Complete Health Care Benefits
for You and Your Family

The Trustees of your Health Services and Insurance Plan have worked hard to provide you with a generous package of health benefits, designed to fit your lifestyle. Your medical coverage through the Blue Cross Blue Shield HealthMate Coast to Coast plan protects you whether you're on the road or close to home. More than half a million physicians participate in the Blue Cross Blue Shield network, so that even when you're traveling, you'll have easy access to care and maximum coverage for services.

Through HealthMate Coast to Coast, you and your eligible family members have comprehensive medical benefits, including: wellness benefits for adults and children, coverage for prescription drugs, hospitalization and surgery, extended care, behavioral health and chemical dependency treatment.

And that's not all – Teamsters Local 251 Health Services and Insurance Plan members also get coverage for dental, vision, hearing, weekly accident and sickness, life insurance and much more.

Coverage for Retirees
When designing your benefits program and making improvements, the Trustees try to do what's best for the members; and that responsibility doesn't end when you retire – the Plan features a self-pay package of benefits available to eligible retirees.

Eligibility
To establish eligibility for coverage, you must work at least 300 hours in covered employment in a calendar quarter, called a "qualifying period." When you work at least 300 hours in a qualifying period, you are eligible for coverage for a three-month period called, called the "eligibility period." The Fund Office will determine your on-going eligibility on a quarterly basis. Your dependents are eligible for benefits on the same date that your coverage begins.

A Plan for Good Health
The Trustees of your Plan want you and your family to stay healthy. That's why the Plan provides free wellness programs, such as free health risk appraisals, cholesterol screening, blood pressure readings and private consultations about your health. You'll also get a bimonthly newsletter containing health tips, information and news.

As part of your HealthMate Coast to Coast coverage, you'll pay only $10 when you use a BlueCard PPO provider for:

• Routine physical examinations for you and your covered family members;
• Routine immunizations for your children, and
• Well-woman annual examinations. Also, when you use a BlueCard PPO provider, there is no copayment for wellness visits for newborns born after January 1, 2001 through 15 months of age.

Legal Services
The Trustees of your Plan have retained the services of attorneys so that you and your eligible dependents may receive free legal help with a variety of services, such as buying a home, preparing a will or handling insurance company claims.

Important Benefit Contact Information
You may always call the Fund Office at (401) 467-3323 if you have a question about any of your benefits, but here are some other contacts to help you get answers to your benefits questions quickly.


Important Benefit Contact Information
For Questions
About . . .
Contact Phone Number Website/E-mail
Medical Blue Cross Blue Shield of Rhode Island
HealthMate Coast to Coast
444 Westminster Street
Providence, RI
02903-3279
To find participating providers:
1 (800) 810-BLUE
For preauthorization:
(401) 272-5670 or
1 (800) 635-2477
Customer Service:
(401) 459-5000 or
1 (800) 639-2227
For general information:
www.bcbsri.com
Prescription Drugs Blue Cross Blue Shield of Rhode Island
444 Westminster Street
Providence, RI
02903-3279
For questions about your coverage or to find a participating pharmacy, call:
(401) 459-5000
 
Dental Delta Dental To find a participating provider:
(401) 752-6100
www.deltadentalri.com
Vision Davis Vision Customer Service:
1-800-584-2866
www.davisvision.com
Hearing Sargent Rehabilitation Center
800 Quaker Lane
Warwick, Rhode Island
02818
(401) 861-6600  
Life Insurance, Accidental Death and Dismemberment and Personal Accident Coverage The Fund Office
1201 Elmwood Avenue
Providence, RI
02907-3799
Telephone:
(401) 467-3323
Fax:
(401) 467-9480
 
Weekly Accident and Sickness
Legal Services
Retiree Benefits

 

Medical Benefits
HealthMate – Coast to Coast Protection
Your medical coverage is provided through HealthMate Coast to Coast from Blue Cross Blue Shield of Rhode Island. Through HealthMate Coast to Coast, you and your family have access to a large network of physicians and hospitals at home and across the country. When you use the Preferred Provider Organization – BlueCard PPO – participating providers will accept a pre-negotiated amount, called an allowance, as payment in full for covered services.

