About the Health and Welfare Plan
Summary of Benefits and Coverage
The Summary of Benefits and Coverage (SBC) is designed to help members better understand and evaluate their overall health plan benefits. The Plan updates the SBCs on an annual basis.
Download the Plan
Your Plan Document provides you with a comprehensive overview of your Health and Welfare Plan benefits. Download the complete Plan below for all details. For questions, please call the Funds Office at 508-533-1400 or email us at [email protected].
- You’ll schedule time to talk with your Health Coach over the phone or in person when it’s convenient for you
- Appointments can range from 30 to 60 minutes.
- Coaching appointments are FREE and confidential.
- Create a personalized plan to help you improve your health, enhance your quality of life, and manage your diabetes.
- Understand the importance of monitoring your blood glucose
- Learn how to set goals to improve your HbA1C
- Recognize the correlation between your stress levels and blood sugar levels
- Expand your knowledge of nutrition
- Develop an exercise plan while managing your blood glucose levels.
All Local 4 Funds eligible participants and their covered dependents have access to mental health care resources from Lyra Health. With Lyra, you can schedule therapy and mental health coaching sessions, and you’ll get unlimited access to a self-care library to help you maintain your emotional well-being. No matter what you’re experiencing—difficulty coping with change, managing anxiety or depression, or navigating your relationship with alcohol—Lyra is here to support you.
How Lyra Health can help
Through Lyra, you and your dependents will receive a range of confidential support services, including:
- 8 mental health sessions per person, per year at no cost.* Lyra’s providers are experts specializing in different issues. With Lyra, you’ll be able to select the mental health coach or therapist who best matches your preferences and begin care right away.
- Lyra Essentials, an on-demand self-care library to help build healthy habits through videos, articles, meditations, and more. These tools are helpful even if you’re not currently experiencing a mental health challenge.
- Expert advice beyond mental health, including legal, financial, identity theft, and dependent care services.
Get started with Lyra in three easy steps:
- Visit local4funds.lyrahealth.com to create your account or call (844) 926-2482 for 24/7 support. Be sure to bookmark the Lyra website and/or save the phone number to your contacts.
- Take the care assessment to get paired with high-quality providers who have diverse backgrounds and identities. Lyra’s mental health providers are custom-matched to you and have appointments available for new clients.
- Meet with your provider virtually or in-person to begin care.
*Local 4 Funds eligible participants and their covered dependents have access through the BCBS Massachusetts health plan to additional continued care coaching and therapy sessions, beyond the 8 free sessions, from a Lyra network provider and access to medication management support at any time. These sessions are billed through the health plan and subject to in-network outpatient mental health cost-sharing, as defined under the health plan.
Effective January 1, 2021, the Medical Plan joined the Blue Cross Blue Shield Exclusive Provider Organization (EPO) Advantage Blue Network. The Plan remains largely the same – you do not need to select a primary care physician, you do not need referrals to see a specialist, and you retain the national coverage of the Blue Cross Blue Shield Preferred Provider Organization (PPO) network. However, going forward, you will only receive coverage if you see a provider within the extensive PPO network. Out-of-network services have been eliminated from the Medical Plan, other than for emergency care.
The following services are part of the Medical Plan:
- Acute Hospital Facility Care, including inpatient admissions, maternity admissions, outpatient facility care, emergency room or inpatient surgery
- Ambulance
- Cardiac Rehabilitation
- Chiropractic Care
- Extended Care Facility
- Holistic Medicine, including acupuncture, homeopathy, massage therapy
- Home Health Care
- Hospice Care
- Preventive Care, including routine adult and child physicals, routine gynecological exams
- Medical and Surgical Care, including maternity care, physician inpatient and surgery services
- Medical Equipment and Prosthetics
- Mental Health/Substance Use Disorder Care
- Lab and X-Ray
- Organ Transplants
- Physical Therapy
- Routine Mammogram and Pap Test
To find in-network providers, click here or call Blue Cross Blue Shield of Massachusetts at 1-800-401-7690.
Hinge Health
Hinge Health provides free digital programs for back, neck, shoulder, and knee pain. Click here to learn more or call 1-855-902-2777.
