Line Construction Benefit Fund
LINECo

Your Comprehensive Major Medical Benefit is designed to substantially cover most forms of medically necessary care. This coverage is subject to various deductibles, copayments, coinsurance, and other limits.

The Blue Card PPO Network is a network of hospitals and physicians throughout the United States that participate in their local BlueCross BlueShield PPO networks. Blue Card PPO providers are Lineco's preferred providers and provide medical care to Lineco participants at negotiated rates.

When you use Blue Card PPO hospitals and doctors for your medical care, you save money twice. First, because the rates charged by PPO providers are usually lower, and second, because the Plan will pay a higher percentage of your covered expenses.   You are not required to use a preferred provider--the choice of a hospital and a doctor is solely yours to make.

• Go to www.bcbsil.com on the internet and follow the links
• Call 1-(800)-810-BLUE (2583).

Before any payments are made by the plan you must satisfy the annual deductible. Only covered expenses apply to the deductible.

Family Deductible
$600 per calendar year.

Hospital certification noncompliance
$250 per admission (does not go towards calendar year deductible).

Emergency room
$50 for each occurrence of hospital emergency room treatment.

The percentage of the charges that the plan pays for most covered expenses after the deductible(s) have been satisfied. You pay the remaining percentage of the charges (that portion is called your percentage copay). For more specific information, see the SPD.

Covered services provided by PPO providers and covered prescription drugs not purchased through the Prescription Drug Mail Service Program:

Before out-of-pocket maximum is met - 80%
After out-of-pocket maximum is met - 100%

Chiropractic care - 50% up to a calendar year maximum benefit of $600

Covered services provided by non-PPO providers:

Before out-of-pocket maximum is met - 70%
After out-of-pocket maximum for all other covered medical expenses is met - 100%

Chiropractic care - 50% up to a calendar year maximum benefit of $600

Once your percentage copays during a calendar year reach the out-of-pocket maximum, the Plan will pay a higher percentage of any further covered expenses during that year.

Per person, unless the person is eligible for Medicare - $1,500
Per person, if the person is eligible for Medicare - $1,125
Per family - $3,000

Note that the following do NOT count towards the out-of-pocket maximum: deductibles, chiropractic care, hearing care, non-surgical TMJ treatment, and non-precertified TMJ/jaw surgery.

Lifetime Maximum Benefit Payable - $2,000,000 per person covered
Calendar Year Maximum Benefit Payable - $1,000,000 per person covered

If Comprehensive Benefits are paid on your behalf during a calendar year, the amount paid, up to $5,000, will be automatically restored to your remaining lifetime maximum benefit on January 1 of the following calendar year.

100% up to $125 per calendar year (no deductible)

Covered routine physical exam expenses in excess of $125 per person per calendar year are not covered under any benefit provided by the Plan.

The Routine Physical Exam Benefit covers Employees, Retirees, and Spouses only.

100% up to $150 per calendar year (no deductible)

If you have more than $150 in covered diagnostic x-ray and lab services in a calendar year, the remainder will be considered under the provisions of the Comprehensive Benefit.

The DXL benefit covers Employees, Retirees, and Spouses only.

Adult Immunizations

Immunizations for employees, retirees, and spouses are covered under the Comprehensive Benefit. You can find out which immunizations are currently covered here.

Most Common Medical Services

Click here for specific information about the many common medical services that the Plan covers under the Comprehensive Medical Benefit.

Programs for Children and Newborns

Prenatal Care Program - Well Child Benefit: Maximum payable per child for well-child expenses incurred from birth through age 4 if the mother (covered employee or spouse) completed the Prenatal Care Program (no deductible; excess expenses are not covered) - 100% up to $500

Childhood Immunizations: Lifetime maximum benefit payable per child for routine immunization expenses - 100% up to $1,000 (no deductible; this benefit is in addition to $500 Prenatal Care Program benefit; excess expenses are not covered)

Unless stated otherwise, the Plan payment percentages for the following types of treatment are as shown under Plan Payment Percentages above. However, expenses for non-surgical TMJ treatment, non-precertified TMJ/jaw surgery, chiropractic care, or hearing care will NOT be paid at 100% even if your out-of-pocket maximum has been met.

Outpatient Speech Therapy:
      Maximum covered per session - $90
      Maximum number of sessions per person per year - 50

Non-Surgical TMJ Treatment: Lifetime maximum benefit per person - $1,000

TMJ/Jaw Surgery: Lifetime maximum benefit per person for jaw surgery that is: (a) out-of-network, or (b) in-network but not precertified - $3,000

Chiropractic Care:
      Plan payment percentage - 50%
      Calendar year maximum benefit per person - $600

Home Nursing Care: Calendar year maximum benefit per person - $5,000

Hearing Care: Maximum benefit payable per ear for hearing exams, tests and hearing aid devices, every 5 years (60 months) for adults and every two years (24 months) for children - 80% up to $1,250 (no deductible)

Skilled Nursing Facility Care: Maximum number of days payable per person per calendar year - 30

Hospice Care: Lifetime maximum benefit per person - $20,000