Benefits at a Glance


The Explanation of an EOB

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Benefits at a Glance

Quick Summary Of Your PIBF Health Plan Benefits – This is not intended to be a complete explanation of benefits available; nor does it include all plan limitations and/or exclusions.  This is a brief description of general benefit information.  For complete benefits and limitations/exclusions, please refer to the PIBF Summary Plan Description.

Medical Plan Deductible – The deductible is the portion you must pay on healthcare expense before the PIBF begins to allow payments.  Once the $500 individual deductible; or $1,000 family maximum family deductible is met, PIBF will then allow payment as stated in the SPD (Summary Plan Description).  Plan deductibles start over every January 1st.  A combination of family members can meet the $1,000 family maximum deductible; however, $500 is the maximum amount any one family member can count toward meeting the family deductible. Your PIBF plan does not have a co-pay.   The patient portion is deductible and co-insurance.

Out of Pocket – Out of pocket is the co-insurance amount you are required to pay (20% of in network or 30% on out of network) on covered medical plan expenses processed by the Pipeline Industry Benefit Fund.  Deductible, non-covered expense and amounts exceeding the payable amount on stand-alone benefits are not included in the accumulated out of pocket total.  Once an individual has met the $5,000 in network or $7,500 out of network out of pocket limit during a calendar year, covered medical expense, for the individual, is paid at 100%.

Member Only Benefits

  • Death/Accidental Death Benefit – $10,000/$20,000 (Active only)
  • Dismemberment & Loss of Sight Benefits – $5,000/$10,000 (Active only)
  • Weekly Disability Benefit – $250 weekly, up to 26 weeks (Active only)
  • Hearing Aid Benefit – $1,000 toward the cost of hearing aid(s) (Active only)
  • Prescription Welding Hood Lens Insert – $75 every calendar year (Active, COBRA)
  • Laser/Lasik Surgery – $1,000 toward the cost of vision correction surgery (Active, COBRA)
  • Physical Exam Benefit – $200 payable every calendar year (Active, COBRA, Retiree)
  • Health Reimbursement Arrangement/HRA – Reimbursement to the member for a portion of your out-of-pocket healthcare expenses (Active, COBRA, Retiree)

Active, COBRA Plan Deductibles & Coverage for Members & Qualified Dependents

  • The PIBF Medical plan has a $500 individual deductible or a $1,000 family maximum deductible every calendar year.  After deductible, PIBF will pay 80% on in-network expense, or 70% on out-of-network expense up to the individual out of pocket maximum of $5,000 on in network expense and $7,500 on out of network expense.  Once the out of pocket has been met during a calendar year, PIBF will then pay charges at 100% for the remainder of that calendar year.
  • The PIBF Dental plan will pay 100% of reasonable expense for a cleaning and exam every six (6) months.  All other dental service is subject to a $100 individual deductible every calendar year.  After deductible, PIBF will pay 80% on in-network expense, or 70% on out-of-network expense up to $1,000 annually per person (no yearly maximum for children 18 and under).
  • The PIBF Vision plan does not have a yearly deductible.  The PIBF will pay $200 per person toward the cost of a vision exam, refraction or the purchase of prescription eyeglasses or contact lenses.  This benefit is available every calendar year (no yearly maximum for children 18 and under).
  • The PIBF pharmacy plan is administered by CVS Caremark and has a $100 individual deductible or a $200 family maximum deductible every calendar year.  After deductible, PIBF will pay 70% on prescriptions purchased at the counter and 80% on prescriptions purchased through the mail service.
  • The pharmacy plan deductible is separate from the PIBF medical plan.  Pharmacy plan co-insurance does not accumulate toward the PIBF medical plan out of pocket maximum.

 

Retiree and Retiree with Medicare Plan Deductibles and Coverage

  • The Retiree Medical plan has a $500 “Inpatient” individual deductible or a $1,000 family maximum deductible every calendar year.  After deductible, PIBF will pay 80% on in-network expense, or 70% on out-of-network expense up to the individual out of pocket maximum of $5,000 on in network expense and $7,500 on out of network expense.  Once the out of pocket has been met during a calendar year, PIBF will then pay charges at 100% for the remainder of that calendar year.
  • The Retiree with Medicare plan does not have a yearly deductible on any out-patient or office services (the portion of your charges considered under Part B of Medicare).  The PIBF will pay 80% of the Medicare co-insurance or Medicare Part B deductible.  The out of pocket maximum on the Retiree with Medicare plan is $5,000 per person.  Once you have met the out of pocket limit, coverage will be at 100% for the remainder of that calendar year.
  • The Retiree with Medicare plan has a $500 individual deductible every calendar year on in-patient service (when you are admitted to a hospital; the portion of your charges considered under Part A of Medicare).  After deductible, PIBF will pay 80% of the Medicare co-insurance or Medicare Part A deductible.
  • The Retiree and Retiree with Medicare Pharmacy plan deductible is $250 per person, or a $500 family maximum every calendar year and is administered by CVS Caremark.  After deductible, PIBF will pay 70% on prescriptions purchased at the counter and 80% on prescriptions purchased through the mail service.  The pharmacy plan deductible is separate from the PIBF medical plan.  Pharmacy plan co-insurance does not accumulate toward the PIBF medical plan out of pocket maximum.

 

PIBF Coverage on Stand-Alone Benefits.  Available to members and qualified dependents under all plans (Active, COBRA, Retiree, Retiree w/Medicare).  NOTE: The yearly deductible does not apply to these benefits.  The excess or non-covered portion does not apply to the patient’s out-of-pocket limit.

  • Chiropractic Benefit – PIBF will pay $25 per visit, up to a maximum of $500 per person; per calendar year.  In addition, PIBF will pay $100 per person; per calendar year for cervical or spinal X-Rays performed by a Chiropractic physician.
  • Non-Surgery Related Physical/Occupational Therapy, Biofeedback or Pulmonary Rehab Benefit – PIBF will pay $25 per visit.
  • Sterilization Benefit – This benefit is available for the PIBF member or spouse only.  PIBF will pay $500 for all expense related to a Vasectomy or $1500 for all expense related to a Tubal Ligation.  If a Tubal Ligation is performed at the same time as another surgery or during an inpatient confinement, the benefit will be limited to $500.