Through the BlueCard PPO, routine office visits are covered in full after a $10 copayment. You are also fully covered for hospitalization and surgery. However, you are free to use any doctor you choose. When you visit non-BlueCard providers, you are generally covered at 80% of the allowance for most services after meeting an annual deductible of $200 and paying any applicable copayment. Non-BlueCard providers may bill in excess of the allowable amount.

Need to find a participating pharmacy?

Most pharmacies in the Rhode Island area participate in the prescription drug network. Contact Customer Service at (401) 459-5000 to receive a list of participating pharmacies.

Prescription Drugs
Through the Blue Cross Blue Shield National Prescription Drug network you pay 20% of the cost for prescription drugs. You may use the mail order service to have your maintenance medication (drugs you take on an on-going basis) sent to your home, or you may have your prescriptions filled at a participating pharmacy.

Once your 20% coinsurance for prescription drugs totals $300 in a calendar year, Blue Cross Blue Shield will pay the entire cost of your prescription drugs for the remainder of the year.

Your Medical Benefits at-a-Glance
Medical Care
BlueCard PPO You Pay Non PPO
Annual out-of-pocket maximum $0 $3,000 per family
Annual deductible $0 $200 per person
Office visits $10 copayment $10 copayment plus 20% of the allowance
Hospitalization and inpatient medical/surgical care $0 20% of the allowance
Physical exams $10 copayment $10 copayment plus 20% of the allowance
Behavioral health and chemical dependency
• Inpatient
$0 20% of the allowance
• Outpatient $15 copayment $15 copayment plus 50% of the allowance

 

Dental Benefits
Your dental coverage is provided through Delta Dental. The Trustees have selected Delta Dental because more than 100,000 dentists participate in the Delta Dental network nationwide. Show your ID card at a participating Delta Dental provider to receive discounted rates for dental services.

With Delta Dental, your preventive, diagnostic, and restorative care is covered in full. This includes oral exams and cleanings, x-rays, extractions, fillings, and root canal work. For other services, such as orthodontia, bridges, dentures, implants and periodontics, you pay 50% of the Delta Dental rate for services.

For dental care outside of the Delta Dental network, you must pay for the services in full and apply for reimbursement. If the non-Delta Dental provider charges more than the Delta Dental rate, you must pay the difference, as well as your coinsurance, if applicable.

Your Dental Benefits at-a-Glance
Dental Care
Delta Dental Provider You Pay Non Network Provider
Annual maximum benefit $1,200 $1,200
Annual deductible $0 $0
Preventive, diagnostic and restorative $0 The difference between non-network rate and Delta Dental's rate
Periodontics, Implants and Prosthodontics 50% of the Delta Dental rate 50% plus the difference between non-network rate and Delta Dental's rate
Orthodontics – up to $1,800 per person per lifetime 50% of the Delta Dental rate 50% plus the difference between non-network rate and Delta Dental's rate

 

Vision Benefits
Your vision benefits are provided through Davis Vision. When you visit a Davis Vision provider, you and your eligible dependents are eligible for an eye exam, glasses and contact lenses once every 12 months.

Your Vision Benefits at-a-Glance
Every twelve months (to the day) you and/or your eligible dependents are entitled to one of the options listed below when you visit a Davis Vision provider:
Eye Exam $0
Eye Exam + Eyeglasses $0
Eye Exam + Two Pairs of Eyeglasses $35 copayment
Eye Exam + Contact Lenses $25 copayment
Eye Exam + Eyeglasses + Contact Lenses $60 copayment

Hearing Care Benefits
You and your dependents are eligible for a hearing exam once every 12 months and a hearing aid once every 36 months. You may also be eligible for an allowance of $1,500 to use toward the purchase of a digital hearing aid. All hearing care benefits are payable through the Sargent Rehabilitation Center.

Life, Accident and Disability Insurance
The Trustees of the Teamsters 251 Health Services and Insurance Plan want you and your family to be protected in the event that something happens to you. The Plan provides life insurance coverage, accident coverage for you and your dependents, and disability benefits in case you are injured or sick and cannot work.