinics or services may not be covered.

PPO Medical Plan – To obtain the highest level of benefits (In-Network), with the lowest out of pocket expenses, participants of the PPO Plan should select Anthem contracted providers. The PPO Plan also provides benefits for Non-Contracted provider services; however, they are paid at a lower percentage, leaving the patient with higher out of pocket costs.

EPO Medical Plan for Non-Residential Employees (for the first one year of eligibility, only the Residential EPO plan is available to Residential employees. After that, Employees, except Residential Employees, may change to the PPO or EPO Non-Residential Plan if they have been covered under the current plan for at least 12 months.  If you are covered under the EPO Plan, you and your dependents 3 years old and up must use the Collective Union Health clinic as your primary care provider.  A referral is not needed for specialist care.  You must use an Anthem provider or services will not be covered.  For a list of providers, visit www.Anthem.com.

EPO Medical Plan Residential Employees – If you are covered under the EPO Plan, you and your dependents 3 years old and up must use the Collective Union Health clinic as your primary care provider.  A referral is not needed for specialist care.  You must use an Anthem provider or services will not be covered.  For a list of providers, visit www.Anthem.com

Retiree Benefits (available to retired employees receiving a pension benefit from the Plumbers & Pipefitters Local 525 Pension Trust) –

  • Not Medicare Eligible – Medical and Prescription benefits for an eligible retired Employee, who is not eligible for Medicare, will be the same as benefits for Employees under the PPO or EPO Plan.
  • Medicare Eligible – When you become eligible for Medicare, you have a choice of two medical plans, the PPO Medicare or EPO Medicare  Plan, which pays secondary to Medicare.
Dental Benefits

Your dental benefit network is provided by Cigna. Using a participating provider that is contracted with Cigna will ensure that you get the most out of your dental benefits provided by the Plan. To locate a participating provider, please contact Cigna at (800) 877-7195 or click on the Cigna link on the right side of the page to connect to their website.

Vision Benefits

Your vision benefit network is Vision Service Plan (VSP). Using a provider that participates with VSP 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.

Life Insurance / Disability

As a member, you are offered basic life/accidental death and dismemberment (AD&D) insurance and disability coverage. The information pertaining to these benefits can be found on this website under the Health Care / Documents tab.

Indemnity Medical Prescription Benefits

Your Prescription Benefit Manager is Navitus. Using a participating pharmacy will ensure that you get the most out of the pharmacy benefits provided by the Plan. To locate a participating pharmacy, please contact Navitus at (855) 673-6504 or click on the Navitus link on the right side of the page.