As of July 1, 2006 BeneSys Inc. is our new Benefits Administrator
PO BOX 159
Troy, MI 48099
Call BeneSys for questions regarding Benefits, Coverage, Summary Plan Description, FSA balance, etc.
Local 98 members can choose to be part of one of two provider networks:
- PPOM or
- Preffered Choices
For more information about either, including a directory of participating physicians and hospitals, please visit their websites or call the Benefits Administrator, BeneSys, at 248-641-4988.
Our Plan Excludes Coverage for Motor Vehicle Accidents!
Michigan law requires that we all have and pay for no-fault insurance policies, which include medical coverage for injuries incurred in motor vehicle accidents. The Plumbers Local 98 plan excludes benefits for an injury or illness arising from a motor vehicle accident in Michigan.
In regards to motorcycle accidents, if the accident involves a motor vehicle coverage is excluded. If you are involved in a motorcycle accident which does not involve a motor vehicle (for example, a motorcycle hits a tree) then coverage would be provided by the Fund.
Contact your auto insurance agent immediately to make sure you are properly covered for such illnesses or injuries under your no-fault policy.
Summary of Benefits
For those participants who have other Group Health Care coverage through their spouse's employment, there are 3 coverage option plans available. Consideration should be given to enrolling in Options II or III to maximize the overall benefits available for your family. For detailed information please contact BeneSys.
- Option I, provides medical and prescription drug coverage.
- Option II (Active Participants & Pensioners Only) Provides dental, vision, life insurance and flexible spending account.
- Option III (Active Participants, Pensioners & Surviving Spouses) Provides life insurance and increased annual flexible spending account.
Golden Dental Plan: those who have signed up for the Golden Dental Plan can receive a Directory of Providers by calling Golden Dental at 800.451.5918.
Health Plan Advocate: Health Plan Advocate is a unique feature designed to help you and your family with your medical benefits and health questions. Health Plan Advocate can help you:
Choose a doctor, especially when you are looking for a qualified specialist that participates in the Plumbers PPO option.
When you have a question about medical care or your health plan benefits. When inpatient or outpatient hospital services are scheduled. Health Plan Advocate will help you understand how to receive the maximum benefit under your plan. Whenever you or a family member is faced with a serious injury or illness.
Health Plan Advocate can be reached at 1-866-942-1394 (The number is also on the back of your health plan card)
As of December 1, 2006 we will no longer be using Pharmacare for prescription drug benefits. Members will be receiving new prescription ID cards in early January 2007.
The new service provider is:
- Envision Pharmaceutical Services and Rx Options
The co-payments under this new plan will remain the same, as shown below. To save money on daily medications try using Immediate Pharmaceutical Services (IPS) Mail Order. Through the mail-in service you can receive a 3 month supply of your medication, reducing your copay. Using the total retail cost of the prescription, the copay schedule is as follows
- Retail: 25% cost of the drug subject to minimum payment of $10 per prescription (unless cost of the drug is under $10, in which case the minimum is cost of drug) and maximum of $50 per prescription.
- Mail Order: 25% cost of the drug subject to minimum payment of $25 per prescription (unless cost of the drug is under $25, in which case the minimum is cost of drug) and maximum of $125 per prescription.
Envision Rx.com Here you will find additional information about your prescription benefit. To access information on the site you will first need to create an account, as follows:
- Click on "Not Registered? Click her to enroll" link located on the left side of the page.
- To create your account, enter all the required information and press the "Register" button.
Once you account has been created you will have access to the following information:
- Overview of your plan and benefits
- Drug coverage and pricing, including co-payments
- Mail order information
- Direct member reimbursement form
- Prescription history
- Participating pharmacies
If you have any questions regarding the new administration of your prescription benefit, please do not hesitate to call the Envision/Rx Options Member Helpdesk at 1-800-361-4542 or the Benefits Administrator, BeneSys, at 248-641-4988.