Medical Plan for Pre-Medicare Retirees

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.

In-Network Provider
Deductible
This is the amount you pay before the Plan pays for covered services. It resets at the beginning of each year.
$750 per covered person
$1,500 per family
Lifetime and Annual Maximum Benefit
Unlimited
Annual Out-of-Pocket Maximum
This is the most you could pay out of pocket each year. It does not include the deductible.
$2,500 per covered person
$6,000 per family
Office Visits for Preventive Care
100% paid by Plan
Office Visits (including any diagnostic category)
After $25 copay, 100% paid by Plan
Doctor On Demand*
100% paid by Plan
Retail Clinic Visits (such as MinuteClinic)
After $25 copay, 100% paid by Plan
Laboratory Services
After $25 copay, 100% paid by Plan
Inpatient Services (services in or billed by hospital)
80% paid by Plan
Outpatient Services (services in or billed by hospital)
80% paid by Plan
Emergency Services
80% paid by Plan
Ambulance
80% paid by Plan
Chiropractic and Acupuncture Treatment
100% paid by Plan, up to 19 visits combined per year
Out-of-Network Provider
Deductible
This is the amount you pay before the Plan pays for covered services. It resets at the beginning of each year.
$750 per covered person
$1,500 per family
Lifetime and Annual Maximum Benefit
Unlimited
Annual Out-of-Pocket Maximum
This is the most you could pay out of pocket each year. It does not include the deductible.
$2,500 per covered person
$6,000 per family
Office Visits for Preventive Care
70% paid by Plan
Office Visits (including any diagnostic category)
70% paid by Plan
Doctor On Demand*
100% paid by Plan
Retail Clinic Visits (such as MinuteClinic)
After $25 copay, 100% paid by Plan
Laboratory Services
70% paid by Plan
Inpatient Services (services in or billed by hospital)
Not covered, unless in the case of an emergency
Outpatient Services (services in or billed by hospital)
70% paid by Plan
Emergency Services
80% paid by Plan
Ambulance
80% paid by Plan
Chiropractic and Acupuncture Treatment
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)