Health Fund

IMPORTANT TERMS

Overview

The Health Fund provides valuable health and wellness benefits to our participants and their dependents. These benefits include medical, prescription drug, behavioral health, dental, vision, life insurance and more.
Check your collective bargaining agreement, or call the Fund Office, to determine what Health Plan applies to you.
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Eligibility Rules

As long as you work in covered employment, and your employer is required to make contributions to the Fund on your behalf, you’re eligible to enroll in the Plan(s) applicable to your collective bargaining agreement. Your collective bargaining agreement determines which Plan(s) are available to you.

Status Changes

Normally, the benefit decisions you make during Open Enrollment each year remain in effect for the entirety of the following year. You may only make changes to your benefit elections during the year if you have a change in status.
Status changes include:
  • Marriage, divorce, or annulment
  • The birth or adoption of your child
  • Your child loses eligibility for coverage (such as reaching age 26)
  • Changes in employment status which affect your eligibility (termination, strike, lockout, change in worksite or work schedule, or the beginning or end of your leave of absence)
  • You become eligible for Medicare or Medicaid
  • You or your dependents become eligible for COBRA coverage
Remember: Let the Fund Office know in writing within 30 days of the status change (90 days for a newborn child) if you need to make changes to your benefit elections. You’ll also need to provide proof of the event (marriage or birth certificate, for example).

OPEN ENROLLMENT

Open Enrollment is your once-per-year opportunity to make changes to your benefit elections. You’ll receive an Open Enrollment Guide each fall to help you choose your coverage for the following year. Fill out the applicable forms at the front of your Enrollment Guide and send them back to the Fund Office to enroll in or continue coverage for the next year.

Choose carefully—the decisions you make during Open Enrollment are effective
from January 1 to December 31 of the following year. You can’t make changes during the year unless you experience a qualified status change.

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Health Management Program

It’s normal to only think about your health during Open Enrollment or when you’re sick. The Health Management Program invites you to consider your everyday decisions—and to get free advice and rewards for participating!

If you’re enrolled in the 36 Phlex, Full-Time, BOLR Full-Time, or BMCA Full-Time medical plans, you have access to the Health Management Program.

Health Management Nurse

Managing chronic conditions like diabetes, asthma, and heart disease is a challenge. That’s why the Fund Office has an on-site nurse who can guide you as you manage your condition.

The nurse can answer your questions, discuss symptoms of chronic conditions, help you prepare questions for your doctor, and offer you support. To get started, schedule a confidential phone call or appointment with the nurse.

The nurse is available 9 a.m. to 4:30 p.m., Monday through Friday, by phone at (215) 568-2345 or (800) 338-9025, ext. 1401.

Health Management Program for Diabetes

Are you ready to get your diabetes under control? If you have diabetes, you may be eligible for our Health Management Program for Diabetes. The Fund’s Health Management Nurse may reach out to you to discuss the program, or you may also contact the nurse by calling at (215) 568-2345 or (800) 338-9025, ext. 1401 (9 a.m. to 4:30 p.m., Monday through Friday).
Participants in the Health Management Program for Diabetes have access to:
  • Personalized telephone coaching and checkups from the dedicated Health Management Nurse
  • Reduced copays for prescription medications for diabetes
  • Diabetes education programs

If you qualify for the program, the nurse will send you an authorization form that explains the program requirements that you will need to fill out and return before starting the program. Here’s an overview of the requirements. To participate and qualify for the reduced prescription drug copays, you must:

  • Have a Primary Care Physician (PCP) and at least two visits a year with either your PCP who is either in an independent PCP practice or a PCP through a Patient Centered Medical Home (PCMH) and/or with the appropriate medical specialist,
  • Accept phone calls on an ongoing basis from the nurse,
  • Enroll in either diabetic classes or meet with an in-network nutritionist (you can get up to six visits per year under your health plan),
  • Get at least two A1C tests per year, unless your physician recommends them more frequently, and
  • Know your numbers. You can use a Health Tracker card provided by the nurse to keep a record of your numbers and provide them to your doctor.

This confidential and voluntary program is available to all medical plan participants with diabetes.

Healthy Lifestyles

Get healthy while you get paid! Healthy Lifestyles, administered by Keystone (formerly Independence Blue Cross), offers you a variety of financial incentives to take care of your body.
  • Up to $150 reimbursed on your fitness center fees
  • Up to $150 reimbursed on an approved weight management program
  • Up to $150 reimbursed on programs to help you quit smoking
You can participate for free if you’re enrolled in the Keystone Direct Point of Service or HMO medical plan. Eligibility begins once you complete 120 visits at approved facilities.
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Behavioral Health Program

If you or your family members are struggling with mental health or substance abuse, remember: you’re never alone. The Behavioral Health Program, administered by MHC, can help you manage a range of issues, including:
  • Anxiety/stress
  • Substance abuse
  • Depression
  • Post-traumatic stress
  • Grief
  • Family problems
  • And much more

The Behavioral Health Program is covered separately from your medical benefits. All members have access to confidential, professional help through MHC.
If you need treatment for mental health or substance abuse issues, contact MHC at (800) 255-3081 or visit the MHC website.

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Benefit Plans

Which Plan am I eligible for? The Health Fund offers five plans to participants:
36Phlex PLAN
BOLR Full-Time Plan
BOLR BMCA Full-Time Plan
BOLR BMCA Part-Time Plan
BOLR Part-Time and Weekend Worker Plan
Eligibility for each Plan varies based on your collective bargaining agreement. Check your collective bargaining agreement to see which Plan(s) are available to you. If you have questions, contact the Fund Office.