Medical Insurance – Northeast Carpenters Fund Home

HEALTH DEPARTMENT

Level II Medical Plan

MAJOR MEDICAL COVERAGE

90/10 Coinsurance Plan

Doctors, hospitals, and other medical services will be covered under a new 90/10 Coinsurance Plan. When Participants visit providers who are in-network with Independence Administrators, the Fund pays 90% of the total Independence Administrator's allowance leaving the Participant with a coinsurance of only 10%

Out of Pocket Maximum

Individual - $1,000 Family - $2,000

All eligible individuals have a $1,000 out of pocket maximum. The most a family can pay in total is $2,000
Participants are responsible for the coinsurance until they have met their out-of-pocket maximum (OOP). Once an individual or family has reached their OOP Max, the Plan will pay 100% for all further In-Network claims for the duration of the Plan Year (April 1 through March 31)

Level II Eligibility Requirements

Commercial Carpenters: 600 hours in the 6 month work period or 1,200 hours in the 12 month work period

Shop/Casino Carpenters: 850 hours in the 6 month work period or 1,700 hours in the 12 month work period

Level II health coverage coinsurance and out-of-pocket maximum.

Level II Independence Administrators Card

Sample Level II Card

Press play to watch the Coinsurance Whiteboard video.

Level I Medical Plan

MAJOR MEDICAL COVERAGE

70/30 Coinsurance Plan

Doctors, hospitals, and other medical services will be covered under a new 70/30 Coinsurance Plan. When Participants visit providers who are in-network with Independence Administrators, the Fund pays 70% of the total Independence Administrator's allowance leaving the Participant with a coinsurance of only 30%

Out of Pocket Maximum

Individual - $2,000 Family - $4,000

(All eligible individuals have a $2,000 out of pocket maximum. The most a family can pay in total is $4,000)

Participants are responsible for the coinsurance until they have met their out-of-pocket maximum (OOP). Once an individual or family has reached their OOP Max, the Plan will pay 100% for all further In-Network claims for the duration of the Plan Year (April 1 through March 31)

Level I Eligibility Requirements

Commercial Carpenters: 450 hours in the 6 month work period or 900 hours in the 12 month work period

Level I health coverage coinsurance and out-of-pocket maximum.

Sample Level I Card

Level I & II Prescription Coverage

HAVE ELIGIBLE OUT-OF-POCKET EXPENSES?

Submit them to your HRA for reimbursement.

FILE A CLAIM

MAJOR MEDICAL FAQs

Are Doctor and Specialist visits covered?

What is the difference between a deductible, a co-pay, and coinsurance?

A deductible is the initial amount of money you must pay for health care services before your insurance starts to pay for covered services. For all In Network Claims through Independence Administrators or Mental Health Consultants, your coverage does not have a deductible.

A co-pay is a fixed dollar amount you are required to pay for health care services. For example, if you fill a 30-day generic prescription you would have a $5 co-pay.

Coinsurance is the set percentage of the allowed amount you are required to pay for health care services.

Is there an "Out-of-Pocket Maximum," and what does that mean?

What if I go out-of-network?

Can I use an Urgent Care Facility, or a Minute Clinic at a pharmacy?

Where can I find a list of Participating Independence Administrator's Providers?

What is considered Preventative Care?

Where can I find the Consolidated Appropriations Act Machine Readable File?

Transparency in Coverage - Machine Readable Files (MRF)

The link below leads to machine-readable files related to our group health plan offerings that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to access and analyze data more easily.

In network and out of network MRFs

HEALTH DEPARTMENT

Level II Medical Plan

Level II Medical Plan

MAJOR MEDICAL COVERAGE

90/10 Coinsurance Plan

Out of Pocket Maximum

Level II Eligibility Requirements

find a provider

Level I Medical Plan

Level I Medical Plan

MAJOR MEDICAL COVERAGE

70/30 Coinsurance Plan

Out of Pocket Maximum

Level I Eligibility Requirements

find a provider

Level I & II Prescription Coverage

HAVE ELIGIBLE OUT-OF-POCKET EXPENSES?

MAJOR MEDICAL FAQs

Transparency in Coverage - Machine Readable Files (MRF)