Health BenefitsAlaska Teamster-Employer Welfare Trust
This page provides basic information about the health benefits available through the Alaska Teamster-Employer Welfare Trust. For eligibility rules and full Plan details, see the Summary Plan Description.
Benefits that work as hard as you do
The medical and prescription benefits described here are for Eligible Employees and Retired Participants covered by Medicare. Dental, Vision, Life and AD&D and Vacation benefits are available to Eligible Employees only.
- Medical Plan Benefit
- Prescription Drug Benefit
- Dental Benefit
- Vision Benefit
- Life Insurance and AD&D Benefit
- Vacation Benefit
Medical Plan Benefit
Your Medical Plan Benefit provides comprehensive coverage of Covered Expenses incurred for an Illness or Injury and is subject to a deductible and coinsurance provision that applies to each Participant each calendar year. For Retired Participants and their Dependents, see the Retiree Rules page.
Preferred provider network
The Medical Plan benefit has been structured to provide an incentive to use Preferred Providers for hospital treatment, office visits, and supplies. You will almost always pay significantly more out-of-pocket if you go out of network for care. Visit the Find a Provider page to find in-network providers.
Deductible
Calendar year deductible for Eligible Employees and their Dependents:
| Individual | Family |
|---|---|
$750 |
$2,250 |
For Retired Participants and their Dependents, see the Retiree Rules page.
Annual Out-of-Pocket Limit
(includes Calendar Year Deductible)
For Eligible Employees and their Dependents
Per Participant – PPO: $3,800
Per Family: $7,600
Per Participant – non-PPO: $7,600
Per Family – non-PPO: $15,200
Per Participant for Prescriptions: $3,200
Per Family for Prescriptions: $6,000
For Retired Participants and their Dependents, see the Retiree Rules page
What’s covered
| Benefit | % of Covered Expense |
|---|---|
Preventive Health Care |
100% subject to UCR and schedule of Routine Examination Benefits, Schedule of Well Child Benefits and Schedule of Immunizations |
Teladoc |
100% |
Services at Coalition Health Centers |
No copay for each year. Deductible waived |
Ambulance Service |
80%; limited to 70% of preferred provider charges |
Hearing Loss Benefit |
70%; up to $800 per hearing device, per ear during any 3 consecutive years; not subject to deductible or out-of-pocket limitations |
Skilled Nursing |
80%; up to 100 days |
Hospice Care |
80% |
| Benefit | Preferred Providers % of Covered Expenses | Non-Preferred Provider % of contract rates |
|---|---|---|
Hospital Services (inpatient & outpatient) |
||
Hospitals in Alaska; within 75 miles of a Preferred Provider facility |
80% |
60% of rate negotiated with Preferred Provider; after additional $1,000 inpatient deductible |
Hospitals in Alaska; not within 75 miles of a Preferred Provider facility |
80% |
60% |
Preadmission Testing |
100% |
100% |
Transcarent Surgery Care
Surgery costs scheduled through Transcarent Surgery Care, formerly known as BridgeHealth, are covered at 100%, including pre-op, surgery, and post-op care. No deductible or coinsurance applies. Visit the Low & No-Cost Care Options page for more information.
| Benefit | Preferred Providers % of Covered Expenses | Non-Preferred Provider % of contract rates |
|---|---|---|
Professional Services and Supplies |
||
Physician visits (home, office, telehealth) |
80% |
60% |
Surgeon and assistant surgeon |
80% |
60% |
Diagnostic x-rays, laboratory testing |
80% |
60% |
Chiropractic office visits (up to 15 visits per year) |
80% |
60% |
Acupuncture (up to 15 visits per year) |
80% |
60% |
Naturopathic Services (some exclusions apply) |
80% |
60% |
Physical, occupational or massage therapy (up to a combined limit of 20 visits per year) |
80% |
60% |
Hinge Health
Hinge Health offers personalized exercise therapy to help manage and prevent joint and muscle pain, like back, knee, and hip issues—at no cost to you. Visit the Low & No-Cost Care Options page for more information.
| Benefit | Preferred Providers % of Covered Expenses | Non-Preferred Providers % of Contract Rates |
|---|---|---|
Speech therapy (up to 20 visits per year) |
80% |
60% |
Cardiac rehabilitation |
80% |
60% |
Medical equipment and prosthetics |
80% |
60% |
Home Health Care Benefit |
80% |
60% |
Prescription Drug Benefit
The Plan pays for covered prescription drugs provided at either retail or mail order pharmacies. You must comply with the program rules regarding generic/name brand, preauthorization when required, and using the mail order pharmacy as indicated in order to obtain maximum benefits.
