Active Health & Welfare – Plan K500

Prescription Drug Coverage

You must obtain your drugs at Kaiser pharmacies. Generic drugs are available with a $15 copayment and brand name drugs with a $30 copayment up to a 30-day supply at Kaiser Pharmacy. For mail order, the copayments are twice those at a retail pharmacy for a 100-day supply.

Dental Options

If your employer has negotiated for dental benefits with your union, dental coverage is available to you and your eligible dependents. Each of your dental care choices covers preventive, basic, and major care. Benefits depend on the plan in which you enroll. New dental eligibles cannot enroll in Delta Dental or the Scheduled Direct Pay Plan for the first 12 months of coverage. Therefore, during their first 12 months of coverage, they are limited to enroll in one of the DMOs shown below. Dental Plan Options include:

• Dental Maintenance Organization (DMO)  The Bright Now!/Newport Dental, MetLife, United Healthcare Dental and United Concordia Dental Plans operate like HMOs, providing services only through participating dental offices. You will be responsible for small copayments for most covered services.
• Delta Dental Plan The Delta Dental plan allows you to use any licensed dentist, but pays a higher benefit when you use Delta Preferred Option Dentists. For most participants, there is a $3,000 annual maximum benefit and you pay 20% of covered expenses when you use a Delta Preferred Option Dentist (30% of covered expenses when you do not). The maximum does not apply to pediatric dental services.
• Scheduled Direct Pay Dental Plan  The Scheduled Dental Plan also allows you to use any licensed dentist of your choice. The Plan pays 100% of a scheduled amount for covered dental treatment, not to exceed a $2,500 annual maximum per eligible person. The maximum does not apply to pediatric dental services. However, the Plan offers members access to a dental PPO network, First Dental Health (FDH). FDH providers offer members treatment at discounted rates. Therefore, your annual maximum benefit goes farther by using a FDH dentist. For information on locating a FDH dentist, please contact FDH at (800) 334-7244 or www.firstdentalhealth.com

Orthodontics

If your employer has negotiated for self-funded orthodontic benefits with your union, Orthodontic coverage is available to you and your eligible dependents once you have been covered by the Plan for three months. If you are eligible for orthodontic coverage, orthodontic treatment will be covered in full up to a lifetime benefit of $2,500 per individual. If you enroll in a Dental Maintenance Organization, orthodontia may be available at discounted rates if you use a panel orthodontist. Regardless which dental plan option you have selected, orthodontic benefits are paid by the Fund Office once a claim is filed by your orthodontist.

Vision Care

If your employer has negotiated vision benefits with your union, you may use Vision Service Plan’s (VSP) network of eye care professionals to receive exams, and purchase lenses and frames. Kaiser also offers eye exams.

Burial Benefit

If you are entitled to medical coverage through the Fund, you are automatically entitled to the Burial Benefit. This benefit provides payment of $2,500 to your designated beneficiary upon the death of a covered Participant. Burial benefits are available to Active Employees and his or her covered Dependents.

Life Insurance

If you are covered for Life Insurance, the amount available upon the death of you or your eligible dependents is dependent on your employer’s collective bargaining agreement with your union.