Medical

Do I have Lineco coverage or Blue Cross/Blue Shield insurance?
How do I file a claim for benefits?
What is my office co-pay?
Are benefits paid directly to my doctor?
When do I need pre-authorization or a referral for the health benefits?
My doctor recommended that I see a nutritionist and go on a weight loss program because I have heart disease. Will the Plan pay for these services?
Am I covered when I travel to another country?
Are DOT physicals covered?
If I am injured on the job, will the plan pay for my medical expenses?
How does the Health Care Reform Act of 2010 affect my medical benefits.




QUESTION: Do I have Lineco coverage or Blue Cross/Blue Shield insurance?

ANSWER: Your coverage is provided through Lineco. Lineco is the Benefit Fund. Blue Cross/Blue Shield is the national provider network. Your provider should bill their local Blue Cross office. Blue Cross in turn works with the Lineco Fund Office, which reviews the claims for final determination of benefits. For coverage details please refer to the relevant Benefit Summary Tab or the SPD.

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QUESTION: How do I file a claim for benefits?

ANSWER: Please refer to the SPD or the Claims FAQ section for details. In addition, please make sure your spouse and dependent children are enrolled by submitting the Family Enrollment Card and any required documentation to the Fund Office.

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QUESTION: What is my office co-pay?

ANSWER: There is no "office co-pay" per se. The Plan is a comprehensive major medical plan. You are responsible for paying the annual deductible and the 20-30% co-insurance. However, certain preventive services may be covered at 100% with no deductible if a Blue Cross/Blue Shield provider is used. Please refer to the 12/10 Summary of Material Modifications (SMM).

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QUESTION: Are benefits paid directly to my doctor?

ANSWER: Yes, benefits are paid directly to providers, except for prescription drug benefits.

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QUESTION: When do I need pre-authorization or a referral for the health benefits?

ANSWER: Preauthorization is required for all Mental Health services (call the MAP/Member Assistance Program at 1- (800) 332-2191). Bariatric surgery and jaw surgery require pre-authorization by the Fund Office. There is also a pre-certification process for medical in-patient admissions. All services must be medically necessary in order to be considered for benefits. Certain prescription drugs also require pre-approval. Please call the Fund office if you or your provider have any questions.

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QUESTION: My doctor recommended that I see a nutritionist and go on a weight loss program because I have heart disease. Will the Plan pay for these services?

ANSWER: The Plan does not have a benefit for any nutritional counseling or for weight loss programs.You can call the MAP program for assistance through the Life Coach program.

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QUESTION: Am I covered when I travel to another country?

ANSWER: The Plan benefits would apply if you are outside the US, and the Blue Cross/Blue Shield Network does have a limited international network.

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QUESTION: Are DOT physicals covered?

ANSWER: DOT physicals are covered under the preventative care benefit. Please refer to the Benefit Summary tab or the 12/10 Summary of Material Modifications (SMM).

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QUESTION: If I am injured on the job, will the plan pay for my medical expenses?

ANSWER: No, the Plan does not cover work-related claims. Refer instead to your employer's worker's compensation program.

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QUESTION: How does the Health Care Reform Act of 2010 affect my medical benefits.

ANSWER: To read a full explanation of changes to the plan, click here.

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