Maximum out-of-pocket limit
A separate maximum out-of-pocket limit applies to prescription drugs: For Active Participants $3,200 per Individual, $6,000 per Family.
Pharmacy network
There are three ways you can fill prescriptions – at a Participating Retail Pharmacy, at the Trust’s Preferred Participating Mail Order Pharmacy, and at Non-Participating Pharmacies. See the Order Prescriptions page for more information on how to order your medications.
Note: If you fail to use your prescription drug card at a participating pharmacy, there is no reimbursement.
Reimbursement limitations
If you or your Physician request that your prescription be filled with a brand-name Drug when a generic equivalent is available, you will be responsible for paying the full difference in price between the generic and brand-name Drug in addition to your brand-name Prescription Drug co-payment. The generic drug price is established by the Plan’s Pharmaceutical Provider.
Co-payment / Reimbursement
| Participating Retail Pharmacy (34-Day Supply) | Preferred Participating Mail Order Pharmacy | Non-Participating Pharmacy | |
|---|---|---|---|
Generic Drugs |
Participant co-payment is 20% of the total cost of the Drug |
Participant co-payment is the lesser of 20% of the cost of the drug or $20 for each prescription |
No reimbursement |
Preferred Brand-name Drugs (Reimbursement Limitations apply) |
Participant co-payment is 35% of the total cost of the Drug |
Participant co-payment is the lesser of 35% of the cost of the drug or $50 for each prescription |
No reimbursement |
Non-Preferred Brand- name Drugs (Reimbursement Limitations apply) |
Participant co-payment is 50% of the total cost of the Drug |
Participant co-payment is the lesser of 50% of the cost of the drug or $100 for each prescription |
No reimbursement |
Specialty Drugs Must be filled at participating Specialty Drug mail order facility |
Not applicable |
Participant co-payment is $100 for each Specialty Prescription (30-day supply) |
No reimbursement |
Out-of-network co-payment
If no in-network pharmacy is located in the area, the copayment is 50% of the Drug cost per each prescription filled out-of-network.
Covered at 100%
If filled through a participating retail pharmacy, the Plan also covers medications and supplements that are designated as “preventive care” under Health Care Reform and which the Plan is required by law to provide. For a list of the covered medications and supplements, see www.hhs.gov. These items are covered at 100% in-network, but you must have a prescription from your doctor (even for the over-the-counter items). Also, not all items are covered for everybody – for example, there are age restrictions, and some items are limited to generic only. Contact the Pharmaceutical Provider for more information.
Dental Benefit
The Plan provides Dental benefits to an active Participant or dependent of an active Participant.
In general, benefits are limited to the least costly treatment which is generally considered appropriate by the dental profession. If you choose more costly treatments, you are responsible for the difference in cost. Your treatment choices are up to you and your dentist.
Annual* Deductible |
$75 |
Annual* Maximum Benefit |
$2,000 per Participant (age 19 and older) |
*Dental Calendar Year
What’s covered
Class I – Diagnostic and Preventive: Exams, x-rays, fluoride, cleanings, sealants. |
80%; $75 deductible waived |
Class II – Basic Dental |
80% |
Class III – Major Dental |
50% |
Orthodontics – Individuals under age 19 |
50%; up to $1,200 lifetime; $75 deductible waived |
Pre-treatment estimates
Whenever you expect that your expenses for a treatment will be more than $500, a pre-treatment estimate is recommended. The pre-treatment estimate will tell you the total charges for a treatment and what part of those charges will be covered by the Plan. This way, before you begin treatment, you will know how much you will have to pay.
To find participating providers
You may use any dentist of your choosing. Be sure to check that they accept insurance before receiving care. Visit the Find A Provider page for more information.
Vision Benefit
This benefit helps pay for annual vision examinations and for glasses and contact lenses, subject to the rules of the Plan. The Plan uses a network of opticians, optometrists, and ophthalmologists called Vision Service Plan (VSP) to provide these benefits in an efficient and cost-effective way.
Reduced benefits are available when you use a provider outside the VSP network. How often you can use the benefit and your copayment are shown in the benefit schedule below.
