PIBF





The office is currently closed   |   Thu July 29, 2010  09:58 PM

 
Home / H & W Benefits

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, Please Refer To The PIBF Summary Plan Description.

NOTE:

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

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 - $100 weekly, up to 26 weeks (Active only)
  • Hearing Aid Benefit - $1,000 toward the cost of hearing aid(s) (Active only)
  • Welding Hood Lenses - $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% up to the annual plan limit of $400,000 or lifetime maximum of $750,000 per person.
  • 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.
  • 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.
  • 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 has a $20,000 annual maximum per person. The pharmacy plan deductible as well as the pharmacy plan annual maximum 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 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% up to the annual plan limit of $400,000 or lifetime maximum of $750,000 per person.
  • 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% up to the $400,000 calendar year max or $750,000 lifetime maximum.
  • 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 subject to the annual and lifetime maximum limits as stated above.
  • 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, up to $20,000 each calendar year.  The pharmacy plan deductible as well as the pharmacy plan annual maximum 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.
  • Out Patient Mental Health Benefit - Applicable to dates of service prior to 1/01/2010 PIBF provides coverage for 10 (ten) outpatient visits payable at 50% per person; per calendar year.  Effective 1/1/2010 the outpatient mental health coverage is no longer included in the PIBF Stand Alone Benefits.  Dates of service beginning 1/1/2010 for outpatient mental health service will not be subject to a visit limit and will be processed the same as the coverage for medical office visits; subject to the calendar year deductible then 80% payment if in network and 70% coverage if out of network.
  • Non-Surgery Related Physical/Occupational Therapy, Biofeedback or Pulmonary Rehab Benefit – PIBF will pay $25 per visit, up to $300 per person; per calendar year for any combination of these types of service.
  • 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.

Yearly Deductible

The deductible is the portion you must pay on healthcare expense before the PIBF begins to allow payments.  Once the specified deductible is met, PIBF will then allow payment as stated in the SPD (Summary Plan Description).  Your PIBF plan does not have a co-pay.   The patient portion is deductible and co-insurance.  Plan deductibles start over every January 1st.  A combination of family members can meet the family maximum deductible; however, $500 is the maximum amount any one family member can count toward meeting the family deductible.  When there are only two in the family, each must meet the individual deductible amount.Deductible is applied as claims are received and processed.  This is not necessarily the order in which you incur the services or pay for service.  For example; you visit the doctor at the beginning of the year, the charge is $50.  The doctor’s office requires you to pay the $50 as your deductible has not been met.  The claim is filed, and after BCBS PPO adjustment, the charge is reduced to $30.  When the claim is processed by PIBF, $30 is the amount applied to deductible.  You would then need to contact the doctor’s office regarding the $20 you have overpaid.  They should credit your account, or issue you a refund.   Keep in mind that until the claim has been filed with PIBF, any amount you have paid will not be credited in our office as “deductible” applied.   

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 medical 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 out of pocket limit during a calendar year, covered medical expense, for the individual,  is paid at 100%, up to the annual or lifetime plan limits for the remainder of that calendar year. 




© 2010 Pipeline Industry Benefit Fund       Privacy Policy | Contact Us