Summary of IBEW Local 136 Family Health Plan
As a member of IBEW you will receive health care coverage for your family.
Breakdown of Blue Cross / Blue Shield Insurance:
| Family Health Plan | $4.80 per hour contribution (paid by employer). ($3.90-health coverage---$.90-special account fund (see page 56 in Summary Plan Book) |
| Major Medical | Maximum benefits payable per lifetime: $1,000,000.00 |
| Prescription Drugs |
The following are covered through Save-Rx Generics: 100% Brands: 80% (after $500.00 maximum out-of-pocket brand names are covered 100%) (Wal-Mart and Sam's Club are not in your network) |
| Hospital (Inpatient & Outpatient) |
Maximum hospital benefits payable per calandar year for all inpatient and outpatient hospital fees: $200,000.00 |
|
Calendar year deductibles |
Per person: $300.00 Per family (aggregate): $900.00 |
|
Emergency room
deductible (per occurrence) |
Fee waived if visit results in an inpatient admission, applies to emergency
room facility fees and emergency room physician fees: $100.00 |
|
Coinsurance(payment percentages)(per calendar year) |
BCBS PPO expenses: 85% Hospital emergency room treatment at an out-of-network hospital: 85% Professional charges by an out-of-network radiologist, pathologist or anesthesiologist for services provided at BCBS PPO hospital: 85% Out-of-network expenses(except as stated above): 75% |
|
PPO maximum out-of-pocket limits per calendar year |
Per person: $1,500.00 Per family (aggregate): $3,000.00 Once a person's PPO out-of-pocket limit is met, most covered BCBS PPO expenses are paid at 100% during the remainder of the year. Deductibles are not counted toward your out of pocket limits. Your Coinsurance percentages for treatment of substance abuse and mental/nervous disorders do not apply to your out-of-pocket limit, and will not be paid 100%. |
| Life Insurance | $10,000 |
| Eye Care (Retirees are excluded) | Vision examinations: $60.00 Eyeglasses: Frame and single vision lenses: $120.00 Frame and bifocal lenses: $135.00 Frame and trifocal or lenticular lenses: $150.00 Contact Lenses (all lenses): $120.00 |
| Dental Insurance (Retirees are excluded) |
Metlife administers the Plan's Dental Benefits $1,000 per Person per Year Preventive and basic care: 80% Major restorative care (crowns and prosthetics):50% |