Medical Benefits > How The Low Option Plan Works
How The Low Option Plan Works
(For COBRA Participants and Extended Coverage Participants Only)
Establishing
Shot... |
Only COBRA participants and Extended Coverage Program
participants are eligible to enroll in the L ow Option Plan. These participants
also have the option of enrolling in any other plan available to them
based on where they live.
The Low Option Plan is a preferred provider organization
(PPO) plan - that is, a network - based medical plan that gives you a
choice when it comes to getting health care. This is how it works. The
network organization, which varies by location, contracts with physicians,
hospitals and other health care providers to provide services at contracted
rates.
(See the Summary Of Benefits for
network information.) Neither you nor the Fund is required to pay
any amount over the contracted rate.
|
Each time you need medical care, you have the option of seeing:
- Any network provider and paying a smaller percentage of the contracted
rate. This means less money out of your pocket; or
- Any non-network provider and paying a percentage of the R&C charge,
plus any amount over the R&C limit. This means your out-of-pocket costs
will be higher.
The Low Option Plan covers a range of medical services, including hospital
treatment. But to keep costs down, the benefits aren't as comprehensive as those
offered by the Fund's other medical plans. The Low Option Plan doesn't include
benefits for wellness, vision, prescription drugs, dental care, life insurance
or accidental death and dismemberment (AD&D) insurance, and it covers network
services at a lower benefit level.
Sub-Topics:
Getting The Most From Your Plan
Close Up: Bobby And Max
Looking At Eligible And Ineligible Expenses
Filing A Claim
Knowing What To Do If Benefits Are Denied
Understanding Coordination Of Benefits (COB)
|
