Eligibility

You are eligible to participate in the Massachusetts Laborers’ Health and Welfare Plan A or Plan B based on the number of hours you work in covered employment. Your eligibility for each 6-month Eligibility Period will depend on the number of recorded hours of employment you accumulated with one or more contributing employers within a period of 12 consecutive months.

Eligibility Requirements

  • 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

Click here for Qualifying/Eligibility Period examples.

Dependent Eligibility

Your dependents’ eligibility will start when your eligibility starts or, if later, on the date they become your qualified dependents. Generally, you may cover your:

  • Lawful spouse (same-sex or opposite-sex),
  • Children ages 19 to 26 years of age provided child meets the definition of “Child” below
  • Unmarried, disabled children beyond the age they would otherwise lose eligibility.

“Child” Defined: The member’s natural or legally adopted child, a child placed with the member for adoption, and a child for whom the member has legal guardianship (provided he or she is also the member’s federal income tax dependent).

See the Summary Plan Description for complete details.

Work Outside of Massachussetts

  •  Contact the Fund Office whenever you work outside the state of Massachusetts.
  •  After June 30, 2005, any contributions remitted to the Rhode Island or Connecticut Funds will be reciprocated back to the Massachusetts Laborers’ Fund provided you are a member of a Massachusetts, Maine, New Hampshire or Vermont Local Union. See the Summary Plan Description for complete details.
  •  If you are entitled to benefits under more than one Fund, your benefits will be coordinated. See “Benefit Coordination” section for more information.

Benefit Coordination

You are required to report any other group health coverage that covers you or an eligible dependent on any claim that is submitted to the Fund Office. If other coverage is available, this Plan will coordinate its benefits with that coverage. See the Summary Plan Description for complete details.

Loss of Coverage

Once you meet the eligibility requirements for either Plan A or Plan B, your participation will continue as long as you work at least 1,000 hours for Plan A or 700 hours for Plan B in a 12-month Qualifying Period for the next 6-month Eligibility Period. Your dependents’ participation will end when your coverage does or, if earlier, when they no longer meet the eligibility requirements.

Continuing Coverage

COBRA provides an option for temporarily continuing coverage if you lose eligibility. See the “COBRA” tab for additional information or refer to the Summary Plan Description for complete details on qualifying events, who is eligible, important deadlines, and the length of time continuation coverage may last.

Annual Deductible

Plan A PPO Provider: $250 individual; $500 family

Plan A Non-PPO Provider in PPO Area: $750 individual; $1,500 family

Plan B PPO Provider: $500 individual; $1,000 family

Plan B Non-PPO Provider in PPO Area: $1,000 individual; $2,000 family

Annual Deductible (If you move from Plan A to Plan B during the calendar year or vice versa)

If you move from Plan A to Plan B, or vice versa, during a calendar year, your payments 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 $500 individual 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.

Medical Preferred Provider Organization (PPO)

BlueCross BlueShield of Massachusetts is the PPO provider except for those services covered by the Wellness Corporation.

The Wellness Corporation/Member Assistance Program (MAP) pre-authorizes:

  • mental health and substance abuse services
  • complimentary care

Find a Doctor

To find a doctor or to confirm that your current doctor participates in the BlueCross BlueShield PPO Network you can:
1. Call 1-800-810-BLUE (1-800-810-2583)
2. Access their Web site at http://www.bcbs.com/

Hospital Pre-Authorizations

You must contact BlueCross BlueShield for pre-authorization for certain services. If you fail to comply with the requirements for non-emergency hospital admission, the penalty could range from a $250 reduction in the amount paid by the Fund to a complete denial of the claim. See the Summary Plan Description for complete details.

If you require inpatient and/or outpatient services for substance/alcohol abuse, nervous/mental illness, or complementary care you must have the service pre-authorized by The Wellness Corporation (1-800-522-6763).

Member Assistance Program (MAP)

Provided by The Wellness Corporation, MAP can help you with family difficulties, marital stress, child and adolescent concerns, illness of a family member, financial pressure, job stress, or alcohol and drug abuse. These services must be pre-authorized or your claim will be denied. Contact MAP at 1-800-522-6763.

What the Plan Covers

Click here for a benefits overview. Complete details are available in the Summary Plan Description.

Filing a Claim

If you go to a provider in the BlueCross BlueShield PPO Network, there is no need to file a claim. Your provider will file it on your behalf directly with BlueCross BlueShield.
Important Note: The provider must include the “UEM” prefix when submitting claims on your behalf.

If your provider has to file an inpatient and/or outpatient claim for substance/alcohol abuse, nervous/mental illness, or complementary care, you must have the service pre-authorized by The Wellness Corporation/MAP. Your provider should submit the claim to the Fund Office at the following address:

The Massachusetts Laborers’ Health and Welfare Fund

P.O. Box 4000

Burlington, MA 01803-0900

Weekly Accident and Sickness Benefit (for members only) can help replace lost income when an injury or illness prevents you from working.

Benefit

Provides a payment up to $39 a day or $273 per week for up to 13 weeks.

