Teamsters Local 1932

Health & Welfare Trust

Open Enrollment

2020 - 2021

Find a doctor close to work or home

Our HMO network

40,000+ physicians

900+ facilities

Trio HMO

16,000+ physicians

800+ facilities

Our PPO network

61,000+ physicians

900+ facilities

BlueCard® network

95% of U.S. physicians

96% of U.S. hospitals

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“There are some big differences between products and plans.Which one’s right for me?”

Trio HMO or Access+ HMO?

A good choice if you’d like…

POS

A select, integrated provider network

that provides you with more coordinated

care. You get all the benefits of our

standard HMO plus these high-value

extras:

• Heal at-home doctor visits; first visit $0

• The Healthy Saving® program. You’ll get discounts on fruits, vegetables, and other healthy foods.

• Meal delivery program and non-emergency medical transportation for qualified patients recovering from serious illness.

A broader HMO network thatoffers more choice of doctors.

• Choose your own doctor, self-refer to specialists in the same medical group as your primary care doctor

• NurseHelp 24/7 and LifeReferrals 24/7 telephone support

• Teladoc 24/7 phone/video doctor visits

• Digitally-enabled wellness programs

• Covered urgent and emergency care while traveling

.

Access+ HMO® Trio HMO

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Access+ and Trio Specialist Program

• Access+ HMO and Trio members can see a specialist without a

referral.

• Members can self-refer to a specialist in the same medical group

as their primary care physician (PCP).

• Self-referral is for initial consultation only. Any follow-up care or

treatment requires PCP and Medical Group authorization.

Check your card!Your Blue Shield HMO or Trio member ID card will have an “A+” next to your personal physician’s medical group or Independent Physicians Association if the group offers the Access+ or Trio+ Specialist option.Please note: This self referral program is not available on HMO Platinum POS plan.

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HMO Gold Trio plan ($20 copay) – HMO Gold Access+ plan ($40 copay)

HMO Gold Trio (Facility Coinsurance 20-40%) HMO Gold (Access+ Facility Coinsurance 40-40%)

Calendar-year

copayment maximum

$3,500 per individual

$7,000 per family

Calendar-year

copayment maximum

$3,500 per individual

$7,000 per family

Office Copay

Self Referral Program

$20/visit

$20/visit

Office Copay

Self Referral

$40/visit

$50/visit

Preventive care No Charge Preventive care No Charge

Inpatient hospital $100 per admission plus 20% Inpatient hospital $100 per admission plus 20%

Outpatient services 40% Outpatient services 40%

Ambulance services No charge Ambulance services No charge

Emergency services

No direct admission

Direct admission

$50/visit

$100 per admission plus 20%

Emergency services

No direct admission

Direct admission

$50/visit

$100 per admission plus 20%

Teladoc $0 Teladoc $0

Retail drug copayments $5/$10/$25 Retail drug copayments $5/$10/$25

This chart is intended to provide a high level summary of plan benefits. The Evidence of Coverage

and Plan Contract should be consulted for a complete description of plan benefits and coverage. 6

HMO Platinum POS plan

Level 1 HMO Level 2 PPO

Annual deductible $0/$0 $0/$0

Calendar-year

copayment maximum

$1,500 per individual

$3,000 per family

$8,000

$16,000

Office visits

Preventive

$10/visit

No Charge

$30/visit

$30/visit

Inpatient hospital No Charge Not Covered

Outpatient services No Charge Not Covered

Ambulance services No Charge No Charge

Emergency services

No direct admission

Direct admission

$50

No Charge

$50

No Charge

Pharmacy deductible $0 $0

Teladoc $0 Not Covered

Retail drug copayments $5/$10/$25 $5/$10/$25

This chart is intended to provide a high level summary of plan benefits. The Evidence of Coverage and

Plan Contract should be consulted for a complete description of plan benefits and coverage. 7

PPO plan

Preferred providers Non-preferred providers

Annual deductible $250/$500 $250/$500

Calendar-year

copayment maximum

$1,750 per individual

$3,000 per family

$2,250 per individual

$4,500 per family

Office visits $10/visit 30%*

Inpatient hospital 20%* 30%*

Outpatient services 20%* 30%*

Ambulance services 20% 20%

Emergency services

No direct admission

Direct admission

$50/visit plus 20%

20%*

$50/visit plus 20%

20%*

Teladoc $0 Not Covered

Retail drug copayments $15/$30/$30 $15/$30/$30

Chiropractic/acupuncture

services (12 visits per year) 20%*/visit (ASH providers only) 30%*

* Deductible Applies. This chart is intended to provide a high level summary of plan benefits. The

