Health

You have medical coverage through Anthem Blue Cross Blue Shield. Your medical plan is a Preferred Provider Organization (PPO) plan, which gives you the freedom to visit any provider without a referral. However, you pay less when you visit providers in the Anthem PPO network.

The plan covers routine and medically necessary care, including annual checkups, preventive tests and screenings, telemedicine, doctor office visits, surgery, hospital care, and substance abuse treatment.

For most services, you pay coinsurance—a percentage of the cost of your care—after you’ve met your annual deductible. Once you reach the plan’s annual out-of-pocket maximum, the plan pays 100% of covered expenses.

Review your full medical plan details online via Anthem Blue Cross Blue Shield. Here’s how:

• Go to the Anthem website.
• Under What type of plan do you want to search with, select Medical (Employer-Sponsored).
• Under Select a plan/network:
• If you live in Connecticut, choose Anthem Choice Century Preferred PPO Basic.
• If you don’t live in Connecticut, choose National PPO (BlueCard PPO).

You also have access to a variety of care options, programs, and services through your plan.

Appropriate care for your needs

The plan covers telemedicine and doctor visits for minor medical issues. You can also visit urgent care for serious, but nonemergency, medical care. For life-threatening medical concerns, the plan covers emergency room care.

Telemedicine through LiveHealth Online

Sneezing? A rash on your arm? Stomachaches? These symptoms don’t feel good, but they’re not emergency situations. You and your covered family members can speak with a board-certified doctor, 24/7, from the comfort of your home.

Visit the LiveHealth Online website on your computer, tablet, or smartphone to schedule and attend your appointment, or access your appointment through Anthem’s Sydney app. You can also download the LiveHealth Online app via the App Store or Google Play.

Anthem’s NurseLine

Registered nurses are available 24/7 to discuss health issues by phone. They can answer your questions about prescriptions, symptoms, vaccinations, and more. This service is available to you at no cost.

Answers to your health questions with Sydney

Sydney is Anthem’s mobile app, and it’s a powerful tool. With Sydney, you can view your ID cards, check claims, find care near you, compare costs, and even sync up your fitness tracker. You have constant access to your health plan. Download Sydney on the App Store or Google Play.

The No Surprises Act took effect on January 1, 2022. This law protects you from balance billing if you get treated by an out-of-network provider at an in-network emergency room or hospital. Balance billing happens when the out-of-network provider charges you the difference between the total cost of your care and what your health plan agreed to pay.

In-network emergency rooms and hospitals often employ out-of-network doctors. If those doctors treat you, you might receive out-of-network care without realizing it. Also, you might not have time to choose between an in- or out-of-network provider in a medical emergency. The No Surprises Act is designed to ensure that you aren’t balance billed if you receive care under these circumstances that are beyond your control.

You should still use network providers whenever possible. Visit the Anthem Blue Cross Blue Shield website to find a list of network providers near you.

Federal regulations require health plans and insurance carriers to disclose pricing information for certain items and services. The required information includes negotiated rates with in-network providers, as well as provider charges and amounts previously paid to out-of-network providers. The regulations require the information to be updated monthly and contained in machine-readable files.

A machine-readable file is defined as a digital representation of data or information in a file that can be imported or read by a computer system for further processing without human intervention, while ensuring no semantic meaning is lost. These files are in the Centers for Medicare & Medicaid Services (CMS) defined format (JSON) and are not meant for a member-friendly search of rates, benefits, or cost sharing. Members should log in to anthem.com for this information.

If you believe that you’ve been wrongly billed, contact the Employee Benefits Security Administration (EBSA) at 866-444-3272 or the Centers for Medicare & Medicaid Services (CMS) at 800-985-3059. For more information, visit the CMS website.

There’s a convenient, affordable way to get help for injuries, muscle aches, and joint pain—and you don’t need to schedule an appointment or leave home to find it! Hinge Health is a digital care clinic that’s available at no cost to all members and dependents enrolled in a medical plan through the Fund.

Access the Hinge Health app at any time, wherever you are, from your mobile device. Once you sign up and answer a few questions, Hinge Health’s team of physical therapists, health coaches, and doctors will design a care plan that’s tailored to your needs.

• Prevention: job-specific exercises and education to help you avoid injuries
• Acute: physical therapy video visits to help you deal with recent injuries
• Chronic: exercise, education, and behavioral change to address high-risk conditions
• Surgery: pre- and post-surgery rehab and continuity of care

Sign up for Hinge Health on their website.

Between medications, insulin, dietary restrictions, and lifestyle management, it can be a challenge to manage diabetes. But you have a powerful digital tool that takes a clinical approach to helping you succeed: Virta Health.

Virta Health works with you to set—and keep—goals to manage your diabetes. You could reduce or eliminate the need for insulin, rely less on medication, and feel more energized. And doctors will be by your side every step of the way.

Virta Health is available at no cost to all members and dependents enrolled in a medical plan through the Fund. To learn more, or to sign up, visit the Virta Health website.

Your prescription drug coverage is administered by OptumRx.

For up to a 30-day supply of your prescription, you can visit any pharmacy in the OptumRx network. You can get up to a 90-day supply of prescription from Stop & Shop, select union pharmacies, and the OptumRx mail-order pharmacy.

Coverage for prescription drugs varies. Generic drugs are the most cost-effective option and just as effective as other drugs. Medications on the OptumRx formulary are preferred drugs and cost more than generic drugs. Brand-name drugs, the most expensive option, should only be used when generic and formulary alternatives are unavailable. Check the OptumRx formulary to see whether your prescriptions are covered as preferred drugs, or if prescriptions you take have generic alternatives.

Your dental coverage is administered by Delta Dental.

You can visit any dentist you’d like, but the plan covers more of the cost when you receive care from dentists in the Delta Dental network. Find a network dentist with Delta Dental’s network provider locator.

Preventive care like exams, X-rays, and teeth cleanings is covered at 100% when you visit a network dentist. For other covered services that you receive from a network provider, you pay a percentage of the cost after you meet the plan’s annual deductible. The plan pays an annual maximum amount per covered person.

For emergency dental care when your regular dentist isn’t available, use Delta Dental’s teledentistry service. You can access a certified dentist within minutes for an initial consultation and prescriptions. Teledentists will send notes from your consultation to your regular dentist. Get started on Delta Dental’s teledentistry website.

Your vision coverage is administered by EyeMed.

You can visit any licensed vision care provider you’d like, but the plan covers more of the cost when you receive care from providers in the EyeMed network. Find a network vision care provider with EyeMed’s network provider locator.

A routine eye exam is 100% covered every 12 months. Benefits for prescription eyeglass lenses are available every 12 months. You receive an allowance for frames every 24 months for adults and every 12 months for children.

The Fund covers up to $4,500 for your hearing exams, testing, and hearing aids once every three years through the University of Connecticut’s Speech and Hearing Clinic. Members enrolled in the medical plan can, instead, take advantage of coverage up to $700 once every three years through Anthem Blue Cross Blue Shield.

To schedule an appointment at the University of Connecticut clinic, contact them at 860-486-2629 or by email at speech&hearingclinic@uconn.edu.

UConn Speech and Hearing Clinic
2 Alethia Drive, U-1085
Storrs, CT 06269