Navigating Your Core Benefits
Welcome your dedicated Client Service Partner, Quantum Health. If you have questions, need education on the process, or want to get the most from your health plan, Quantum can help. To learn more, click here.
Know Your Rights and Protections Against Surprise Medical Bills
When you receive emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from “surprise billing.”
To learn more about the “surprise billing,” click here.
National IAM Benefit Trust Fund Medical and Rx Plans
The National IAM Benefit Trust Fund offers four medical plans. Covered employees and their dependents may participate in a Benefit Trust Fund medical plan if it is negotiated into the Collective Bargaining Agreement. The primary differences between the plans are the annual deductible amounts, coinsurance (the percentage paid for covered services after the annual deductible is met), copayments the participant must pay, and the annual out-of-pocket maximum.
Medical Coverage
The Fund medical plans use the CareFirst Administrators network. The network consists of more than one million participating providers nationwide. Plan participants have the flexibility to see any doctor or health care provider they choose. However, participants who select CFA network providers will incur the lowest out-of-pocket expenses because the participating providers have agreed to accept pre-negotiated, reduced rates for covered services, and they are paid at the greater in-network benefit percentage. You are not required to use an CFA provider. It is your choice. However, Plan C will not cover any services obtained outside the CFA network except as specifically noted in the Summary Plan Description.
Medical Services
Benefit Trust Fund medical plans cover an array of medical services. Preventive services, such as annual physical exams and certain routine immunizations, are covered at 100% under all three plans when care is received from an in-network provider. Other medical services are covered at varying benefit levels, depending on service. Before you visit a medical provider, it is always a good idea to double check that the services you are planning to receive are covered by the Benefit Trust Fund medical plan, and that the provider participates in the OAP network.
Prescription Drug Plans
The National IAM Benefit Trust Fund provides prescription drug coverage as part of each medical plan. Prescription drug coverage is administered by CVS Caremark for Plans A, A+, B and C.
With the prescription drug program, participants receive a prescription drug card to use at participating retail pharmacies around the nation.
Participants can use mail-order and online ordering to fill prescriptions for long-term or maintenance medications, up to a 90-day supply.
The Benefit Trust Fund plans have a drug formulary—a list of brand-name and generic drugs covered under the plans. While most prescription drugs are covered, participants must pay different co-payments for each category of drug: generic drugs, preferred drugs (brand-name drugs on the formulary) or non-preferred drugs (brand-name drugs not on the formulary).
For more information on prescription drug co-payments and plan formularies, see the medical plan Schedule of Benefits or click here contact the Fund Office.
To view the complete formulary, visit CVS Caremark's website.