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Medical Benefit Plans Offered by the Trust

The Washington Teamsters Welfare Trust offers comprehensive medical coverage to thousands of Plan participants. Please select your Plan below to find out more about your benefit offering.

Trust Medical Plan
Kaiser Permanente Plan
Overview

Premera Blue Cross (Premera) is the Trust’s preferred provider organization (PPO) nationwide. Participants have access to the BlueCard® PPO network, one of the largest national networks available.

The BlueCard® PPO network includes the Heritage and Heritage Plus 1 networks and provides for:

  • Medical services, including physician and hospital services
  • Behavioral health and chemical dependency services
  • Medical supplies and equipment

The BlueCard® PPO network of physicians and other healthcare professionals provides eligible employees and dependents with efficient, cost-effective services and supplies at discounted rates. Although you may see any provider covered by the plan, you receive higher benefits if you use in-network Trust Medical Plan providers.

Find an in-network provider by searching the BlueCard® PPO network online, or call (800) 810-BLUE (2583) and reference the prefix TMP.

Log in or look to your benefits booklets for more information. Booklets are available online at www.nwadmin.com.

Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association serving businesses and residents of Alaska and Washington state, excluding Clark County.
Premera Blue Cross: New PPO Medical Plan FAQ

As of October 1, 2016 the Washington Teamsters Welfare Trust began using Premera Blue Cross (Premera) as its Preferred Provider Organization (PPO) nationwide. Participants have access to the Premera BlueCard® PPO network, one of the largest networks available.

 

What Changed?

The Premera BlueCard PPO network, one of the largest provider networks, will replace Cigna and its affiliated networks as the provider network for all medical services, including physician and hospital services, behavioral health and chemical dependency services, medical supplies and equipment, and wellness programs. Premera will also begin providing pre-certification and pre-authorization for inpatient stays and certain outpatient procedures, along with case management, 24-hour NurseLine services, and other health care management programs previously provided through Cigna. You are not required to use the network, but use of network providers will result in significantly lower out-of-pocket expenses. Check to see if your provider is part of the BlueCard® PPO network.

 

What Stayed the Same?

This change will not affect your Plan’s medical benefits, deductible, copays, coinsurance, or out-of-pocket maximum, etc. It will also not affect your prescription drug benefits or pharmacy network. If you also receive dental or vision benefits through the Trust, these benefits and provider networks are remaining unchanged. In addition, Northwest Administrators will continue to process medical claims and provide customer service.

Why is the Trust Making this change?

The Trust is making this change in anticipation of achieving greater savings by accessing Premera’s increased provider discounts. These savings will help the Trust maintain benefits and keep your out-of-pocket expenses and premiums as low as possible while still providing a broad network of providers.

What Do You Need to Do?

  • Start using your new card on October 1, 2016—For all medical services, you must use your new card beginning on October 1, 2016 for claims to be processed and for services to be authorized appropriately.
  • Check to see if your provider(s) are in the Premera BlueCard Network—Before you see a doctor or receive medical services, you should check to see if your current doctor and other health care providers are part of the BlueCard® PPO network. You can also check with your doctor’s office, or call BlueCard® PPO Provider Locator at (800) 810-BLUE (2583). Be sure to reference the group alpha prefix TMP.

What if my Health Care Provider is Not in the BlueCard® PPO Network?

If your provider(s) are not in the BlueCard® PPO network, you may want to consider switching providers. Your current doctor may have a recommendation, or you can search for an in-network provider.  Please note that you are not required to use the Premera network, but use of out-of-network providers may result in significantly higher out-of-pocket expenses.

What if I’m Going to Have a Procedure or Service that has Already Been Pre-Certified but it Hasn’t Been Provided or Scheduled Yet?

If you have already received pre-certification for a procedure, service or hospital stay after October 1, 2016 you will NOT need to get a new authorization with Premera. If a hospital pre-certification or other medical management issue is currently in process with Cigna, you do not need to do anything. Cigna will coordinate with Premera to ensure your care is transitioned smoothly. However, if the intended service provider is not in the BlueCard® PPO network, and doesn’t meet one of the conditions discussed in the following question and answer for an extension of the PPO level of benefits, you may want to consider changing to a BlueCard® PPO network provider.

What if I’m Currently Receiving Ongoing Treatment or am Scheduled for Surgery or Hospitalization?

If you are receiving ongoing treatment or care for the second or third trimester of a pregnancy, chemotherapy, recent major surgery, mental health or substance abuse, radiation therapy and other health care services, or are scheduling a surgery or hospitalization on or after October 1, please check to make sure the providers are part of the BlueCard® PPO network. Using non-network providers may result in higher out-of-pocket expenses for you. If the providers are not part of the network, and one of the above conditions applies, you may request an extension of the PPO coinsurance level of benefits for those services by completing a Transition of Care form.

