Medical Plan for Active Participants
Highlights
Here are some key facts about your medical coverage provided by your Operating Engineers Local 49 Health and Welfare Fund. It’s important to understand that the Plan works differently depending on whether the provider you use is within the Fund’s network.
Notes:
- Active Non-Bargaining or Bargaining Premium participants have the same Plan details shown in the table below, except your deductibles are $750 per covered person and $1,500 per family.
- West River participants have a different Plan. See the details.
Deductible
This is the amount you pay before the Plan pays for covered services. It resets at the beginning of each year.
This is the amount you pay before the Plan pays for covered services. It resets at the beginning of each year.
Lifetime Maximum Benefit
Annual Out-of-Pocket Maximum
This is the most you could pay out of pocket each year. It does not include the deductible.
This is the most you could pay out of pocket each year. It does not include the deductible.
Office Visits for Preventive Care
Office Visits (primary care or specialist)
Doctor On Demand*
Diagnostic Testing and Imaging
Laboratory Services
Inpatient Services (services in or billed by hospital)
Outpatient Services (services in or billed by hospital)
Emergency Services
Ambulance
Chiropractic and Acupuncture Treatment
In-Network Provider
$500 per covered person
$1,000 per family
$1,000 per family
Unlimited
$2,500 per covered person
$6,000 per family
$6,000 per family
100% paid by Plan
After $25 copay, 100% paid by Plan
100% paid by Plan
80% paid by Plan
After $25 copay, 100% paid by Plan
80% paid by Plan
80% paid by Plan
80% paid by Plan
80% paid by Plan
100% paid by Plan, up to 19 visits combined per year
Out-of-Network Provider
$500 per covered person
$1,000 per family
$1,000 per family
Unlimited
$2,500 per covered person
$6,000 per family
$6,000 per family
80% paid by Plan
70% paid by Plan
100% paid by Plan
70% paid by Plan
70% paid by Plan
Not covered, unless in case of emergency and then 80% paid by Plan
70% paid by Plan
80% paid by Plan
80% paid by Plan
100% paid by Plan, up to 19 visits combined per year
* Learn more about Doctor on Demand.
Details
- See the full benefit grid for Active Hourly Participants (participants who work under a master agreement).
- See the full benefit grid for Active Non-Bargaining and Bargaining Premium Participants.
- West River participants: review your Summary of Benefits and Coverage (SBC).
- Review the SPD.
- Learn how to read your Explanation of Benefits (EOB).
- Visit the Blue Cross Blue Shield website.
Health care questions? We have answers.
TEAM is your partner when you need help:
- Understanding your medical conditions
- Finding a specialist
- Learning about your medications
- Getting a second opinion
- With a mental health issue
- Seeking substance abuse treatment
Visit our website or call:
- 800-634-7710 (Toll-free)
- 651-642-0182 (Local)
- 218-727-8589 (N. Minnesota)
