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.
Lifetime and Annual 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.
Office Visits for Preventive Care
Office Visits (including any diagnostic category)
Doctor On Demand*
Retail Clinic Visits (such as MinuteClinic)
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
Unlimited
$2,500 per covered person
$6,000 per family
100% paid by Plan
After $25 copay, 100% paid by Plan
100% paid by Plan
After $25 copay, 100% 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
Unlimited
$2,500 per covered person
$6,000 per family
70% paid by Plan
70% paid by Plan
100% paid by Plan
After $25 copay, 100% paid by Plan
70% paid by Plan
Not covered, unless in the case of an emergency
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

You have questions. We have answers!

Sometimes you need an advocate to help you work through the medical system. TEAM is there when you need:

  • Information about the quality of care provided by a physician or facility;
  • Help finding a medical specialist;
  • Answers from an RN;
  • Information about alternative treatments; or
  • Help getting the services you need.

Call 1-800-634-7710.

Save money on your health care needs

Use our wellness programs to help you get and stay healthy

Learn about your Health Reimbursement Arrangement (HRA)