Click each question below to learn more information. For any additional questions you may have, please contact the Benefit Office at (781) 272-1000 or (800) 342-3792.

faqs

How is my eligibility determined?

Your eligibility to participate in Plan A or Plan B for each 6-month Eligibility Period will depend on the number of recorded hours of employment you accumulate with one or more contributing employers within a period of 12 consecutive months as follows:

  • Plan A-1,000 recorded hours within a 12-month Qualifying Period = coverage during a 6-month Eligibility Period
  • Plan B-700 recorded hours within a 12-month Qualifying Period = coverage during a 6-month Eligibility Period

What is my deductible?

In general, the amount of your deductible is dependent on whether you are eligible for Plan A or Plan B as outlined in the chart below.

Plan A
Annual Deductible

Plan B
Annual Deductible

PPO Provider
(Network)

Non-PPO Provider in
PPO Area
(Non-Network)

PPO Provider
(Network)

Non-PPO Provider in
PPO Area
(Non-Network)

$250 per individual $750 per individual $500 per individual $1,000 per individual
$500 per family $1,500 per family $1,000 per family $2,000 per family

See question 3 below for information on how your deductible changes if you move from Plan A to Plan B, or vice versa, during a calendar year.

What if I change plans during the calendar year?

If you move from Plan A to Plan B, or vice versa, during a calendar year, the payments you make toward your deductible will accumulate. For example:

  • If you have met the individual $250 calendar-year PPO Provider deductible for Plan A and then switch to Plan B for the next six-month Eligibility Period, you must pay an additional $250 to meet the individual $500 calendar-year PPO Provider deductible for Plan B.
  • If you have met the individual $500 calendar-year PPO Provider deductible for Plan B and then switch to Plan A for the next six-month Eligibility Period, you automatically meet the $250 individual calendar-year PPO Provider deductible for Plan A.

How do I request a new card (medical, dental or prescription drug)?

To order a new dental card contact Delta Dental at 1-800-872-0500.

To order a new prescription drug card, contact Express Scripts at 1-800-467-2006.

To order a new medical card, contact MLBF at 1-800-342-3792 or 781-272-1000.

Will my coverage continue once I stop working?

When you no longer have enough hours in a qualifying period to gain eligibility, you will have the option to elect COBRA continuation coverage.   Go to the COBRA pages for additional information.

How do I find a provider in the network?

Go to the BlueCross BlueShield Web site at: www.BCBS.com

What is the chiropractic benefit after deductible?

Under Plan A and Plan B, the Fund will pay 80% of the provider’s charge, up to a maximum benefit of $50 per visit, with a limit of 30 visits per calendar year.
Complete details are available in the Summary Plan Description.

What is the massage therapy benefit after deductible?

Under Plan A and Plan B, the Fund will pay 80% of a participating provider’s charge, up to a maximum benefit of $50 per visit, with a limit of 12 visits per calendar year.  Authorization must be obtained from the MAP program (E4 Healthcare)  at 1-800-522-6763.  MAP will advise you on participating massage therapists in your area.  Complete details are available in the Summary Plan Description.

What is my copay?

If you use a PPO Provider, your co-payment is $20.

Do I have to pay the balance on my bill from my doctor?

You should have received an “Explanation of Benefits” in the mail that provides the breakdown of your bill—how much was covered and how much you have to pay. If you have not received an “Explanation of Benefits” for the services on the bill, your provider must resubmit the bill.

What is the physical therapy benefit?

There is a $20 copay after deductible, if you use a PPO provider.

What is the inpatient benefit?

Please refer to the “Eligible Medical Expenses” chart in the Summary Plan Description for Plan A and Plan B coverage..

Is a pre-certification required for an inpatient admission?

Your provider must contact BCBS.

What kind of details do I have to provide about an accident?

You must include a description of the injury and how, when and where the accident happened on the Explanation of Benefits or in a separate note. You may fax this information to the Fund Office at 781-238-0703 or mail it to:

The Massachusetts Laborers’ Health and Welfare Fund

PO Box 3005

Burlington, MA 01803

What is the durable medical equipment benefit?

Plan A Plan B
PPO Provider Non – PPO Provider PPO Provider Non- PPO Provider
Fund pays 100% of the first $5,000 after deductible, plus 85% of the excess charges Fund pays 100% of the first $5,000 after deductible, plus 75% of the excess charges Fund pays 100% of the first $5,000 after deductible, plus 85% of excess charges Fund pays 100% of the first $5,000 after deductible, plus 75% of excess charges
Motorized wheelchairs and scooters are covered up to $2500

What is the status of my claim?

Go to the Member Dashboard to check your claim status.

Do I need pre-certification for counseling?

Yes, you must call the MAP program (800)522-6763, for any inpatient, intensive outpatient, or partial hospitalization program.

Who do I pay my deductible to?

Please refer to your explanation of benefits (EOB) or wait for the provider to bill you.

Can I use my Blue Cross Blue Shield card for my prescriptions?

No, you must use the Express Scripts card.

Am I eligible as a new member when I reach 700 hours?

If you are a newly initiated laborer as of November 1, 2008, you would be eligible for benefits under the Plan B policy on the 1st of the month following the month in which you attain 700 hours.

Does the Health & Welfare plan cover any gym/fitness benefit?

Effective 1-1-2016, the Plan provides a fitness reimbursement benefit up to $150.00 per calendar year for each member and spouse who have had a routine physical within 12 months preceding the reimbursement submission, and providing sufficient proof of at least 4 months of a paid membership at a qualified health club for the calendar year for which the reimbursement is sought.  Claim forms for this benefit will be available on the Fund website and from the Fund Office beginning 4-1-2016.

What is a Qualified Health Club?

A full-service health club with a variety of exercise equipment, including:

  • Cardiovascular equipment like treadmills and bikes
  • Strength-training equipment like free weights and weight machines

What does NOT qualify for fitness reimbursement?

You can’t receive the fitness reimbursement for expenses towards personal training, lessons, coaching, equipment, clothing, or any of the clubs below:

  • Martial arts or yoga centers
  • Gymnastics, tennis, aerobic, spin, barre, boxing or pool-only facilities
  • Country clubs or social clubs
  • Sports teams or leagues

Does the Health & Welfare plan cover nutritional counseling?

Effective 1-1-2016, the Plan provides coverage for medical nutrition counseling with a 12 visit per calendar year maximum.  Benefits will be paid at 80% of Blue Cross/Blue shield PPO allowance (after Deductible).  No benefits provided for services outside of the Blue Cross/Blue Shield PPO Network.  This replaces the plan’s previous nutrition benefit included under complementary care through the MAP program.  No authorization is required.

Does the Plan cover weight loss programs?

The plan does not currently provide benefits for weight loss programs. However, many Weight Watchers locations offer a discount if you present your Blue Cross/Blue Shield identification card.