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Health Benefits Provided
Each benefit’s waiting period starts when Covered Employment begins, as long as you are enrolled. If enrollment occurs after a benefit’s waiting period, eligibility for that benefit will begin on the date of enrollment.
| Benefit | ||
|---|---|---|
| Health Center for Care& Related Pharmacy |
|
Covered in full with no charge provided a Health Center is used.Prescriptions available for the Urgent Care visit only with a co-pay.(See below.) |
| Health Center & Pharmacy |
|
Provided by the Health Center |
| $5 co-pay for generic drugs on formulary. | ||
| $15 co-pay for brand-name drugs on formulary but not available generically. | ||
| 90-day supplies of certain generic drugs are $12.00 or less. 90-day formulations and dosages may vary and are at the discretion of the pharmacy. | ||
| Drugs not on formulary may be provided at actual cost to the Fund.Use of an outside pharmacy is not reimbursed. | ||
| All Other HealthCenter Services |
|
Covered in full with no charge provided a Health Center is used. |
| Hospitalization |
|
1.) With participating hospitals, 100% for covered services. First 120 days(semi-private room) covered in full. Next 180 days covered at 50% ofsemi-private room rates. 2.) With non-participating hospitals, first 120days (semi-private room) covered at $30 a day for room and 80% ofallowed charges. Next 180 days covered at $15 a day for room and40% of allowed charges. |
| Emergency Room(see terms above) |
|
You must go within 72 hours of injury or 12 hours of onset of illness.Ambulance services are only covered for acute conditions byreferral from the Health Center. |
| Dental Care |
|
Dental services provided through Health Centers & related providers. |
| Optical Care |
|
Eye Care available through the Queens, Brooklyn, and Harlem Health Centers& 14 Penn Plaza. Prescription eye wear available from a store of your choosing,reimbursements offered according to plan details and eligibility. |
| Members HealthAssistance Program(MHAP) |
|
Confidential consultative and crisis prevention assistance for emotional, alcohol- and drug-related problems. |
| Substance AbuseTreatment |
|
Must receive referral from MHAP office. 7 days of active treatment percalendar year for detoxification. 30 days of in-patient rehabilitation serviceswith a maximum of 2 admissions per lifetime. |
| Inpatient PsychiatricTreatment(non-substance abuserelated) |
|
30 days of inpatient care per calendar year for approved conditions. You must call Empire BlueCross BlueShield using the numberon the back of your card before admission. |
| Life Insurance |
|
For member only, $10,000 |
| Accidental Death& Dismemberment |
|
For member only, up to $10,000 |
| Disability |
|
For member only, 50% of your gross weekly salary (max of $300)for up to 26 weeks. Health coverage also continued during aperiod of paid disability. |
For more information, read the Health Summary Plan Description – Health SPD July 2014
