HEALTH AND WELFARE OVERVIEW
The Midwest Operating Engineers Local 150 Health and Welfare Fund is designed to help members and their eligible dependents afford proper health care. The Fund also provides members with disability, life, and accident coverage.
Contributing employers pay the full cost of the Fund and make all contributions. Employee contributions are neither required nor allowed (except for self-payments and COBRA payments). Employer contributions are based on the rate(s) specified in applicable collective bargaining agreements.
Getting in the Plan
If you work under the jurisdiction of Operating Engineers Local 150 and your employer contributes to the Fund on your behalf, you are eligible for Plan benefits in a benefit quarter if you work at least 300 hours in the corresponding contribution quarter. For more information on eligibility (161K, PDF).
Adding or Deleting Dependents From Coverage
If you need to add a dependent (spouse or child), please complete the Dependent Enrollment Form (12K, PDF) and send or fax it to the Fund Office.
If your dependent no longer meets the definition of a dependent, for example if you divorce or your child reaches the limiting age, you have up to 60 days following the event to notify the Fund Office in writing of the status change. If you do not notify the Fund Office in 60 days, your dependent may not be eligible for COBRA continuation coverage.
Medical (for you and your eligible dependents)
You can visit any doctor or hospital. However, the Plan offers a Preferred Provider Organization (PPO) network of doctors and hospitals through BCBS. You can save money by using a network provider because network providers have agreed to charge negotiated rates. If you go to a network provider, the Plan pays a higher percentage of a lower amount than if you go to a non-network provider. If you use a non-network provider, the Plan pays a percentage of the reasonable and customary amount.
The Fund’s medical coverage can help you and your family get and stay well. For most medical benefits, here’s how the Plan’s medical benefits work:
- Each year, before the Plan pays anything for most covered expenses, you or your family pay the first dollars of allowable expenses. This is the calendar year deductible.
- After satisfying the deductible, you and the Plan share allowable expenses, this is known as copayment. The amount you pay varies depending on if you use an in-network or out-of-network provider.
- Once your payments toward the deductible and copayments for eligible medical charges reach the Plan’s annual out-of-pocket maximum, the Plan usually pays 100% of most allowable expenses for the rest of the calendar year. (Expenses not covered under the Plan do not apply toward the out-of-pocket maximum. In addition, some expenses are never paid at 100%.)
- The Plan pays benefits up to an annual maximum. In addition to the annual maximum, each eligible individual also has a nonrenewable Supplemental Lifetime Fund maximum. This is a lifetime amount for each eligible person that is available to supplement amounts that exceed the annual maximum benefit amount.
For more information on medical benefits, click here.
Dental (for you and your eligible dependents)
The Plan covers dental expenses. You can visit any dentist to help you and your family take care of your teeth. However, the Plan offers a Preferred Provider Organization (PPO) network of dentists through DentalGuard Preferred Select Network. You can save money by using a network dentist because network dentists have agreed to charge negotiated rates. If you go to a non-network dentist, the Plan pays benefits up to a scheduled amount. The Plan pays the scheduled amount for eligible dental expenses, up to $1,000 per person each calendar year (orthodontia has a different maximum). More details on dental benefits.
The Fund’s Dental Plan has a $1,000 calendar year maximum benefit and payment is based on a fee schedule, called the Maximum Allowable Charge Table, which sets maximum fees for services. Network dentists have agreed to accept the fee schedule as payment in full. Non-network dentists can charge you more than the fee maximum and you would have to pay the additional amount to the dentist since it is not covered under the Plan.
For example, for a crown the dentist’s fee is $825.
The network rate for a crown is $568 (from the fee schedule), which a network dentist would consider payment in full. The Fund would consider benefits at 70%, or $397.60 , which means your share would be $170.40 owed to your dentist.
However, when your dentist is not in the network, the Fund would only pay the $397.60 and you would owe your dentist $427.40 ($170.40 plus the difference between $825 and $568).
Family Supplemental Benefit
This benefit reimburses your family up to $1,500 each year for medically necessary medical, dental, and visions expenses that are not covered services by the Plan, not reimbursed, and would be deductible for tax purposes. This benefit does not reimburse expenses that have been applied toward deductibles, coinsurance, or out-of-pocket maximums. To submit a claim, complete the Family Supplemental Benefit Claim form (13K, PDF) and return it to the Fund Office.
For more information, go to the Family Supplemental Benefit page.
Disability (for active employees in Plan A only)
If you are an active employee covered under the Fund and are unable to work due to a nonoccupational illness or injury for more than eight consecutive days, you may receive up to $250 a week from the Plan. To submit a claim, complete the Member’s Disability Benefit Application form (24K, PDF) and return it to the Fund Office.
For more information, click here.
Death Benefit (for active employees in Plan A only)
If you are an active employee covered under the Fund, the Plan provides a death benefit to your beneficiary if you die or to you if one of your dependents dies. Be sure your beneficiary designation is up-to-date. To change your beneficiary, complete the Beneficiary Designation form (81K, PDF) and return it to the Fund Office. If you need to make a claim, call the Fund Office.
For more information, click here.
Accidental Dismemberment Benefit (for active employees in Plan A only)
If you are an active employee covered under the Fund, the Plan pays you $1,000 to $5,000 if you are seriously injured in an accident. The amount depends on the severity of the accidental loss. Call the Fund Office if you need to make a claim.
For more information, click here.
Retiree Health and Welfare Plan
To be eligible for the Retiree Health and Welfare Plan, you must:
1. Be eligible for Health and Welfare Plan coverage in the active plan on your retirement date;
2. Have at least 10 years of service in the Pension Plan; and
3. Have at least 40 quarters of eligibility in the active Health and Welfare Plan.
If you have a bank of hours to run out for active coverage on your retirement date, your retiree eligibility will begin when you no longer have sufficient hours for active coverage. When you become eligible for retiree coverage, you are no longer eligible for weekly disability, death, or accidental dismemberment benefits. You must pay a monthly premium for healthcare benefits.
Once you become eligible for Medicare, Medicare will become your primary coverage and Fund coverage will be secondary, which will reduce your monthly payment for the Retiree Health and Welfare Plan.
To help you save for healthcare expenses after retirement, the Fund provides The Retiree Medical Savings Plan.
Preexisting Condition Limitation
Payment for covered medical expenses and prescription drugs for a pre-existing condition will be limited to $15,000 until the eligible person has been covered under the Plan for 12 consecutive months. The 12-month period will be reduced by the length of the person’s creditable coverage. Benefits for pregnancy, newborn and adopted children are not subject to the preexisting condition limitation.
Protecting Your Privacy
The Midwest Operating Engineers Welfare Fund (the “Plan”) is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information. For more information about your privacy rights, click here.