What’s covered
Benefit schedule when using a VSP provider:
| Frequency | Your Copayment | |
|---|---|---|
Eye Examinations |
once every 12 months |
$10 |
Lenses |
once every 12 months |
$25 (for both lenses and frames) |
Frames |
once every 24 months |
• $150 allowance for a wide selection of frames |
Contacts (can be chosen instead of lens and frames) |
12 months |
$150 allowance for contacts and contact lens exam (fitting and evaluation) |
Benefit Schedule when using a non-VSP provider:
| Frequency | Pay Plan (you pay entire remainder) | |
|---|---|---|
Eye Examinations |
once every 12 months |
Up to $50 |
Lenses |
once every 12 months |
Up to $50/single vision |
Frames |
once every 24 months |
Up to $70 |
Contacts (can be chosen instead of lens and frames) |
12 months |
$150 allowance for contacts and contact lens exam (fitting and evaluation) |
To find participating providers
Visit www.vsp.com.
Exclusive Member Extras
Receive access to more than $2,500 in savings with VSP Exclusive Member Extras. Download flyer.
VSP Individual Vision Plan
If you’re retiring or not eligible for vision benefits through work, we can help. Enroll directly in a VSP Individual Vision Plan for as low as $17 a month. Download flyer.
Life Insurance and AD&D Benefit
Life insurance benefit
Participant – $25,000
Spouse and Dependent Child – $2,000
Accidental death & dismemberment
In addition to the amount payable for life insurance, for the participant only an additional benefit of $25,000 is available if the death or a dismemberment is caused by an accident.
See the Retiree Rules for life insurance benefits for retirees.
Vacation Benefit
If you are working for an Employer covered by a Collective Bargaining Agreement or Written Agreement that requires contributions for Vacation Benefits, then you are eligible for Vacation Benefits. Vacation Benefits are payable so long as the Welfare Trust holds Vacation Plan funds contributed on your behalf.
Amount of benefit
The amount you will receive is exactly equal to the amount that your Employer contributes to the Welfare Trust for you. Please note that before depositing Vacation Plan funds with the Welfare Trust; your Employer must pay your employment and income withholding taxes. Only those amounts actually contributed to the Welfare Trust by your Employer and credited to you are included in the benefits paid each quarter. Any investment earnings will be used to pay for administrative expenses involved in maintaining the Plan.
When benefits are paid
Benefits are automatically sent to your address on file with the Plan, as of the beginning of each quarter, February 1, May 1, August 1, and November 1. There may be a delay of up to 10 business days from the time the Welfare Trust receives a contribution to when it credits the contribution to you.
Medical Plan Benefit
Medical Plan Benefit
Your Medical Plan Benefit provides comprehensive coverage of Covered Expenses incurred for an Illness or Injury and is subject to a deductible and coinsurance provision that applies to each Participant each calendar year. For Retired Participants and their Dependents, see the Retiree Rules page.
Preferred provider network
The Medical Plan benefit has been structured to provide an incentive to use Preferred Providers for hospital treatment, office visits, and supplies. You will almost always pay significantly more out-of-pocket if you go out of network for care. Visit the Find a Provider page to find in-network providers.
Deductible
Calendar year deductible for Eligible Employees and their Dependents:
| Individual | Family |
|---|---|
$750 |
$2,250 |
For Retired Participants and their Dependents, see the Retiree Rules page.
Annual Out-of-Pocket Limit
(includes Calendar Year Deductible)
For Eligible Employees and their Dependents
Per Participant – PPO: $3,800
Per Family: $7,600
Per Participant – non-PPO: $7,600
Per Family – non-PPO: $15,200
Per Participant for Prescriptions: $3,200
Per Family for Prescriptions: $6,000
For Retired Participants and their Dependents, see the Retiree Rules page
What’s covered
| Benefit | % of Covered Expense |
|---|---|
Preventive Health Care |
100% subject to UCR and schedule of Routine Examination Benefits, Schedule of Well Child Benefits and Schedule of Immunizations |
Teladoc |
100% |
Services at Coalition Health Centers |
No copay for each year. Deductible waived |
Ambulance Service |
80%; limited to 70% of preferred provider charges |
Hearing Loss Benefit |
70%; up to $800 per hearing device, per ear during any 3 consecutive years; not subject to deductible or out-of-pocket limitations |
Skilled Nursing |
80%; up to 100 days |
Hospice Care |
80% |
| Benefit | Preferred Providers % of Covered Expenses | Non-Preferred Provider % of contract rates |
|---|---|---|
Hospital Services (inpatient & outpatient) |
||
Hospitals in Alaska; within 75 miles of a Preferred Provider facility |
80% |
60% of rate negotiated with Preferred Provider; after additional $1,000 inpatient deductible |
Hospitals in Alaska; not within 75 miles of a Preferred Provider facility |
80% |
60% |
Preadmission Testing |
100% |
100% |
Transcarent Surgery Care
Surgery costs scheduled through Transcarent Surgery Care, formerly known as BridgeHealth, are covered at 100%, including pre-op, surgery, and post-op care. No deductible or coinsurance applies. Visit the Low & No-Cost Care Options page for more information.