Eligibility

  • If you become totally disabled and unable to work because of:
    any injury not arising out of or in the course of your employment;
  • any disease not entitling you to benefits under any Workers’ Compensation, occupational disease law, or similar legislation; or
  • any injury or disease not entitling you to automobile insurance wage continuation payments.

When Payments Start

  • If the disability is the result of an accident, payment starts the first day of disability.
  • If the disability is the result of illness, payment starts the eighth day of disability.
  • If the disability is related to pregnancy, payment starts the eighth day of disability.

Length of Payments

If you meet the eligibility requirements, you will receive up to 13 weeks for any one continuous period of disability that is due to the same or related cause(s). Refer to the Summary Plan Description for complete details.

Filing a Claim

You and your doctor must FULLY complete a Provider’s Green Claim Form and return that completed form to the Fund Office within 90 days of the date your disability began. If you and your doctor do not FULLY complete the claim form, it will be rejected.

Maximum Lifetime Benefit

Plan A Only
Implants: $5,000 per individual per lifetime (based on 50% of reasonable and customary charges, up to $2,500 per year)
Orthodontia: $2,500 per individual per lifetime up to the age of 19.

Maximum Annual Benefit

Plan A and Plan B: None.

Calendar-Deductible

Plan A and Plan B: No deductible.

Preferred Provider

The Delta Preferred Option USA Plus Plan (DPO Plus) is provided by Delta Dental of Massachusetts. Dentists who participate in the DPO Plus Plan will:

  • Accept fees determined by Delta Dental Plan.
  • File claims directly with Delta Dental.
  • Locate a participating provider at: www.deltadentalma.com

The DPO Plus Plan leverages two of Delta’s dental networks – Delta Preferred Option and Delta Premier. Members recognize the greatest savings when using a Delta Preferred Option dentist, but can also enjoy value when receiving services from a Delta Premier dentist.

Pre-Treatment Estimates

You are encouraged to have your dentist submit a request for a pre-treatment estimate for any services that are likely to total $300 or more. See the Summary Plan Description for complete details.

What the DPO Plus Plan Covers

Click here for a benefits overview. Complete details are available in the Summary Plan Description

Filing a Claim

If you use a participating dentist there is no need to file a claim. If you go to a non-participating dentist, you must return a dental form (available athttp://www.deltadentalma.com) within 90 days of the date of service to Delta Dental.

Davis Vision Plan

Preferred Provider

If you use a participating Davis Vision provider, you will not have to pay anything. Locate a Davis Vision Provider at www.davisvision.com

What the Plan Covers

  • Glass or plastic single vision, bifocal or trifocal lenses (You may select two complete pairs of eyeglasses, one for near vision, one for distance vision, in lieu of receiving a bifocal)
  • Oversize and over diopter (high power) lenses
  • PGX (photosensitive) glass lenses
  • Glass grey #3 prescription sunglasses lenses
  • Progressive addition lenses
  • Supershield coating for both single vision and multi-focal lenses
  • Polycarbonate lenses for children and monocular patients

The Davis Vision provider will provide detailed information about the options that are available to you under this Plan. (see Summary Plan Description for exceptions).

Filing a Claim

There is no need to file a claim.

The Optional Plan

Preferred Provider

You may use your own provider; however, you will only be reimbursed up to the maximum allowance listed below

What the Plan Covers

  • Refraction and pathological examination by an optometrist, including the fitting of glasses and the verification of prescription lenses. Maximum $20
  • Complete medical eye examination (exclusive of treatment), refraction, and pathological examinations by an ophthalmologist, including the fitting of glasses and the verification of prescription lenses. Maximum $30.00
  • Frame (when prescription lenses are required) Maximum $20.00
  • Lenses:
    • Single vision: Single $15.00/ Pair $30.00
    • Bifocal: Single $20.00 / Pair $40.00
    • Trifocal: Single $25.00 / Pair $50.00
    • Repair or replacement of broken or damaged frame or lenses, if it can be satisfactorily shown that the existing frame or lenses cannot be made serviceable: Frame $10.00 / Lenses: as above.

Filing a Claim

Pay in full and file for the reimbursable amount within 90 days. Reimbursements are sent to the member not the provider. Click here for a claim form.

Plan Administrator

Express Scripts

Participating Retail Pharmacies

  • Locate participating retail pharmacies at www.express-scripts.com.
  • Present your Express Scripts identification card.
  • No need to submit a claim form, just pay the copayment.

Preferred Medication List

Express Scripts’ list of preferred brand-name drugs is available at www.express-scripts.com.

Required Pre-Authorization

Certain drugs must be pre-authorized. If you have questions about which drugs require pre-authorization, only your physician should contact Express Scripts at 800-417-8164 or send a fax to 800-357-9577.

What the Plan Covers

Retail Pharmacy

  • 30-day supply
  • Generic drug: $5 copay
  • Preferred brand-name: $15 copay
  • Non-preferred brand-name: $25 copay
  • Copayment for any refills beyond the third refill will be 50% of the cost. The Fund covers the remaining cost.
Mail-order Service

  • 90-day supply
  • Generic drug: $10 copay
  • Preferred brand-name: $30 copay
  • Non-preferred brand-name: $50 copay
  • The Fund covers the remaining cost.

Filing a Claim

If you use a participating retail pharmacy or the mail-order service, you do not need to file a claim. If you use a non-participating pharmacy, you must file a claim within 90 days from the date of purchase. Contact Express Scripts for a claim form at www.express-scripts.com or 800-467-2006.

COBRA provides an option for temporarily continuing coverage if you, or your qualified beneficiary, lose eligibility.

Plan Overview

  • Self-pay basis after “qualifying event” (see below for list of qualifying events)
  • Includes medical, dental and vision coverage elections
  • Excludes life insurance, AD&D and weekly accident and sickness benefits.

Qualifying Events

Click here to view a COBRA continuation coverage chart.

Fund Office Notification Responsibilities

The Fund will determine when a qualifying has occurred when the loss of eligibility is due to:

  • Reduction of hours as follows:
    • working less than 1,000 hours in a 12-month Qualifying Period for Plan A
    • working less than 700 hours in a 12-month Qualifying Period for Plan B
    • retirement
  • The death of the member
  • The member becoming entitled to Medicare benefits (under Part A, Part B or both)

For the other qualifying events listed below, you must notify the Fund Office.

Member Notification Responsibilities

Qualifying Event

  1. Your divorce or legal separation*
  2. A child no longer qualifies as a “dependent child”
  3. A second qualifying event
  4. A qualified beneficiary is determined to be disabled by the Social Security Administration
  5. Determination by the Social Security Administration that the qualified beneficiary is no longer disabled

*See the “General Notice of COBRA Continuation Coverage Rights” for additional information on continuation coverage because of divorce or legal separation.

Notification Deadline

For events 1-3: No later than 60 days after the later of (1) the date of the relevant qualifying event or (2) the date on which coverage would be lost under the Plan as a result of the qualifying event.

For event 4:  No later than 60 days after the date of the disability determination and before the 18-month COBRA continuation period ends.

For event 5: No later than 30 days after the date of the Social Security Administration determination that the qualified beneficiary is no longer disabled.

How to Provide Notice

You or your dependents must complete a COBRA Notice of Qualifying Event. No other form of notice will be accepted by the Fund. Make a copy of the Notice for yourself before mailing it to the address below.

Where to Send the Notice

The COBRA Notice of Qualifying Event should be sent by U.S. mail to:
COBRA Department
Massachusetts Laborers’ Health and Welfare Fund
Burlington, MA 01803-5201

Electing Coverage

The COBRA continuation coverage you are able to elect will be based on the coverage you were eligible for at the time of your qualifying event (excluding retirement, see below) as follows:

  • If you had coverage under Plan A and you are not eligible for Plan B at the time of your loss of eligibility, the Fund will extend Plan A COBRA continuation rights.
  • If you had coverage under Plan B at the time of your loss of eligibility, the Fund will extend Plan B COBRA continuation rights.

You and/or your covered dependents have 60 days to make your COBRA election from the later of:

  • The date you would have lost coverage because of the qualifying event; or
  • The date you received the election form and COBRA information from the Fund Office.
    If you do not elect COBRA within 60 days, you will forfeit your right to continuation coverage.

You may elect core (medical) only, core plus dental or core plus dental and vision.

Cost

If you elect continuation coverage, you will be charged the full cost of the Plan plus an administrative fee. Premiums are approximately 50% higher during a disability extension.

Sending in Payment

The first payment must be sent within 45 days following your submission of the COBRA election form and include the cost of coverage retroactive to the first day coverage would have otherwise terminated. Subsequent payments must be made within 30 days after the first day of the coverage month.

Life Insurance can help provide for your beneficiary in the event of your death.

Benefit

Pays your beneficiary $10,000 in the event of your death from any cause.

Your Beneficiary

Your beneficiary for this benefit is person(s) that the Massachusetts Laborers’ Health and Welfare Fund has on file for you for your health and welfare benefits. To change or update your beneficiary for the Health & Welfare Fund complete a Beneficiary Designation Form.

Extended Benefit

If you should die within 31 days from the date your insurance is terminated, the full amount of insurance will be payable to your named beneficiary or estate.

Conversion Privileges

Within 31 days of your termination from the Plan, you may convert your group life insurance to an individual policy by mailing an application to The Union Labor Life Insurance Company.

Filing a Claim

Your beneficiary should complete The Union Labor Life Insurance Claim Form and return it along with any required documentation to the Fund Office.

Accidental Death and Dismemberment (AD&D)

Benefit

If your death is the result of an accident, your beneficiary may receive an additional death benefit. If you lose a limb or your sight as a result of an accident, a benefit may be paid to you.

Refer to the Summary Plan Description for a schedule of the description of losses and benefits payable.

Your Beneficiary

Your beneficiary for the accidental death benefit is the same person you have for your life insurance. To change or update your beneficiary for the Health & Welfare Fund complete a Beneficiary Designation Form.

Filing a Claim

Your beneficiary should complete an AD&D Benefits Claim Form and return it along with any required documentation to the Fund Office.