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OPERATING ENGINEERS
TRUST FUNDS

Full Health Plan Options

The Fund offers four full health plans:

  • Operating Engineers PPO Plan: This Plan is the same plan offered to Active and non-Medicare Retirees.
  • UnitedHealthcare Group Medicare Advantage PPO: This plan allows you to use any provider that accepts Medicare. This means there is no in and out of network differences. All benefits are the same no matter what provider you use.
  • Kaiser Permanente Senior Advantage Plan: This plan requires that you use Kaiser providers. This Plan is only available to Participants in Kaiser services areas in California.
  • Health Plan of Nevada HMO: This plan requires that you use providers in the HMO. This Plan is only available to Participants who reside in Nevada.

Both Medicare Advantage plans, UnitedHealthcare Group Medicare Advantage PPO and Kaiser Permanente Senior Advantage Plan, include coverage for medical, hospital, prescription drug and vision benefits. They include all of the benefits of Medicare as well as some additional benefits and lower out-of-pocket expenses than traditional Medicare. All of your benefits are provided by the plan you choose, so there is no need for coordinating benefits between Medicare and your Operating Engineers coverage.

Note: You must be enrolled in Medicare Parts A and B and pay your Part B premium.

Dental benefits are provided by the Fund, as outlined in Dental Benefits.

Retiree Death Benefits provided by the Fund, are outlined in Retiree Death Benefits.

Coverage for Dependents

Operating Engineers PPO Plan: If you elect this Plan, your dependents will automatically be covered by this Plan.

UnitedHealthcare Group Medicare Advantage PPO: If you elect this Plan, your dependents age 65 or older will automatically be covered by this Plan. Your dependents under age 65 will be covered by the Operating Engineers self-funded PPO as outlined in PPO Plan Benefits.

Kaiser Senior Advantage Plan: If you elect this Plan, your dependents must also be enrolled in a Kaiser Plan.

Health Plan of Nevada HMO: If you elect this Plan, your dependents must also be enrolled in a Health Plan of Nevada Plan.

Coverage for Full Health Plan Options

Coverage for Full Health Care Plans
Item Kaiser Senior Advantage HMO Plan

UnitedHealthcare
Medicare Advantage PPO Plan

(The following benefits are effective July 1, 2017)

Operating Engineers
PPO Plan
Deductible
None
None
None
Annual Out-of-Pocket Maximum $1,500 per individual/
$3,000 per family
None
$6,000 per individual/
$12,000 per family per calendar year

 

Coverage for Full Health Plans (Professional Services)
Professional Services Kaiser Senior Advantage HMO Plan

UnitedHealthcare Medicare Advantage PPO Plan

(The following benefits are effective July 1, 2017)

Operating Engineers PPO Plan
Office Visits $5 co-pay per visit
No charge
Generally not to exceed $15 co-pay per visit
Routine Physical No charge: 1 per calendar
year
No charge for Medicare covered services No charge;
Plan pays difference between Medicare allowance and their paid amount
Lab and X-ray No charge
No charge
No charge;
Plan pays difference between Medicare allowance and their paid amount
Therapy (Physical, Occupational, and Speech) $5 co-pay per visit
No charge
No charge;
Plan pays difference between Medicare allowance and their paid amount
Chiropractic $5 co-pay per visit for manual manipulation of spine No charge for manual manipulation of spine;
No charge for up to 26 visits per year for routine chiropractic care
No charge for up to 26 visits per year;
Plan pays difference between Medicare allowance and their paid amount
Outpatient Surgery $5 co-pay per visit
No charge
No charge;
Plan pays difference between Medicare’s allowance and their paid amount
Inpatient Hospital No charge
No charge
No charge;
Plan pays the Medicare Inpatient Deductible

 

Coverage for Full Health Plans (Other Services)
Other Services Kaiser Senior Advantage HMO Plan

UnitedHealthcare Medicare Advantage PPO Plan

(The following benefits are effective July 1, 2017)

Operating Engineers PPO Plan
Ambulance No charge
No charge
No charge;
Plan pays difference between Medicare allowance and their paid amount
Emergency Care $20 co-pay per episode
No charge
No charge;
Plan pays difference between Medicare allowance and their paid amount
Urgent Care $5 co-pay per visit
No charge
No charge;
Plan pays difference between Medicare allowance and their paid amount
Durable Medical Equipment No charge, including diabetic testing supplies
No charge
No charge;
Plan pays difference between Medicare allowance and their paid amount
Skilled Nursing Facility No charge up to 100 days No charge up to 100 days No charge up to 60 days
Hearing Benefits $5 co-pay per exam No charge for one routine hearing exam, every 12 months;
Plan pays up to $1,000 for one hearing aid per ear every 3 years
Plan pays $1,000 for one hearing aid per ear, every 3 years
Mental Health No charge for inpatient;
$5 co-pay per visit for individual outpatient evaluation and treatment;
$2 co-pay per visit for group outpatient treatment

No charge (subject to 190 day inpatient stay lifetime maximum);

No charge for outpatient treatment

No charge;
Plan pays difference between Medicare allowance and their paid amount
Chemical Dependency No charge for inpatient detoxification;
$5 co-pay per visit for outpatient evaluation and treatment
No charge
No charge;
Plan pays difference between Medicare allowance and their paid amount
Prescription Drugs $5 per prescription (walk in or mail order up to a 100-day supply

Walk-in Pharmacy (30-day supply):

  • $5 – Generic drug;
  • $15 – Preferred brand drug;
  • $30 – Non-preferred brand drug;

Mail Order (90-day supply):

  • $10 – Generic drug;
  • $30 – Preferred brand drug;
  • $80 – Non-preferred brand drug;

Walk-in Pharmacy (30-day supply):

  • $10 – Generic drug;
  • $25 – Preferred brand drug;
  • $40 – Non-preferred brand drug;

Mail Order (90-day supply):

  • $25 – Generic drug;
  • $62.50 – Preferred brand drug;
  • $100 – Non-preferred brand drug;

 

Coverage for Full Health Plans (Vision Benefits)
Vision Benefits Kaiser Senior
Advantage HMO Plan

UnitedHealthcare Medicare Advantage PPO Plan

(The following benefits are effective July 1, 2017)

Operating Engineers PPO Plan
Routine eye exams $5 co-pay No charge: One exam every 12 months $15 co-pay: One exam every 12 months
Eyewear Up to $150 allowance every two years Up to $130 eyewear allowance every two years;
Up to $175 contact lens allowance in lieu of eyewear every two years
$25 co-pay: Lenses, frames, or contacts, once every 24 months

 

Additional Benefits Under UnitedHealthcare Medicare Advantage PPO

  • Nurseline: You may call the Nurseline 24 hours a day, 7 days a week to speak to a registered nurse about your medical concerns and questions. There is no charge for this service. The Nurseline phone number is on your UnitedHealthcare identification card.
  • Fitness Program: The SilverSneakers fitness program provides free membership at network fitness centers. If you live more than 15 miles from a network fitness center, you are entitled to the SilverSneakers Steps at Home program which provides general fitness, strength,
    walking or yoga in your home at no charge.
  • Routine Foot Care: The Plan provides up to 6 visits per year for routine foot care. You pay $30 for each visit.
  • Pharmacy Saver: Hundreds of prescription drugs can be obtained with co-pays as little as $1.50 when obtained from many of the national and regional pharmacy chains.

Revised 09/2019

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