Health & Welfare

CONTACT INFORMATION:

Local 234 Health & Welfare Fund
4880 Hubbell Avenue, Suite 1
Des Moines, IA 50317
Toll-Free 844-568-6335 – at beginning of recording press extension 5600 or 5601

 

The Operating Engineers Local 234 Health & Welfare Fund provides coverage for eligible active participants, their spouses, and dependent children. This Plan also provides coverage for Retirees and their spouses.

Eligibility Rules for Actives
To be eligible for benefits under the Plan, you must satisfy the eligibility rules and your EMPLOYER must make contributions to the Fund on your behalf.

Eligibility – Presently Eligible Participants
If you are presently eligible, you will remain eligible until you fail to meet the requirements stated in the “Continued Eligibility” section below.

Initial Eligibility – New Participants
If you accumulate 500 hours of COVERED WORK within a consecutive 12-month period, you will become eligible on the first day of the first calendar month following the month that your 500 hours of COVERED WORK are reported.

For example: You work your 500th hour on May 18th. Your EMPLOYER is required to report your hours and pay the contributions by June 10th. You will be eligible for benefits on July 1st.

Continued Eligibility
Once you have met the initial eligibility requirements, you will be eligible for benefits for the rest of the benefit quarter in which you attained initial eligibility AND for the next full benefit quarter. To continue eligibility in future benefit quarters, you must have at least 300 hours paid on your behalf by CONTRIBUTING EMPLOYERS during each contribution quarter or 1200 hours over the corresponding twelve month period. Both of these schedules are as follows:

AT LEAST 300 CONTRIBUTION HOURS DURING . . .
Contribution Quarter

(for work performed during)

Benefit Quarter

(provides eligibility for)

May, June, July October, November, December
August, September, October January, February, March
November, December, January April, May, June
February, March, April July, August, September

** OR **

At Least 1200 Contribution Hours During The . . .
12 Month Contribution Period

(for work performed during)

Benefits Quarter

(provides eligibility for)

May 1 through April 30 October, November, December
August 1 through July 31 January, February, March
November 1 through October 31 April, May, June
February 1 through January 31 July, August, September
More Specifically
November 1, 2015 – October 31, 2016 April – June 2017
February 1, 2016 – January 31, 2017 July – September 2017
May 1, 2016 – April 30, 2017 October – December 2017
August 1, 2016 – July 31, 2017 January – March 2018
November 1, 2016 – October 31, 2017 April – June 2018
February 1, 2017 – January 31, 2018 July – September 2018
May 1, 2017 – April 30, 2018 October – December 2018
August 1, 2017 – July 31, 2018 January – March 2019
November 1, 2017 – October 31, 2018 April – June 2019
February 1, 2018 – January 31, 2019 July – September 2019
May 1, 2018 – April 30, 2019 October – December 2019

 

Coverages

The Plan covers the following for Active participants, spouses and children:

  • Medical including Mental Health and Substance Abuse
  • Dental and Orthodontia
  • Prescriptino Drug – Retail and Mail Order
  • Routine Vision
  • Short Term Disability – Participant only
  • Death Benefit – Participant, Spouse, Children

The Plan covers the following for Retired participants and spouse:

  • Medical including Mental Health and Substance Abuse
  • Dental and Orthodontia
  • Prescription Drug – Retail and Mail Order
  • Routine Vision
  • Death Benefit – Participant only

Medical Coverages:

(Active participants are covered by Wellmark Alliance Select PPO.  Retiree participants must contact the Health & Welfare Fund office PRIOR to retirement for information relating to insurance coverage options.)

  • In-Patient: 80/20 after calendar year deductible for in Network (PPO)
  • In-Patient: 60/40 after calendar year deductible for out of Network (Non-PPO)
  • Emergency Room: $100 co-pay each visit; 80/20 for in Network
  • Emergency Room: $100 co-pay each visit; 60/40 for out of Network
  • Out-Patient Facility: 80/20 after $100 calendar year deductible for in Network
  • Out-Patient Facility: 60/40 after $200 calendar year deductibble for out of Network

Deductibles – Calendar year deductible is $100 OR $200 family for in Network; $200 individual OR $400 family for out of Network.
Out-of-Pocket – Calendar yearmaximum out-of-pocket is $2,500 per person; out-of-pocket includes deductible and coinsurance amounts; it does not include the co-pays.

Pre-Existing – There is no pre-existing condition clauses.

  • Office visit:
In Network – $20 office co-pay plus 80/20 for office services (labs, injections, xrays, etc)

Out of Network – $200/$400 calendar year deductible then 60/40

  • Well Child Benefits:
Birth to age 7

In Network Paid in full

Out of Network 40% coinsurance; deductible waived

  • Routine Physicals (see below for Health Dynamics Physical info):
In Network Paid in full every calendar year

Out of Network – $200 deductible; 60/40; every calendar year

  • Immunizations:
In Network paid at 100%

Out of Network – $200/$400 deductible, then paid at 60/40

Immunizations received at pharmacy paid at 70/30 (travel immunizations are not covered)

  • Mental Health/Substance Abuse:
Inpatient/Outpatient: In Network 80/20; Out of Network 60/40

Office: In Network 100%; Out of Network 60/40

 

Health Dynamics Physicals:
All eligible participants and spouses are encouraged to use this benefit on a yearly basis. 100% covered. Must be completed by only certain providers.Please select the location most convenient for you and call the corresponding number to schedule and appointment (more sites to be added soon):

Ankeny, IA
Medix Occupational Health
1824 SW White Birch Circle
515-964-9003

Waterloo, IA
Northeast Iowa Family Practice Center – Medical Art Center
2055 Kimball Ave, Suite 101
319-272-2112 Opt. 1

South Sioux City, NE
Tri-State Physicians & PT Clinic
3900 Dakota Avenue
402-494-5173

Rochester, MN
Rochester Clinic
3070 Wellner Dr NE
507-218-3095

Sioux Falls, SD
Sanford Occupational Medicine
900 E. 54th St. N., Suite 200
605-328-9300

Dental Coverage:
80/20 per person up to a calendar year, maximum payment of $1240

Orthodontia Benefits:
80/20 per person up to a lifetime payment of $2,000

Prescription Drug Benefit:
Retail: 20%/30%/40%

Mail Order: $10/$25/$50 for each co-pay with a maximum of 2 co-pays

Routine Vision Benefit:
Adults – $400 every 24 months, Children – $150 every 12 months – Based on date of service

Short Term Disability:
Active participants only. $200 per week, up to 13 weeks for illness or injury, non-work related; $200 per week, up to 4 weeks for work-related injury.

Death Benefit:

Active Participant – $7,500
Active Spouse – $1,000
Active Child – $ 500
Retired Participant $2,000

Accidental Death:
Active Participant – $2,000

Chiropractic Care:
In Network 80/20; Out of Network 60/40

CONTACT INFORMATION:

Local 234 Health & Welfare Fund
4880 Hubbell Avenue, Suite 1
Des Moines, IA 50317
Toll-Free 844-568-6335

NOTICE: If a discrepancy should arise between what is stated here and the Plan Document for the Local 234 Health & Welfare Fund, the Plan Document shall prevail in each and every circumstance.