Our health coaching partner TrestleTree can bring you and your families individualized physical and mental wellness plans to fit your individual needs. TrestleTree, founded in 2001, has had great success across many industries in motivating people to make practical and achievable lifestyle changes. They can help you manage chronic conditions, such as diabetes, hypertension, and metabolic syndrome) and lifestyle modifications, such as lowering your HbA1C, blood pressure, weight, or cholesterol, to stop smoking and to work on stress management. They can fit you with glucometers, blood pressure cuffs, scales, and any other tools you might need to start the journey to better health. You can get started today by contacting Karen Larsen at 508-533-1400 x127 or TrestleTree at 1-866-523-8185 or visit the TrestleTree web page. You can also enroll here!
Lyra Health is our Employee Assistance Plan and offers a range of confidential support services, including mental health therapy, substance use treatment, coaching, an on-demand self-care library, and expert advice beyond mental health, including legal, financial, identity theft and dependent care services. Call 844-926-2482 for 24/7 support or visit local4funds.lyrahealth.com.
Lyra Health
Lyra Health provides support for mental health, substance use, and work-life balance.
Andy Franzen, an instructor at the Local 4 Training Center, will assist members, participants, and their families access the highest care provided by Lyra.
Contact Member Assistance Coordinator Andy Franzen by calling 1-781-364-6322 or via email at [email protected]
Please reach out if you, your family member, or friend is struggling with substance abuse or mental health, as we care about your well-being above all else.
For more information, visit local4funds.lyrahealth.com or call 844-926-2482.
Substance Use Resources
Eligible members and their dependents have access to the outpatient substance use programs on the attached flyer. For additional information, contact Karen Larsen, LICSW at 508-533-1400 x127.
Blue Cross Blue Shield of Massachusetts (Dental Blue)
Blue Cross Blue Shield of Massachusetts administers both the Medical Plan and the Dental Plan for eligible Local 4 members and their covered dependents. This integrated approach to medical and dental care lowers cost and increases the quality of dental coverage.
The following services are among those covered through Dental Blue:
- Preventive and diagnostic care covered at 100%.
- Two fluoride treatments per year are covered, regardless of age.
- All fillings are covered for all teeth at 80%.
- Crowns, inlays, and onlays are covered at 80%.
- Orthodontia is covered regardless of age, with a lifetime maximum of $2,500 per person for non-medically necessary orthodontia.
- Nitrous oxide (laughing gas) is covered as part of the Plan’s general anesthesia benefit.
An increased level of benefits may be available to you if you have certain medical conditions such as diabetes, pregnancy, or oral cancer.
To find a dentist in the Dental Blue network or more information, click here or call 1-617-246-5000.
EyeMed
The EyeMed network includes a host of eye care professionals and many eyewear retailers.
The following services are covered through EyeMed:
- Annual Eye Examinations
- Contact Lenses
- Eyeglasses
- Safety Eyewear
To find an in-network eye care professional or for more information, click here.
TruHearing will provide eligible participants and dependents covered under the Basic Benefits Plan with free hearing tests as well as access to better discounts on hearing aids within a broader network.
The Plan also provides an allowance of $1,300 per ear, every four years, for hearing aids when purchased through a TruHearing provider. Please see the attached flyer for more information and pricing. Benefits are limited to services received from providers affiliated with TruHearing.
When you use TruHearing, you are eligible for a pair of Standard hearing aids at no cost to you, or you can upgrade to advanced ($299 each) or premium aids ($699 each). TruHearing bills the Plan directly for your allowance and any difference is paid directly to TruHearing by the member.
- 7,000+ provider locations nationwide
- Hearing aids from the top 6 major manufacturers
- Some hearing aid models at zero out of pocket cost
- 100’s of hearing aid makes, models, styles, and colors to choose from
- 1 year of follow up visits at no charge
- 2 years (80 cells per ear) of free batteries (non-rechargeable models)
- 3-year manufacturer warranty
If you or your eligible dependents are interested in scheduling an appointment, or if you have questions regarding your hearing benefits, contact TruHearing at 1-888-934-4744. This number is exclusively set up for eligible Local 4 members.
In order to access the benefits offered through the Hearing Plan, you must first contact TruHearing to maximize your full in-network hearing aid allowance. Do not use your Blue Cross Blue Shield medical ID card for this benefit. Contact TruHearing to find out if your current hearing aid provider is in the TruHearing network.
