Home Health & Welfare
BCBS of AL COVID-19 Update

As the illness caused by the novel coronavirus, COVID-19, continues to spread, many are concerned about the possible impacts to themselves and their families. 

Blue Cross and Blue Shield of Alabama is closely monitoring the situation and has prepared contingency plans to ensure business operations continue to run smoothly in the event of a widespread outbreak. While these steps may not be necessary, these plans include: 

·       Continuing to process claims electronically. (Please note that 99% of claims are processed electronically, so we do not anticipate any disruption to claims processing.)

·       Heavily utilizing telework to maintain staffing of critical business areas. We expanded our telework capabilities, and currently have almost 100% of the workforce working from home.

In addition, Blue Cross has taken the following steps for benefits related to COVID-19:

·       Telehealth services are available to all members beginning March 16, 2020. Telehealth allows in-network PPO providers to provide medically necessary services to members that can be appropriately delivered via telephone consultation. This is applicable for members who wish to receive their care remotely and wish to limit their exposure. It can also serve as an initial screening for members who need to be tested for COVID-19.
PLEASE NOTE FOR GROUPS WITH TELEDOC COVERAGE

·       The newly expanded services being provided for telehealth are different from the services provided by Teladoc. The expansion of telehealth services effective 3/16/2020 is available to all members on both Underwritten and Self-Funded groups and allows in-network PPO providers to provide medically necessary services that can be appropriately delivered via telephone consultation. If the telehealth service is filed with a COVID-19 related diagnosis as outlined by the CDC and American Medical Association, the telehealth service will be covered at 100% with no member cost sharing. If the telehealth service is not filed with a COVID-19 related diagnosis as outlined by the CDC and American Medical Association, the telehealth service will be subject to member cost sharing (copays, deductibles, etc.) and contract benefits will apply.

·       In addition to the newly expanded services being provided for telehealth, Teladoc services are also available separately to members that have the Teladoc benefit on their benefit plan. Please note that Teledoc copays are not being waived at this time. 

·       In-network diagnostic tests for COVID-19 will be covered at 100% with no member cost sharing. Out-of-network diagnostic tests for COVID-19 will be covered at the out-of-network benefit level.

·       If an in-network office visit, urgent care visit, emergency room visit, behavioral health visit, or telehealth service results in a claim being filed by the in-network PPO provider with a COVID-19 related diagnosis as outlined by the CDC and American Medical Association, that office visit, urgent care visit, emergency room visit, behavioral health visit, or telehealth service will be covered at 100% with no member cost sharing. Out-of-network services will be covered at the out-of-network benefit level.

·       More than one in-network office visit, urgent care visit, emergency room visit, behavioral health visit, or telehealth service for the same member incurred on the same day will be covered if the urgent care visit, emergency room visit, behavioral health visit, or telehealth service is rendered by different in-network PPO providers and the claims are filed with a COVID-19 related diagnosis as outlined by the CDC and American Medical Association.

·       Inpatient deductibles and copays will be waived if a member is admitted to an in-network hospital with a COVID-19 related diagnosis as outlined by the CDC and American Medical Association.

·       We will increase access to prescription medications by waiving early medication refill limits on 30-day prescription maintenance medications (consistent with a member’s benefit plan) and/or encouraging members to use their 90-day mail order benefit.   The early refill allowance applies to prescription drugs including retail, maintenance, mail order and specialty drugs and will be effective until 5/31/2020.  We will also ensure formulary flexibility if there are shortages or access issues. Patients will not be liable for additional charges that stem from obtaining a non-preferred medication if the preferred mediation is not available due to shortage or access issues.

Please contact Blue Cross Blue Shield of Alabama at 800-292-8868 with further questions.

 
Local 52 Health & Welfare Plan

2020 Health, Dental and Vision insurance Information

The health & welfare rate for 2020 is $6.66 per hour.

The Health insurance premium is  $1062.00 per month.

Dental and Vision coverage is an added benefit of the plan.

