National Roofers Health & Welfare
| |
About the Plan
The National Roofers Union and Employers Joint Health and Welfare Fund was formed subject to collective bargaining agreements by and between various local unions of the United Union of Roofers, Waterproofers, and Allied Workers and employers in the roofing industry. Due to economies of scale and a mobile workforce, the collective bargaining parties designed the Fund as a “multiemployer” Fund so that workers for the unionized employers in the industry could be covered by one health benefit program.
The Trustees of the National Roofers Union & Employers Joint Health & Welfare Fund hire Wilson-McShane Corporation to perform various functions associated with administration of the Fund. This includes processing medical claims, dental claims, vision claims, and disability income benefits as well as eligibility administration and employer contribution processing. The Plan also contracts with a variety of other Service Providers, such as Cigna.
Cigna is the Plan’s Medical Preferred Provider Organization (“PPO”). The Plan contracts with Cigna to utilize their network of providers and doctors. Using the Cigna network, the Plan receives significant discounts on incurred claims. CIGNA also provides utilization & disease management as well as a prescription drug program.
Cigna is the Plan’s Medical Preferred Provider Organization (“PPO”). The Plan contracts with Cigna to utilize their network of providers and doctors. Using the Cigna network, the Plan receives significant discounts on incurred claims. CIGNA also provides utilization & disease management as well as a prescription drug program.
Benefits of this plan include:
- Medical Benefits
- Prescription Drug Benefit
- Dental Benefits
- Vision Benefits
- Weekly Disability Income Benefits
- Life and Accidental Death and Dismemberment Benefits
REMINDER
New insurance cards were issued in conjunction with the transition to the new administration office, Wilson-McShane Corporation. Please remember to present your new insurance National Roofers Union and Employers Joint Health & Welfare Fund insurance card when visiting a clinic or hospital any time after January 1, 2017 to assure that the billing is done correctly. Using your old insurance cards will result in benefits not being processed and therefore no insurance payment. If you have misplaced your new insurance card(s) please contact the Local Union at 702-453-5801 or Wilson-McShane Corporation at (800) 622-8780 and request current versions from the claims department.
| |
- Co-pays:
Yes, for In-Network Providers.
In-Network Providers: The office co-pay is $20 per primary care physician or specialist visit. For all other services performed and billed during an office visit, the Plan pays 80% after the Deductible is met. For all other professional fees, the Plan pays 80% after the Deductible is met.Non-Network Providers: The Plan pays 50% after the Deductible is met for professional fees.
- Deductible
$400 per person per calendar year
$1,200 per family per calendar year
- Pharmacies
You can go to any retail pharmacy to have your prescription filled; however, if you use a Cigna retail pharmacy or the mail-order program, you will save money. To find a Cigna pharmacy near you, or to access the mail-order program, call the Customer Service Number: (800) 244-6224 (Customer service is available 24 hours a day, 7 days a week for precertification, ordering mail order drugs, questions, etc.).
- How to find an in network providor
- Go to this website: www.cignasharedadministration.com
- Click on the “Find a Doctor” button
- Select the option for “Shared Administration OAP Provider Directory”
- Enter your search location, e.g. Salt Lake City, UT
- Select “medical” plans and then choose “OAP” from the drop down menu
- Questions
If you have any questions or need further assistance, please call the Local Union at 702-453-5801 or the Fund office at 800-922-8780 or