We have partnered with Progyny, a leading fertility benefits provider, to provide a comprehensive and inclusive family building benefit for every unique path to parenthood. Your Progyny benefit includes comprehensive treatment coverage leveraging the latest technologies and treatments, personalized emotional support, guidance from dedicated Patient Care Advocates (PCAs), and access to high-quality care through a premier network of fertility specialists. To learn more and activate your benefit, call: 866-606-9789 or visit the Progyny Member Guide.
Covered employees enrolled under the Basic Benefits Plan are eligible for life insurance benefits. Covered employees enrolled under the Supplemental Benefits Plan are not eligible for life insurance unless they have purchased the Bridge Plan.
The life insurance benefit amount is $50,000 if you die while you are covered under the Plan. Upon your death, Symetra Life Insurance Company pays the proceeds of your life insurance as a lump sum to your designated beneficiary. The Plan also has a Spousal Life Insurance benefit. If your Spouse dies while you’re covered under the Plan, you will receive a $2,000 lump sum payment from Symetra.
Contact the Benefit Funds Office at 508-533-1400 for more information.
Our health coaching partner TrestleTree can bring you and your families individualized physical and mental wellness plans to fit your individual needs. TrestleTree, founded in 2001, has had great success across many industries in motivating people to make practical and achievable lifestyle changes. They can help you manage chronic conditions, such as diabetes, hypertension, and metabolic syndrome) and lifestyle modifications, such as lowering your HbA1C, blood pressure, weight, or cholesterol, to stop smoking and to work on stress management. They can fit you with glucometers, blood pressure cuffs, scales, and any other tools you might need to start the journey to better health. You can get started today by contacting Karen Larsen at 508-533-1400 x127 or TrestleTree at 1-866-523-8185 or visit the TrestleTree web page. You can also enroll here!
Fitness Reimbursement
Eligible members, spouses, and their dependents can be reimbursed up to $175 per year (per family) for a qualified health club membership or fitness classes though Blue Cross Blue Shield of Massachusetts.
A qualified health club has a variety of exercise equipment, including cardiovascular equipment like treadmills and stationary bikes and strength-training equipment like weights and weight machines. Certain online classes are also included.
Click here to fill out the fitness reimbursement form. Reimbursement forms must be received by Blue Cross Blue Shield no later than March 31 of the year following the year in which the fees were incurred.
Weight Loss Reimbursement
Eligible members, spouses, and their dependents can be reimbursed up to $175 per year (per family) for qualified weight-loss programs through Blue Cross Blue Shield of Massachusetts, such as Weight Watchers.
Click here to fill out the weight loss reimbursement form. Reimbursement forms must be received by Blue Cross Blue Shield no later than March 31 of the year following the year in which the fees were incurred.
As of January 1, 2021, the Massachusetts Paid Family and Medical Leave Act will begin providing up to 20 weeks of paid leave for residents of the Commonwealth with a serious health condition, at up to $850 per week. For more information about the PFLMA, please visit Mass.gov. As such, the Trustees of the Plan have decided to reduce the Weekly Accident and Sickness Benefit (Loss of Time) available under the Plan. Eligible participants must first exhaust any state medical benefits that are available to them, such as the 20 weeks of paid medical leave under the PFLMA. If participants remain disabled after 20 weeks have ended, they may be entitled to up to an additional six weeks of Loss of Time from the Plan, at the customary $500 per week (less FICA). Residents of a state that does not have a paid medical leave, or who are not eligible for state leave benefits, may apply for Loss of Time through the Plan as usual. Contact the Benefit Funds Office to request an application for the Loss of Time benefit.
Buy-In Plans
Learn the benefits, costs, and eligibility requirements for the Plan’s COBRA and Buy-In Plans:
Documents and Resources
Frequently Asked Questions
NOTE: The following FAQs are abbreviated explanations of complicated Plan benefits. Please review the applicable Summary Plan Descriptions if you still have questions, and please note any discrepancy between these FAQs and the Plan Documents will be resolved in favor of the Plan Documents, which are the controlling documents.
The Benefit Funds offers a Member Self-Service Module (“MSS”) that allows members to access basic benefits information online, in a secure and encrypted manner. On MSS, members are able to check their Health Plan eligibility, as well as review their listed dependents and beneficiaries. Additional benefits of MSS include the ability to check hours received on a month-to-month basis, generate a basic estimate of pension benefits, and record address changes, phone numbers or email addresses.
