Health and Welfare
Outside Iron Workers
The Intermountain Ironworker Health and Welfare Trust (trust fund) offers medical, prescription drug, dental, vision, weekly disability, death, and accidental death and dismemberment (AD&D) coverage. When you are eligible, you will be notified by the Trust Fund Administrator, Compusys of Utah.
All benefits provided by the trust fund, except for life/AD&D coverage, are self-funded and provided directly to plan participants.
PPO Medical Plan. The medical plan provides benefits for all covered participants and family members. Discounts are provided through a preferred provider organization (PPO) operated by CIGNA that uses the CIGNA Open Access Plus network of providers. Claims are discounted by CIGNA if they are provided by PPO providers and paid by Compusys the plan’s administrator.
To maximize your plan benefits, always use in-network or PPO providers. To locate a CIGNA provider, visit CIGNA’s website at www.cianasharedadministration.com and click on “Find A Doctor”, and then select “Shared Administration OAP Provider Directory”. You may also contact Cigna at 1-800-768-4695 to find out if a specific provider is in the network. You can also find a link to Cigna on the Plan’s website, www.iiw.compusysut.com.
EnvisionRxOptions administers the Plan’s prescription drug benefits.
Your prescription drug benefits are administered by EnvisionRxOptions and your prescription drug benefit can be found by registering at
www.envisionrx.com.
Costco Mail Order/Online Pharmacy provides your ninety (90) day prescription drug mail order service. If you have any questions on how to get started using the Costco Mail Order/online Pharmacy please visit
www.pharmacy.costco.com or contact the pharmacy at 1-800-607-6861. Costco membership is not required to use the Costco Pharmacy.
ADDING A DEPENDENT FOR PLAN COVERAGE?
Participants who are adding dependents for Plan coverage are required to submit documentation to the Plan Office. If you add a dependent for coverage, the Plan Office will send you a letter that explains what you need to do and what documents you will need to submit. Only your dependents that meet the Plan’s definition of eligible dependents may be enrolled.
Get A Flu Shot Today!
FREE flu shots are available at Participating Network Pharmacies for eligible participants in the CIGNA PPO Medical Plan.
- Get your flu shot at an Albertsons, City Market, King Soopers or Safeway pharmacy, and the pharmacy will submit a claim for you.
- Get your flu shot at other Participating Network Pharmacies, and you may need to pay for your shot and then submit a paper claim form to the Plan Office.
For more information, visit www.MyClGNA.com or call 800-CIGNA24 (800-244-6224). You can also call the Plan Office at 888-867-9510.
NOTE: For covered participants 18 and over, flu shots received at a Participating Network Pharmacy are covered 100%, but are not covered at all when received at a doctor’s office. For those under 18, flu shots are covered 100% if they are received at a Network doctor’s office or at a Participating Network Pharmacy.
HOW THE MEDICAL PROGRAMS WORK
You may go to any health care provider. However, when you use non-network providers, you pay a higher percentage and your out-of-pocket maximum is higher.
CIGNA HealthCare Preferred Open Access Plus. To locate a network provider, contact CIGNA directly by:
- Visiting www.mycigna.com; or
- Calling 800-244-6224.
Deductible
You must meet your deductible before the Plan pays for most covered services. The deductible applies to all covered expenses except as noted in the attached Benefit Summary (network physician office visits, prescription drug co-pays and advanced radiology co-pays).
You must meet your deductible before the Plan pays for most covered services, including inpatient hospital, outpatient surgery, therapeutic X-ray, MRI, CAT, PET, hospice, and skilled nursing facility care. Deductible amounts ($800-Class I, $550-Class II, $300-Class III) are based on hours worked. See your Summary Plan Description or call the Fund Office for more information.
Coinsurance
Once you or your family (if applicable) meet the annual deductible, the Plan pays a percentage of covered expenses and you pay the rest. The coinsurance percentage paid varies, depending on whether you use network or non-network providers, as well as what Class your hours worked puts you in (see above).
Co-Pays
When you or family members (if applicable) go to a network physician’s office, you may pay a separate co-pay for each office visit (Class III). Participants in Class II and I do not have office visit copays, but rather these charges are subject to the deductible as explained above. In addition, advanced radiology procedures and prescription drugs are subject to copays You are responsible for paying this co-pay even if you have met your deductible and out of pocket maximum. Your co-pay does not apply toward meeting your annual deductible or out-of-pocket maximum.
Out-of-Pocket Maximums
Once you meet your deductible and your other covered expenses reach the out-of-pocket maximum, the Plan pays 100% of most covered expenses you incur for the rest of the year. Please note that amounts you pay toward meeting your annual deductible or co-pays do not apply toward meeting your out-of-pocket maximums.