Evidence of Coverage and Plan Contract should be consulted for a complete description of plan

benefits and coverage. 8

PPO Needles plan

Preferred providers Non-preferred providers

Annual deductible $0 $250/$750

Calendar-year

copayment maximum

$1,500 per individual

$3,000 per family

$2,250 per individual

$4,750 per family

Office Copay

Preventive

$10/visit

No Charge

30%*

Not Covered

Inpatient hospital No charge 30%*

Outpatient services No Charge $30%*

Ambulance services No charge No Charge

Emergency services

No direct admission

Direct admission

$50/visit

No charge

$50/visit

30%*

Teladoc $0 Not Covered

Retail drug copayments $10/$15/$15$10/$15/$15 plus 25% of

purchase price

Chiropractic/acupuncture

services (30 visits per year)

$10/visit (ASH providers

only)30%*

* Deductible Applies. Must be validated by benefit administrators to participate in this specific plan. This chart is intended to provide a

high level summary of plan benefits. The Evidence of Coverage and Plan Contract should be consulted for a complete description of plan

benefits and coverage. 9

Shield Concierge for all members“High-touch” service and support

Available Monday thru Friday 7am to

of member care activity and service

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Need additional information?

• Contact your dedicated Shield Concierge team

at (855) 599-2657 to get answers to your questions

about health plans, doctors, and more.

• Book a one-on-one consultation with an expert

Blue Shield representative – best for complex or

personal health coverage questions.

• Visit blueshieldca.com/teamsters1932 for more

information.

Access to care - consumers in control

LifeReferrals 24/7

Experienced professionals ready to assist with personal, family,

and work issues, around the clock

NurseHelp 24/7SM

Confidential, secure phone access to an RN, day or night

Telebehavioral health

(in CA only)

Online access to therapistsand psychiatrists, provided by

Blue Shield’s mental health service administrator (MHSA).

WellvolutionProvides access to guided, digital

programs for improving sleep, managing stress, supporting

weight-loss and exercise, quitting smoking, and preventing disease.

Telephonic/video doctor visits

24/7/365 on-demand (phone/video) access to a board-certified, state-licensed, physician

blueshieldca.com / mobile app

Benefit information, key decision-support tools like Find a Doctor and Treatment Cost Estimator and much more

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Easy-to-use, on-the-go options for managing family health*

Doctors on callPPO and Trio members can have a doctor come to them for a low copay, appointments via phone web or mobile. ($0 for first visit for Trio plans)

* See all your care options in one place at blueshieldca.com/teamsters1932

Blue Shield’s mental health service administrator (MHSA)

Additional programs and services available through Blue Shield’s MHSA:

• Behavioral Health Utilization Management Program – Applies clinical expertise and supports optimal use of behavioral health services for the evaluation and treatment of mental health conditions and substance use disorders.

• Complex Case Management Program – Optimizes the physical, social, and mental functioning of our members through advocacy, communication and resource management.

• Behavioral Health Condition Management– Designed to help members overcome depression so they can more effectively manage their chronic medical conditions(s) and lead a better quality of life.

• Life Referrals 24/7 – Offers confidential assistance on a range of topics to assist with life’s challenges.

• Autism Connections® - A benefits management program managed by Blue Shield’s MHSA that offers help to Blue Shield members and their families to meet the challenges of Autism Spectrum Disorder (ASD).

• Telebehavioral Health (in CA only) – A means of delivering outpatient mental health and substance use disorder services via online video therapy sessions on a secure web-based platform.

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Inpatient and outpatient mental health and substance

abuse services

Contact Teladoc

“I feel like I have the flu, but I don’t want to wait in the ER on a Friday night.”

Log in to your Teladoc account or call Teladoc, anywhere, anytime, to request a phone or online video consultation for primary care services.

Step 1

Contact Teladoc

Step 2

Talk with a doctor

Step 3

Resolve the issue

Step 4

Settle up

Step 5

Smile<10 MinutesAverageWait Time

A board-certified doctor reviews your Electronic Health Record (EHR) and consults with you, just like an in-person visit.