The life insurance policy available from the IUOE Local 4 Health and Welfare Plan is a benefit for eligible members. For more information, contact the Benefit Funds Office at [email protected] or by calling 1-508-533-1400. Additionally, the Union offers a life insurance policy that members pay for. Contact the Union for information about that separate policy.
Eligible members can order ID cards via the secure BCBS Member Central website: bluecrossma.org. Additionally, the Benefit Funds’ Eligibility Team can trigger new ID cards. To contact the Eligibility Team, call 1-508-533-1400 or email [email protected].
Members can also download the MyBlue Member App from the Apple App and Google Play stores. The App gives members instant access to their ID cards, claims history, copays as well as tools to search for providers.
Effective January 1, 2025, Optum Rx is the new pharmacy benefit manager for the IUOE Local 4 Health and Welfare Fund. Optum provides safe, easy, and cost-effective ways for members to get the medication they need. To view a list of network pharmacies, use the Optum Rx app or log in to OptumRx.com. To learn if a medication is covered, go to OptumRx.com to check the Plan’s formulary (list of covered medications). Optum Rx offers a no-cost program to help manage diabetes. Eligible members are automatically enrolled and receive a letter with information. One free blood glucose meter and supplies are available. Members should call Optum Rx at 1-855-241-2213 for more information.
Effective January 1, 2022, eligible members and their covered dependents are enrolled in the Vision Plan with EyeMed. An eye exam and one pair of eyeglasses or contact lenses once every 12 months for members, spouse and covered dependents are available when provided by an EyeMed provider. EyeMed’s network is far larger than the Plan’s last provider. There are many more providers covered in Massachusetts, New Hampshire, and Maine. EyeMed’s network also includes LensCrafters, Pearl Vision, Target, and online retailers such as 1-800-CONTACTS and Glasses.com. Create a member account at eyemed.com or download the Members App on the App Store or Google Play.
The Subscriber Reimbursement Form is available on the Funds website: local4funds.org under Important Forms and Documents.
A claim form is due by March 31 for the prior year. Further questions can be directed to BCBS Member Services at 1-800-401-7690.
Learn more at one of the below forms:
New medical ID cards were mailed during October 2023 to reflect the new Employee Assistance Program benefit through Lyra. Your medical ID card suffix should begin with IUH. The newly issued cards also include information on the front about Plan costs such as deductibles and maximum out-of-pocket costs.
As a covered employee, you must work 1,000 or more credited hours (1,500 or more hours if you are a participant in Local 4D covered by an Equipment House Contract during a calendar year (January through December) to become eligible for coverage under the Basic Eligibility Rule. You are then covered for the 12-month period beginning the following March 1 through February 28 (or February 29 during a leap year). First-year Local 4D members only require 1,000 hours for eligibility.
If you cannot meet the requirements of the Basic Eligibility Rule, you may become eligible under the Supplemental Eligibility Rule on the first day of the month following the month you work 500 or more credited hours during the calendar year.
As of January 1, 2021, the Massachusetts Paid Family and Medical Leave Act will begin providing up to 20 weeks of paid leave for residents of the Commonwealth with a serious health condition, at up to $850 per week. For more information about the PFLMA, please visit: mass.gov/orgs/department-of-family-and-medical-leave. As such, the Trustees of the Plan have decided to reduce the Loss of Time benefit available under the Plan. Eligible participants must first exhaust any state medical benefits that are available to them, such as the 20 weeks of paid medical leave under the PFLMA. If participants remain disabled after 20 weeks have ended, they may be entitled to up to an additional six weeks of Loss of Time from the Plan, at the customary $500 per week (less FICA). Residents of a state that does not have a paid medical leave, or who are not eligible for state leave benefits, may apply for Loss of Time through the Plan as usual. Contact the Benefit Funds Office to request an application for the Loss of Time benefit.
If you are Legally Separated or Divorced, and you are required by your Separation Agreement/Divorce Decree to cover your ex-spouse under your Health Plan, you must submit the Separation Agreement/Divorce Decree to the Health Fund. Your ex-spouse will only be covered until either you or your ex-spouse gets remarried.
Yes, if you meet certain criteria. You must be Totally Disabled as defined by the Plan, eligible for Basic Plan coverage at the onset of the disability, continuously eligible for benefits for at least 12 months prior to the onset of the disability, and apply for credit within 24 months of losing earned coverage. You may be eligible for 30 hours of credit per week for up to 52 weeks of your disability.