Health Coverage is through Blue Cross Blue Shield of Alabama. 1-800-292-8868  www.bcbsal.com

Dental Coverage is through Guardian. 1-800-541-7846    www.guardiananytime.com

Vision Coverage is through VSP.  1-800-877-7195   www.vsp.com

Blue Cross Blue Shield of Alabama health insurance- There are no changes to copays or deductibles for 2020. All benefits remain the same with the exception of Medication Synchronization. Medication Synchronization allows members to prorate their prescription drug copays when they choose to align their maintenance medication refills to the same day. Medications can then be picked up at the pharmacy on the same day. You are not required to synchronize your refills, it is a convenience feature only. The option to participate or decline is available at your pharmacy. Please refer to the BCBS Benefit booklet for complete coverage details. Contact Blue Cross Blue Shield of Alabama at 1-800-292-8868 or online at www.bcbsal.com. Many services are available on the website; view and file claims, find a doctor, manage prescriptions, compare drug costs and find a pharmacy. Blue Cross now offers an APP for mobile devices that includes many of the online services.

 
Notice-Health & Welfare

Legal Notices are available under the Documents/Health & Welfare section.

Privacy Notice, Grandfathered Status, Electronic Benefit Booklets, Womens Health & Cancer Rights Act, Rights Under Newborns & Mothers Health Protection Act, Creditable Drug Coverage, MarketPlace, COBRA, Premium Assistance under Medicaid and CHIP, Local 52 Hour bank system.

icon H&W Legal Notices

 
Health & Welfare

If you need additional information, contact Kay Pinckard at 334-272-0240 ext. 5.

The current health insurance provider is Blue cross Blue Shield of Alabama. You may contact BCBS at 1-800-292-8868 with any coverage or claim questions. You may also find participating providers and print claim forms at www.bcbsal.com.  If you are traveling or live out-of-state, please contact BCBS at 1-800-810-2583 to find a participating provider in your area.

Dental insurance is a benefit of the health & welfare plan.  Dental coverage is provided by Guardian.  You may contact Guardian at 800.541-7846 with any coverage or claims questions. www.guardiananytime.com

Vision insurance is a benefit of the health & welfare plan.   Vision coverage is provided by VSP.  VSP does not issue id cards. A participating provider will verify your coverage via your social security number.  You may contact VSP at 800.877.7195 with any coverage or claims questions.  www.vsp.com

A $20,000 term life insurance policy is a benefit of the health & welfare plan.  You must be enrolled in the health plan or an eligible retiree to qualify for life coverage.


HOW DOES THE HEALTH & WELFARE HOUR BANK SYSTEM WORK?  AND HOW ARE HOURS REPORTED TO THE HEALTH & WELFARE PLAN? 

The Plumbers & Steamfitters Local Union 52 Health & Welfare Plan was created to provide health coverage to Eligible Employees.   While the Plan provides an Hour Bank to be used by Qualified Participants and Eligible Employees during times when work is slow or not available, the Hour Bank is not a vested benefit and use of it is limited to Eligible Employees as provided in the Plan’s governing documents. Under the terms of the Plan, an Eligible Employee is an individual who is employed by or seeking employment with an Employer to render services which under the terms of a collective bargaining agreement or other agreement require the Employer to make contributions to this Plan. You currently meet these guidelines and are eligible for coverage.     

However, should it be determined, that you are no longer employed or seeking employment with an Employer who contributes to the Plan. Consequently, you are not an Eligible Employee or Qualified Participant. As such, you would no longer have access to an Hour Bank to continue coverage under the Plan. Without the Hour Bank, you would not have sufficient hours for participation in the Plan. At that time, your coverage under the Plan would terminate and you would receive Notice of Continuation Coverage under COBRA. Any remaining Hour Bank balance will be forfeited to the Plan.

Hour Bank and Health Premiums effective January 1, 2020 - The health & welfare benefit rate of $6.66 per hour is based on working 160 hours each month to cover the health premium of $1062.00. Premiums are deducted from your hour bank on the 1st of each month for the following month (ex: on 01/01/20, premium for 02/01/20 is deducted. Local Contractors are required to remit hours to the Plan by the 15th of the month following the work month (ex: January work hours will be received in February). Premium notices are mailed around the 15th of each month if your hour bank is depleted. If you receive a premium notice, please do not disregard it…you are receiving the notice because 1) you have been out of work and your hour bank is depleted or 2) you are working out of town and your hours have not been received. Please call the Benefit Office immediately so we can contact the Contractor or Local to locate your hours. Please note that your health & welfare hour bank insurance coverage is based on hours receivednot hours worked. Therefore, if you are working out of another Local, have not worked enough hours or hours have not been received by the plan… and you receive a premium notice, you must pay the premium for your health insurance coverage to continue. 