| Benefit | Preferred Providers % of Covered Expenses | Non-Preferred Provider % of contract rates |
|---|---|---|
Professional Services and Supplies |
||
Physician visits (home, office, telehealth) |
80% |
60% |
Surgeon and assistant surgeon |
80% |
60% |
Diagnostic x-rays, laboratory testing |
80% |
60% |
Chiropractic office visits (up to 15 visits per year) |
80% |
60% |
Acupuncture (up to 15 visits per year) |
80% |
60% |
Naturopathic Services (some exclusions apply) |
80% |
60% |
Physical, occupational or massage therapy (up to a combined limit of 20 visits per year) |
80% |
60% |
Hinge Health
Hinge Health offers personalized exercise therapy to help manage and prevent joint and muscle pain, like back, knee, and hip issues—at no cost to you. Visit the Low & No-Cost Care Options page for more information.
| Benefit | Preferred Providers % of Covered Expenses | Non-Preferred Providers % of Contract Rates |
|---|---|---|
Speech therapy (up to 20 visits per year) |
80% |
60% |
Cardiac rehabilitation |
80% |
60% |
Medical equipment and prosthetics |
80% |
60% |
Home Health Care Benefit |
80% |
60% |
Prescription Drug Benefit
Prescription Drug Benefit
The Plan pays for covered prescription drugs provided at either retail or mail order pharmacies. You must comply with the program rules regarding generic/name brand, preauthorization when required, and using the mail order pharmacy as indicated in order to obtain maximum benefits.
Maximum out-of-pocket limit
A separate maximum out-of-pocket limit applies to prescription drugs: For Active Participants $3,200 per Individual, $6,000 per Family.
Pharmacy network
There are three ways you can fill prescriptions – at a Participating Retail Pharmacy, at the Trust’s Preferred Participating Mail Order Pharmacy, and at Non-Participating Pharmacies. See the Order Prescriptions page for more information on how to order your medications.
Note: If you fail to use your prescription drug card at a participating pharmacy, there is no reimbursement.
Reimbursement limitations
If you or your Physician request that your prescription be filled with a brand-name Drug when a generic equivalent is available, you will be responsible for paying the full difference in price between the generic and brand-name Drug in addition to your brand-name Prescription Drug co-payment. The generic drug price is established by the Plan’s Pharmaceutical Provider.
Co-payment / Reimbursement
| Participating Retail Pharmacy (34-Day Supply) | Preferred Participating Mail Order Pharmacy | Non-Participating Pharmacy | |
|---|---|---|---|
Generic Drugs |
Participant co-payment is 20% of the total cost of the Drug |
Participant co-payment is the lesser of 20% of the cost of the drug or $20 for each prescription |
No reimbursement |
Preferred Brand-name Drugs (Reimbursement Limitations apply) |
Participant co-payment is 35% of the total cost of the Drug |
Participant co-payment is the lesser of 35% of the cost of the drug or $50 for each prescription |
No reimbursement |
Non-Preferred Brand- name Drugs (Reimbursement Limitations apply) |
Participant co-payment is 50% of the total cost of the Drug |
Participant co-payment is the lesser of 50% of the cost of the drug or $100 for each prescription |
No reimbursement |
Specialty Drugs Must be filled at participating Specialty Drug mail order facility |
Not applicable |
Participant co-payment is $100 for each Specialty Prescription (30-day supply) |
No reimbursement |
Out-of-network co-payment
If no in-network pharmacy is located in the area, the copayment is 50% of the Drug cost per each prescription filled out-of-network.
Covered at 100%
If filled through a participating retail pharmacy, the Plan also covers medications and supplements that are designated as “preventive care” under Health Care Reform and which the Plan is required by law to provide. For a list of the covered medications and supplements, see www.hhs.gov. These items are covered at 100% in-network, but you must have a prescription from your doctor (even for the over-the-counter items). Also, not all items are covered for everybody – for example, there are age restrictions, and some items are limited to generic only. Contact the Pharmaceutical Provider for more information.
