As an alternative to the Self-Funded Medical benefits, medical coverage may be elected through Kaiser. Kaiser benefits are described in detail by Kaiser brochures, which are available, upon request, from the Plan Administrator at no additional cost.
Active Employees, Pre-Medicare Retirees, and Medicare-eligible Retirees
The Plan provides benefits for drugs or medicines, including insulin, that relate directly to the treatment of an illness of injury and that cannot be legally dispensed without a prescription and that by law must bear the legend “Caution – Federal law prohibits dispensing without a prescription”.
The Plan provides benefits through a contract with Catamaran/OptumRx which contracts for prescription drugs and insulin at discounted rates resulting in savings to the Participant and to the Plan. The Plan uses a copayment structure that reduces out-of-pocket costs when using generic drugs and preferred brand name drugs. When a prescription is filled at a participating Retail Pharmacy, the copayment will be at one of these tiers:
- Generic Drugs: The copayment is $10 for each prescription (up to a 30-day supply);
- Formulary Preferred Brand-Name Drugs: The copayment is 20% with a $15 minimum and a $25 maximum for each prescription (up to a 30-day supply);
- Non-Preferred Brand-Name Drugs / All Other Drugs: The copayment is 30% with a $30 minimum and a $75 maximum for each prescription (up to a 30-day supply).
For questions concerning Retail pharmacy prescription benefits, contact:
CATAMARAN/OPTUMRX Customer Service: (800) 880-1188
- To elect coverage through Kaiser, you must complete a Plan election card and the enrollment packet of the HMO. You may elect HMO coverage when first eligible under the Plan or at the open enrollment period established by the Board of Trustees. Currently, there is an annual open enrollment election period in October of each year, to be effective on January 1 of the next year. If you do not actively enroll in an HMO, you will automatically be enrolled in the PPO Plan or, if you are retired and eligible for Medicare, the Medicare Supplemental Plan.
- Claim forms for these benefits are available from the Trust Fund Office or the Local Union. The Trust Fund Office may assist you in completing any of these forms, but you are ultimately responsible for submitting your own claims for these benefits. Submit insurance claims directly to the insurance company, at the address on the form.