DOES THE HEALTH PLAN COVER HEALTH CLUBS?

Yes, as of January 1, 2008 the Health Plan covers up to $150 per family, per year in Health Club reimbursements.  Health Clubs with a variety of cardio-vascular and strength-training exercise equipment, such as traditional health clubs or Y’s, qualify. Note that martial arts centers, gymnastic facilities, country clubs, tennis, aerobic or pool-only facilities, social clubs, sports teams, leagues, personal training, lessons, coaching, exercise equipment or clothing do not qualify.

 To receive the benefit, you must complete the special Fitness Claim Form which can be obtained on this web site or by contacting the Fund Office.  The weight loss benefit can only be claimed after you have belonged for 4 months during the calendar year.

WHY DO YOU SEND ME INJURY INVESTIGATION LETTERS WHEN I DID NOT HAVE AN INJURY?

The Health & Welfare Plan does not cover services that are related to a workers comp injury or motor vehicle related injuries if your auto insurer has not paid PIP benefits or we do not have a subrogation agreement on file. Also, services where a law suit might be involved would be the responsibility of the third party payer in the absence of a subrogation agreement.  If the Plan receives a claim from your doctor or hospital that uses a diagnosis that might be related to one of the situations noted above, we try to investigate to make sure it is a liability the Plan should pay. Your claim will be denied until we receive a response.  By not responding in a timely fashion the discount we have with the Blue Cross Blue Shield provider is at risk. If the provider refuses to honor the discount because the requested information has not been provided on a timely basis, any amounts over the negotiated rate could be your responsibility.

DO DIAGNOSTIC TESTS SUCH AS MRI'S, CT SCANS, COLONOSCOPIES AND HYSTEROSCOPY'S REQUIRE A PRE-APPROVAL?

If your doctor prescribes these tests a pre-approval is not required. However, note that routine screening colonoscopies are limited by the Center for Disease Control and Prevention guidelines of once every 10 years after age 50, unless there are symptoms that would warrant more frequent testing.

DO YOU COVER ROUTINE ULTRASOUND FOR MY PREGNANCY?

The Plan covers medically necessary ultrasounds.  Those billed as supervision of routine pregnancy will be denied as not medically necessary.

WHY DO YOU NOT COVER INFERTILITY SERVICES WHEN THERE IS A MASSACHUSETTS STATE MANDATE TO COVER THESE?

The Health & Welfare Plan is enabled under a federal law known as ERISA and as such, federal laws supercede state law with respect to the Plan's insurance benefits.  This applies to other benefits that might be mandated by Massachusetts but are not a federal requirement.