Hospital/Medical - Alaska Teamster-Employer Welfare and Pension Trusts

Welfare BenefitTabs™

On this page: Deductibles/Maximums – Preventive Care – Dr. Visits and Related Benefits – Hospital and Facility Benefits – Mental Illness/Substance Abuse Benefits
Hospital/Medical Benefits for Working Participants & Families
PPO Plan See SPD Section 5.4 or 5.8 for more information.

Click here to Find Network Providers.

You will almost always pay significantly more out-of-pocket if you go out of network for care.
Cost ContainmentMore Information

Cost Containment Programs are designed to help control increasing health care costs by not paying benefits for services that are not Medically Necessary. In general, you will need to check with the Utilization review (Aetna PPO) before hospitalization or any major planned medical procedure. Failure to do so may significantly increase out-of-pocket costs.
Deductibles and Maximums

Your Medical Plan Benefit provides comprehensive coverage of Covered Expenses incurred for an Illness or Injury, and is subject to a deductible and coinsurance provision that applies to each Participant each calendar year. The Medical Plan benefit has been structured to provide an incentive to use Preferred Providers for hospital treatment, office visits, and supplies.

Routine Physical Examination	100%; subject to UCR and Schedule of Routine Examination Benefits.
Well Child Care	100%; subject to UCR and Schedule of Well Child Benefits
Immunizations	100%; subject to UCR and Schedule of Immunizations

Professional Services and Supplies
	PPO	Non-PPO
Physician visits (home, office, or hospital visits)	80%	60%
Surgeon and assistant surgeon	80%	60% * Non-emergent orthopedic or podiatric surgery charges from a non-PPO provider are not covered.
Diagnostic x-rays, laboratory testing	80%	60%
Chiropractic office visits (up to 15 visits per year)	80%	60%
Acupuncture (up to 15 visits per year)	80%	60%
Naturopathic Services (some exclusions apply)	80%	60%
Physical or occupational therapy (up to 20 visits per year)	80%	60%
Speech therapy (up to 20 visits per year)	80%	60%
Cardiac rehabilitation	80%	60%
Medical equipment and prosthetics	80%	60%
Home Health Care Benefit	80%	60%
	% of Covered Expense
Skilled Nursing Facility	80%; up to 100 days
Hospice Care	80%
Ambulance Service	70%; limited to 70% of preferred provider charges for non-Emergency air ambulance services
Hearing Loss Benefit	70%; up to $800 per hearing device, per ear during any 3 consecutive years; not subject to deductible or out-of-pocket

	PPO	Non-PPO
Hospitals in Alaska, within 75 miles of a Preferred Provider facility	80%	60% of rate negotiated with Preferred Provider; after additional $1,000 inpatient deductible
Hospitals in Alaska; not within 75 miles of a Preferred Provider facility	80%	60%
Hospitals outside of Alaska	80%	60%
Preadmission Testing	100%	100%
Emergency Room	Benefits are extended for Hospital outpatient emergency room care when required for Emergency treatment of an Illness or Injury. No benefits will be extended for emergency room care that is not related to an Emergency and/or could have been provided in a Physician’s office, an outpatient clinic or urgent care center.
Facility Charges related to Surgery	Benefits for all charges related to surgery are subject to rules regarding precertification and to rules about reimbursement for services rendered on an inpatient versus outpatient basis. Check the SPD, section 5.8 when arranging for a surgery.
Skilled Nursing Facility	80%; up to 100 days
Hospice	80%

Mental Illness / Substance Abuse

Benefits are extended for the treatment of Mental Illness, and alcohol, drug, or chemical dependency, on the same basis as for treatment of any other condition.

Medical, dental, vision, life insurance, and more.