Member Assistance Program

In addition to the BlueCard® PPO network, the Trust offers Member Assistance. The ComPsych® GuidanceResources® program offers free, confidential counseling, self-improvement tools and other resources to help you take charge of your life, physically and emotionally.

These services are available 24 hours a day, 7 days a week to you and covered household members.

Call (866) 301-0313 or visit GuidanceResources®, using Web ID: WATEAMSTERS. You may also download the “GuidanceResources® Now” app for your smartphone.

Premera Personal Health Support

The Trust offers participants Premera’s Personal Health Support programs to help members with such things as managing complex medical conditions, a recent surgery, or admission to a hospital. Participants work with a trained Personal Health Support Clinician, who’s primary role is to support you and your entire family through a potentially difficult time.

Personal Health Support services include:

  • Helping participants have access to health improvement resources and in following providers’ prescribed treatment plan,
  • Coordinating care services as needed,
  • Helping to understand your health plan’s coverage,
  • Management and assistance with chronic conditions, and
  • Finding useful community resources.

Premera’s Personal Health Support teams are made up of trained nurses and other certified health care specialists. Participation is voluntary. To request help from Premera’s Personal Health Support team, call 855-869-6775.

Precertification

Precertification is the process of determining if services, equipment or supplies are medically necessary and will be covered by your Plan prior to your obtaining them. This process protects you from unexpected costs. With precertification you will have the assurance that the services you receive are medically necessary and eligible to be covered by the Plan prior to incurring the expense.

Premera Care Management

When you or a covered family member receives care from a participating Premera Blue Cross doctor or facility, your provider will arrange all the care you may need, including getting prior authorization and hospital inpatient precertification, as required.

Through Care Management, a participating Premera doctor or facility may be able to lower your out-of-pocket costs by recommending one of Premera’s preferred facilities, or by helping identify treatments or procedures that may be avoidable. This also keeps you in-network and possibly avoiding out-of-network uncovered costs.

Overview

With the Kaiser Permanente Plan (formerly Group Health Options), when you choose in-network care, you get access to providers at all Kaiser Permanente medical centers. In addition, you have access to a number of contracted community physicians in the area.

If you choose out-of-network care, you can see First Choice Health or First Health network providers at a discounted rate. Or you may see any licensed provider you want, anywhere in the U.S., for most covered services. However, your out-of-pocket costs will be higher, and there may be additional paperwork.

Find an in-network provider online, or call Kaiser Permanente at (888) 901-4636.

Find the complete details of your medical coverage in your Summary Plan Description booklet, available online at www.nwadmin.com, or by contacting Kaiser Permanente.

Eligibility or claims questions? Call the Trust office at (800) 458-3053.

Behavioral Health Services

Kaiser Permanente’s Behavioral Health Services pre-authorizes and coordinates non-emergency mental health and chemical dependency care. You do not need a referral from your personal physician to get these services and you can call if you have marital, parenting, or emotional concerns, substance abuse, or addiction concerns. Call (888) 287-2680 or search “Behavioral Health Services” on the Kaiser Permanente website.

Hospital Precertification

Precertification is the process of determining if services, equipment or supplies are medically necessary and will be covered by your Plan prior to your obtaining them. This process protects you from unexpected costs. With precertification you will have the assurance that the services you receive are medically necessary and eligible to be covered by the Plan prior to incurring the expense.

Case Management

Kaiser Permanente’s Case Management is a free service to help you access the medical care and services you need, and that are most appropriate for you. Case Managers help you stay informed about specific diseases and specific care settings and ensure that you receive access to timely, appropriate medical care.

Case Management teams are made up of trained nurses and other certified health care specialists. Case Managers help with trauma, emergencies, and the following chronic conditions:

  • Chronic Heart Failure (CHF)
  • End Stage Renal Disease (ESRD)
  • HIV/AIDS
  • Bariatric
  • Transplants
  • Occupational Medicine
  • Behavioral Health
  • Oncology

Your Case Manager will coordinate access to care, assess chronic conditions, monitor your progress, assist with discharge planning and follow-up, and help ensure that your benefits are used effectively. Most importantly your Case Manager will be there to support you and your entire family through a potentially difficult time.

Complex Case Management, a service targeting recently discharged patients with significant needs, is available to you if you have complex conditions such as diabetes, depression, or conditions that are more severe than the ones mentioned above.

Case Management is a voluntary program. If you or a covered family member is facing a complex medical condition that may require inpatient, outpatient or at-home care you may be eligible. Call Kaiser Permanente at (866) 656-4183 to find out more.