When working through another Local, it normally takes 2-3 months, sometimes longer, for the Plan to begin receiving hours worked. The health & welfare rate per hour is different for each Local. Therefore, based on that rate you may need to work more/less hours to cover the premium each month. If the rate for that Local is less, then you would need to work more hours to cover the monthly premium. This lower rate could cause a reduction in your hour bank balance and over time may cause you to owe premium out of your pocket. If the rate for the Local is more, then you would need less hours to cover the monthly premium and this should help increase your hour bank balance.

This Plan is legally required to inform you that although Local 52 expects coverage provided by the Health & Welfare Plan to continue in its present form for an undeterminable period, it is subject to modification or termination at any time.


For additional information, please read the Benefit Booklets and Summary of Benefits located under the Document/Health & Welfare section.

2020 BCBS benefit summary

2020 Guardian Dental Benefits

2020 VSP Vision benefit summary

 

How Can You Help Control Health Insurance Costs

Health care costs continue to rise. As you know, our health insurance premiums are directly influenced by our claims. Therefore, leading to higher insurance premiums. The following tips will help you manage your health care, and the costs that go with it, more effectively.

~~ Ask your doctor and pharmacist if generic drugs can be substituted for specific drugs prescribed. Generics are made available after the brand name patent has expired. They are equally effective and safe and contain the same basic active ingredients as brand name drugs. Generic drugs are reimbursed at 100% with no deductible, compared to the Brand name that is reimbured at 80% after a $500 deductible. If there is no generic available, ask your doctor for samples.

~~ Make sure you understand how any test, x-ray or procedure relates to the diagnosis and treatment of your illness. Don't be afraid to ask your doctor questions. It keeps you informed about your health and may keep your costs down.

~~ If you are planning a hospital stay, ask your doctor if routine tests can be performed before you are admitted to the hospital.

~~ Use the Emergency room for Emergencies ONLY. Emergency room visit costs are almost double that of a visit to your regular doctor. Please visit your regular doctor for everyday illnesses.

~~ Review bills from doctors and hosptials. Ask the hospital for an itemized statement. Bills could contain mistakes. If you find an error, please contact the provider immediately.

~~ Have outpatient surgery when the procedure can be safely and effectively performed as part of your treatment. Outpatient surgery can spare you a hospital stay, letting you recover in your own home.

~~ Sign up for InfoSolutions, Blue Cross' medical information network. Information such as chronic illnesses, test results, procedures, filled prescriptions, immunizations and allergies are stored securely so that authorized doctors can access it for use during your treatment and care. This may lead to faster diagnosis and treatment for you.

~~ If you have a chronic disease such as diabetes, asthma, coronary artery disease or congestive heart failure, consider participating in Blue Cross' Care Management program. This program focuses on managing these conditions to improve your health and wellness.

~~ Routine medical procedures are performed during the week in most hospitals. Going into the hospital on the weekend to wait for a Monday procedure can be costly. Make sure any weekend stay is medically necessary.

~~ Follow a healthy lifestyle. More information about healthy living can be found at www.bcbsal.com by selecting the "For Your Health" link.

Source: Blue Cross Blue Shield of Alabama flyer fyh124. "Blue Cross Blue Shield of Alabama and the Local 52 Health & Welfare Plan care about your health and wellness. "For your Health" is an informational series designed to provide you with specific ideas for ensuring you and your family enjoy a healthy and safe lifestyle. Sources are available upon request."

24-Hour Toll-Free Nurse Hotline

Did you know that Blue Cross Blue Shield of Alabama offers a 24-hour toll free Nurse Hotline? With Blue Cross' Care Management hotline, an experienced nurse is a phone call away to help you with answers to your health care questions. With the hotline, you have immediate access to a registered nurse 24 hours a day, 7 days a week, 365 days a year. This valuable service is free by calling:
1-800-896-2724

When you call the Care Management hotline, nurses provide information on:
* Effective home treatment and prevention
* When to call your physician
* Communicating effectively with your doctor
* Preparing for doctor visits
* Making wise decisions about tests, medications and surgeries
* Understanding prescription medications and how to make them work well for you
* Lifestyle choices to improve your health

The information you discuss with Care Management nurses may be printed and mailed to you if you prefer.

Health care information is also available on the website. For online access to a health library containing the most comprehensive health information available, visit www.bcbsal.com and select "For Your Health Wellness Tools for You."

There is no cost to you for calling the Care Management 24 hour hotline.

Tel-A-Doc

IMAGINE waking up with flu symptoms, but you can’t get in to see your Primary Physician. What should you do? No worries… With Teladoc, connecting with a doctor is
EASY.  See the link below for more information.

BCBS Tel-A-Doc

 


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