Medical Plans

National IAM Benefit Trust Fund Medical Plans

The National IAM Benefit Trust Fund offers three medical plans, which are administered by CIGNA. Covered employees and their dependents may participate in a Benefit Trust Fund medical plan if it is negotiated into the Collective Bargaining Agreement. All three plans generally pay benefits for the same eligible medical expenses. The primary differences between the plans are the annual deductible amounts, coinsurance (the percentage paid for covered services after the annual deductible is met), and the annual out-of-pocket maximum.

Medical Coverage

All Fund medical plans are PPO plans that use the CIGNA Open Access Plus (OAP) network. The network consists of more than one million participating providers nationwide. Plan participants have the flexibility to see any doctor or health care provider they choose. However, participants who select OAP network providers will incur the lowest out-of-pocket expenses because the participating providers have agreed to accept pre-negotiated, reduced rates for covered services, and they are paid at the greater in-network benefit percentage.

Medical Services

Benefit Trust Fund medical plans cover an array of medical services. Preventive services, such as annual physical exams and certain routine immunizations, are covered at 100% under all three plans when care is received from an in-network provider. Other medical services are covered at varying benefit levels, depending on service. Before you visit a medical provider, it is always a good idea to double check that the services you are planning to receive are covered by the Benefit Trust Fund medical plan, and that the provider participates in the OAP network.

For a list of covered medical services, view or download sample Schedules of Benefits for the National IAM Benefit Trust Fund medical plans, or contact the Fund Office.

Schedule of Benefits – H001 (PDF)

Schedule of Benefits – H002 (PDF)

Schedule of Benefits – H003 (PDF)

View a comparison of Plans H001, H002, and H003 (PDF)

Medical Summary Plan Descriptions

For more detail about how the plans work, including specific information about covered services and benefits, contact the Fund Office to receive a Summary Plan Description (SPD). You can view and download sample medical Summary Plan Descriptions below.

Sample Summary Plan Description – H001 (PDF)

Sample Summary Plan Description – H002 (PDF)

Sample Summary Plan Description – H003 (PDF)

Medical Summary of Material Modifications

Whenever a change is made to a medical plan, the Fund Office will send a Summary of Material Modification (SMM) to explain the change. SMMs should be retained in your Summary Plan Description for future reference. All changes made to a medical plan since the last printing of the Summary Plan Description will be included when the booklet is revised and a new edition of the SPD is issued.

For example, the Fund made changes to its medical plans to comply with the Patient Protection and Affordable Care Act of 2010 (ACA), also known as "Health Care Reform." Such changes include expanding eligible dependent coverage to children up to age 26 and removing lifetime maximum payment limits. You can view and download recent medical Summaries of Material Modifications below.

CVS Caremark Formulary and Prior Authorization Effective January 1, 2017 (PDF)

Changes to CVS Caremark Formulary and Prior Authorization Effective January 1, 2016 (PDF)

Advanced Control Specialty Formulary Effective January 1, 2016 (PDF)

Cigna PHS+ Care Management Program Effective January 1, 2016 (PDF)

Legal Spouse Coverage Effective August 13, 2015 (PDF)

Trustee Changes through August 13, 2015 (PDF)

Changes to CVS Caremark Formulary, Generic Step Therapy, and Prior Authorization of Compounds Effective January 1, 2015 (PDF)

Definition of Allied Health Professional Amended Effective October 1, 2014 (PDF)

Dental and Vision Benefits Waiver, Domestic Partnership and Same Sex Marriage dated May 22, 2014 (PDF)

Change to CVS Caremark Formulary and Prior Authorization Requirement for Male Androgens Effective January 1, 2014 (PDF)

Medical Summary of Benefits and Coverage (SBC)

Medical Summary of Benefits and Coverage - H001 (PDF)

Medical Summary of Benefits and Coverage - H002 (PDF)

Medical Summary of Benefits and Coverage - H003 (PDF)

SBC Uniform Glossary (PDF)

Request a Medical ID Card

Participants in a National IAM Benefit Trust Fund medical plan will receive a CIGNA medical ID card in the mail (a separate ID card is provided for the covered employee and each eligible enrolled dependent). Your medical ID card has your member number and important contact information. Present your medical ID card whenever visiting a medical provider.

If you need health care before you receive your ID card, you can log into CIGNA's website and print a temporary ID card. You can also access CIGNA’s website to request a replacement ID card or an additional ID card for any covered participant.

 

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The National IAM Benefit Trust Fund offers three medical plans that cover an array of medical services.

Frequently Asked Question (FAQ)

How many different plans does the Fund offer?

The Fund offers multiple Medical, Dental, and Vision plans. Short-Term Disability and Life and Accidental Death & Dismemberment benefits are also available.

How do I notify the Fund of my address change?

If you move, please notify the Fund of your new address. To change your address,
fill out a new Enrollment Form and mail or fax it to the Fund using the mailing address or fax number found on the form. Always complete a new Enrollment Form when you have a change in personal information.

Do Medical Plans include Prescription Drug Coverage?

Yes. Our Plans include excellent prescription drug benefits.

What is a PPO?

A Preferred Provider Organization is a type of medical plan that covers the cost of eligible medical care and services received from network and non-network providers. Network providers (primary care doctors, specialists, hospitals, and other medical facilities) agree to a discounted fee schedule for services provided. When a participant or covered family member sees a network provider for care, the participant pays less out of pocket because of the discounted fees. The Fund contracts with CIGNA Healthcare for the use of their nationwide network of participating providers. There are currently more than 750,000 participating providers in the CIGNA "Open Access Plus" Network—the network used by the Fund’s medical plans.

Are participants required to receive services only from a PPO provider?

No. Participants have the choice of selecting a non-PPO physician. However, receiving services from a physician who participates in the CIGNA network may result in significant savings for participants.

Must participants have a referral from their primary care physician in order to see a specialist?

No. Referrals are not required.

Who processes health care plan claims?

Medical claims are processed by CIGNA Healthcare. Dental claims are processed by Delta Dental Insurance Company, and Vision claims are processed by Fund Office staff.

Do the Fund plans have a waiting period for "pre-existing conditions" under the medical plans?

No. The waiting periods for pre-existing conditions were waived for all plans by the Board of Trustees.

What are the age limits for dependent children?

Children can be covered dependents until they reach age 26 providing they continue to meet provisions for dependent coverage.

Does the Fund offer COBRA coverage for health care?

Yes. The Fund administers COBRA for its Contributing Employers. Upon notification from the Employer that a participant is losing coverage due to a "qualifying event," the Fund will send notification to the participant advising him or her of COBRA rights to continue health care coverage by making payments to the Fund Office.

Does the Fund offer Retiree Health Care Plans?

Yes. Employers that have negotiated a Benefit Trust Plan for their Active employees may also establish a Retiree plan.

How Do I Find a Contributing Employer?

To find a Contributing Employer click on this link to view a map and listings by territory.

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