The doctor recommends a treatment for your medical issue. If a prescription is needed, it’s sent electronically to the pharmacy of your choice.

Your medical issue gets resolved, and you save time and money!

• $0 for Trio and PPO plans.

• $45 consultation fee for Bronze Plan until deductible is met, then $5 copay.

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Imagine this:

blueshieldca.comA simpler digital experience for you

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Redesigned, rebuilt app for easy use

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Generic drugs are effectiveand save you money

A generic drug…

• Is therapeutically equivalent to its brand drug

• Contains the same active ingredient as its brand drug

• Is generally more cost-effective

Go to Learn about your pharmacy benefits section of

blueshieldca.com/teamsters1932 to find our drug formulary and

learn about prescriptions by mail. Our Blue Shield Plus Drug Formulary

is a list of our preferred brand-name and generic drugs.

Average price of a brand drug:

$412

Average price of a generic drug:

$20

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Online and in-person programs for both general wellbeing and disease reversal

Proven and backed by doctors’ methods for results

Largest collection of scientifically-backed apps

A personal digital health coach, taking guesswork out of your health strategy

A new way to achieve your health goals

Included with your health plan at no additional cost

Take charge of your

health with Wellvolution

Wellness discount programs

Alternative Care Discount Program

Relax and save up to 25% savings on acupuncture,

chiropractic, and therapeutic massage services from

practitioners participating in the ChooseHealthy program.

The program also offers:

• Access to online health classes and articles at no additional cost to you

To find a participating provider, visit

blueshieldca.com/wellnessdiscounts or call Alternative Care

Discounts at (888) 999-9452.

Fitness and exercise

Our gym membership program, Fitness Your WayTM , offers

extremely low rates to Blue Shield members age 18 and older.

• Work out at any facility within a wide network of more than

800 locations in California and 10,000+ locations nationwide.

• Meet your lifestyle needs by working out anytime, anywhere,

and as often as you need while tracking progress of your goals

online.

To enroll, visit fitnessyourway.tivityhealth.com/bsc or call (833)

283-8387. To find locations, visit

fitnessyourway.tivityhealth.com/locations.

Vision discounts

Discount provider network

Save 20% on:

• Routine eye exams

• Frames, lenses, tints & coatings

• Extra pair of glasses

• Hard contact lenses

Access participating providers at blueshieldca.com/fad.

MESVision Optics

Competitive prices on many contact lens brands as well as a

selection of sunglasses, reading glasses and eye care

accessories.

Learn more at MESVisionOptics.com.

Nvision Laser Eye Center

Save 15% on LASIK procedures.

To learn more, call NVISION at (877) 91 NVISION, or visit

NVISIONcenters.com to find a provider.

QualSight LASIKSave on LASIK surgery at more than 45 surgery centers in

California.

To find out if you are a potential candidate, call (877) 437-6110

or visit qualsight.com/-lasikca.

BlueCard® Network

Traveling, or residing outside of California? The BlueCard Program gives you access to covered services when you’re away from home. Over 90% of U.S. providers are in BlueCard’s national network, and providers in 170 countries are in the Blue Shield Global Core Network.

To find a BlueCard national provider:

• Go to blueshieldca.com/fad and select the Providers Outside of CA link.

• Or, call BlueCard Access at (800) 810-BLUE

(2583), seven days a week, 24 hours a day.

To find an international provider:

• Go to blueshieldca.com/fad and select the Coverage outside of the US link to be

connected to Blue Shield Global Core.

• Or, call the Global Core Service Center at

(800) 810-BLUE (2583) from the U.S. or 1 (804)

673-1177 collect from outside the U.S.

Coverage outside of California:

BlueCard® Network

Blue Shield Global Core Network

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Registering on blueshieldca.com is easy

• Have your member ID number and email address handy.

• Create a username and password, select security Qs and As.

• After you register, you will be taken to your personalized dashboard every time you log in.

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Search the directory of providers at

Blueshieldca.com/teamsters1932

Finding a doctor

You can search for a participating physician by:

• Gender

• Specialty

• Language preference

• Location

Create and download

your own custom directory.

• Be sure to select your

specific plan choice

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Our mission is to ensure all Californians have access to high-quality health care at an affordable price.

blueshieldca.com/teamsters1932