Dental Benefit
Dental Benefit
The Plan provides Dental benefits to an active Participant or dependent of an active Participant.
In general, benefits are limited to the least costly treatment which is generally considered appropriate by the dental profession. If you choose more costly treatments, you are responsible for the difference in cost. Your treatment choices are up to you and your dentist.
Annual* Deductible |
$75 |
Annual* Maximum Benefit |
$2,000 per Participant (age 19 and older) |
*Dental Calendar Year
What’s covered
Class I – Diagnostic and Preventive: Exams, x-rays, fluoride, cleanings, sealants. |
80%; $75 deductible waived |
Class II – Basic Dental |
80% |
Class III – Major Dental |
50% |
Orthodontics – Individuals under age 19 |
50%; up to $1,200 lifetime; $75 deductible waived |
Pre-treatment estimates
Whenever you expect that your expenses for a treatment will be more than $500, a pre-treatment estimate is recommended. The pre-treatment estimate will tell you the total charges for a treatment and what part of those charges will be covered by the Plan. This way, before you begin treatment, you will know how much you will have to pay.
To find participating providers
You may use any dentist of your choosing. Be sure to check that they accept insurance before receiving care. Visit the Find A Provider page for more information.
Vision Benefit
Vision Benefit
This benefit helps pay for annual vision examinations and for glasses and contact lenses, subject to the rules of the Plan. The Plan uses a network of opticians, optometrists, and ophthalmologists called Vision Service Plan (VSP) to provide these benefits in an efficient and cost-effective way.
Reduced benefits are available when you use a provider outside the VSP network. How often you can use the benefit and your copayment are shown in the benefit schedule below.
What’s covered
Benefit schedule when using a VSP provider:
| Frequency | Your Copayment | |
|---|---|---|
Eye Examinations |
once every 12 months |
$10 |
Lenses |
once every 12 months |
$25 (for both lenses and frames) |
Frames |
once every 24 months |
• $150 allowance for a wide selection of frames |
Contacts (can be chosen instead of lens and frames) |
12 months |
$150 allowance for contacts and contact lens exam (fitting and evaluation) |
Benefit Schedule when using a non-VSP provider:
| Frequency | Pay Plan (you pay entire remainder) | |
|---|---|---|
Eye Examinations |
once every 12 months |
Up to $50 |
Lenses |
once every 12 months |
Up to $50/single vision |
Frames |
once every 24 months |
Up to $70 |
Contacts (can be chosen instead of lens and frames) |
12 months |
$150 allowance for contacts and contact lens exam (fitting and evaluation) |
To find participating providers
Visit www.vsp.com.
Exclusive Member Extras
Receive access to more than $2,500 in savings with VSP Exclusive Member Extras. Download flyer.
VSP Individual Vision Plan
If you’re retiring or not eligible for vision benefits through work, we can help. Enroll directly in a VSP Individual Vision Plan for as low as $17 a month. Download flyer.
Life Insurance and AD&D Benefit
Life Insurance and AD&D Benefit
Life insurance benefit
Participant – $25,000
Spouse and Dependent Child – $2,000
Accidental death & dismemberment
In addition to the amount payable for life insurance, for the participant only an additional benefit of $25,000 is available if the death or a dismemberment is caused by an accident.
See the Retiree Rules for life insurance benefits for retirees.
Vacation Benefit
Vacation Benefit
If you are working for an Employer covered by a Collective Bargaining Agreement or Written Agreement that requires contributions for Vacation Benefits, then you are eligible for Vacation Benefits. Vacation Benefits are payable so long as the Welfare Trust holds Vacation Plan funds contributed on your behalf.
Amount of benefit
The amount you will receive is exactly equal to the amount that your Employer contributes to the Welfare Trust for you. Please note that before depositing Vacation Plan funds with the Welfare Trust; your Employer must pay your employment and income withholding taxes. Only those amounts actually contributed to the Welfare Trust by your Employer and credited to you are included in the benefits paid each quarter. Any investment earnings will be used to pay for administrative expenses involved in maintaining the Plan.
When benefits are paid
Benefits are automatically sent to your address on file with the Plan, as of the beginning of each quarter, February 1, May 1, August 1, and November 1. There may be a delay of up to 10 business days from the time the Welfare Trust receives a contribution to when it credits the contribution to you.
Eligibility, enrollment, claims or any other questions?
Call the Welfare Trust Office at (907) 751-9700 or (800) 478-4450.