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Benefits Medical Expense Benefit When you or your eligible Dependents incur expenses as a result of a non-occupational illness or injury, the Medical Expense Benefit Plan reimburses you or your provider for a portion of the Covered Charges. You or your eligible dependent must first satisfy the deductible or make a required co-payment as shown in the Schedule of Benefits (see links below). After the deductible is met, the Plan pays the percentage of the Usual and Customary Charges shown in the Schedule of Benefits. Once you have met the out-of-pocket limit, the Plan may pay up to 100% of Covered Charges incurred for the remainder of the calendar year up to the calendar year maximum. Click here to see the Summary Plan Description, 2007 Edition. Medical Expense Benefit description begins on Page 16. Click
the name of the Network below to see a Schedule of Benefits To
find a Network Physician or Hospital, visit the carriers website For Blue Cross Blue Shield of Illinois and HFN network participants: for information about medical benefits or to check on the status of a claim, contact:
for preauthorization
of inpatient hospitalization, outpatient surgeries,
For Health Alliance network participants: for information and claim forms regarding medical benefits, contact:
for preauthorization
of inpatient hospitalization, outpatient surgeries,
For preauthorization of all Mental Health and Substance Abuse treatment, contact:
Prescription Drug Benefit Click here to see the Summary Plan Description, 2007 Edition. Prescription Drug Benefit information begins on Page 58. To see a list of participating SavRX pharamacies, or to find out if a drug is covered, visit SavRX at http://www.savrx.com/ Vision and Hearing Care Benefits Click here to see the Summary Plan Description, 2007 Edition. Vision and Hearing Care Benefit information begins on Page 65. for information about vision and hearing benefits, or to check on the status of a claim, contact:
Dental Benefit Plan Click here to see the Summary Plan Description, 2007 Edition. Dental Care Benefit information begins on Page 61. for information about dental benefits, contact:
Other NCILHWF Benefits For information regarding the Loss of Time Benefit, see page 67 of the 2007 Edition of the Summary Plan Description. Questions regarding Loss of Time claims can be directed to:
For information regarding the Death and Accidental Death and Dismemberment Benefits, see 2007 Edition page 72 of the Summary Plan Description. Questions regarding Death and Accidental Death and Dismemberment claims can be directed to:
For information regarding Retiree Benefits, see the Summary Plan Description, 2007 Edition beginning on page 32. Questions regarding Retiree Benefits can be directed to:
Please note:
NCILHWF is not responsible for the content of external internet sites.
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North Central Illinois
Laborers' Health & Welfare Fund |
