Life Events

Major Surgery

If you have been advised that you will undergo major surgery, you should become fully informed of the Welfare Trust benefits covering hospitals and surgery. Also, if you have not already done so, you should make sure that you have made arrangements for financial matters such as power of attorney for health care, general power of attorney, will, and designations of beneficiaries.

Plan Checklist

  • The Plan uses a Preferred Provider Organization (PPO Network) of physicians and hospitals. There are different networks and reimbursement levels available based on the location you receive medical services and the type of service you receive.

    In general, it will be preferable for you to use a PPO provider whenever possible, because you receive a higher level of reimbursement when you use a PPO provider.

  • You must follow all the Cost Containment rules in order to avoid a reduction in benefits payable for any scheduled surgery or hospitalization. If you don't follow the required Precertification Review, Concurrent (Continued Stay) Review, or Case Management procedures, or if you undergo a medical procedure that has not been determined to be Medically Necessary under the Second Medical Opinion Program, the Administrative Office may refer your claim for Retrospective Review to determine if services were Medically Necessary.

    Effective April 1, 2011, precertification is required on all:
    • Hyperbaric Oxygen Therapy Service
    • Chemotherapy/Radiation Therapy Services
    • Durable Medical Equipment (DME) costs in excess of $5,000
    • Blepharoplasty surgical procedures
    • Sleep Study Testing
  • You must follow the rules governing whether a surgery is to be performed on an inpatient or an outpatient basis. Failure to follow the rules can result in a reduction in benefits payable The surgical procedures listed in Section 5.9 of the Welfare SPD are usually performed on an outpatient basis as "same day surgery" (confinement of less than 15 consecutive hours). If any of these procedures are performed on an OUTPATIENT basis, Covered Expenses are payable at 80% if performed at a PPO facility, or 70% if performed at a non-PPO facility with a 20% penalty.

Also Consider...

There is risk involved any time you perform an action. There is a certain risk involved in going out your front door and driving to work. There is undeniably a greater level of risk involved in having a major surgery than in normal day-to-day activities. While it is not beneficial to exaggerate the risks involved, financial planners do recommend that people preparing to undergo scheduled major surgery should at least review several documents which would come into play in the event of death. If you have a family and/or you have assets, you should already have considered these. But if you have sufficient time before surgery, this is an appropriate point to begin working on these. Here are the items which you may wish to update, revise, or consider prior to surgery: