About the Health and Welfare Plan

We provide and administer a comprehensive array of benefits such as prescription drugs, dental, vision, hearing, life insurance, substance use and mental health treatment, and more for eligible members and their families. The Plan’s Trustees work hard to ensure that they actively combat medical inflation, with an eye toward the future, but that they also maintain today’s unparalleled care, low member costs, and innovative solutions such as Livongo for Diabetes and Hypertension and Hinge Health for musculoskeletal ailments.

BENEFITS

DOCUMENTS & RESOURCES

FAQS

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 office@local4funds.org.

Download the Plan Document

The Plan has waived all member cost share, including copays, coinsurance, and deductibles, for any COVID-19-related inpatient or outpatient care retroactive to March 6, 2020, and lasting until the state of emergency has been lifted from your state of residence. This means that you will bear no cost whatsoever for any COVID-19-related testing, counseling, treatment, and supportive care via telehealth or at any doctor’s offices, urgent care centers, emergency departments, or hospitals and other acute care facilities.

Modern Assistance offers an unlimited Virtual Counseling Program on a confidential video platform. To speak with a trained, licensed clinician, call 1-800-878-2004.

Modern Assistance Programs, Inc. (MAP) offers comprehensive mental health and substance abuse services at its office in Quincy, MA. All EAP services provided at the office are free and require no copay, coinsurance or deductible. Due to the ongoing pandemic, virtual services are available via a confidential video platform.

EAP services include adolescent counseling (ages 12 and older); individual, couples, and family counseling; anger management; workplace conflict and problem resolution; and more. For more information, call the Member Services Line at 1-800-878-2004 or visit modernAssistance.com.

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.

Well Connection
Well Connection is an easy-to-use, low cost, secure, and confidential telehealth option. The website and app provide convenient access to treatment for minor medical and behavioral health issues, like flu, migraines, bronchitis, insomnia, and depression. The app is available for download from both Google Play and the Apple App Store. Click here to learn more or call 1-800-262-BLUE (2583).

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.

Livongo
Livongo offers online coaching services to help manage chronic conditions such as diabetes and hypertension at no added cost to participants. The Livongo for Diabetes Program provides Type 1 and Type 2 diabetics with advanced technology to help manage their care. Qualifying members and dependents will receive a connected meter, at no additional cost, as well as unlimited supplies of strips and lancets. To learn more about the Diabetes Program, visit welcome.livongo.com/LOCAL4 or call 1-800-945-4355. When enrolling please provide the Plan’s registration code: LOCAL 4. The Livongo for Hypertension Program is also offered at no cost to qualifying members and covered dependents with high blood pressure. Members enrolled in the program will receive a free digital blood pressure monitor, an app to track and manage your readings, as well as personalized support from health coaches. To sign up or to learn more about the Hypertension Program, visit ready.livongo.com/LOCAL4/enter or call Livongo at 1-800-945-4355. When enrolling please provide the Plan’s registration code: LOCAL 4.

Head over to our Videos page to hear about one Local 4 member’s own experience with the Livongo for Hypertension Program.

Modern Assistance Employee Assistance Program (EAP) Modern Assistance Programs, Inc. (MAP) offers comprehensive mental health and substance abuse services at its office in Quincy, MA. All EAP services provided at the office are free and require no copay, coinsurance, or deductible.  Due to the ongoing pandemic, virtual services are available via a confidential video platform.

EAP services include adolescent counseling (ages 12 and older); individual, couples, and family counseling; anger management; workplace conflict and problem resolution; and more. For more information, call the Member Services Line at 1-800-878-2004 or visit Modernassistance.com.

CVS Caremark
Caremark provides access to pharmacy and clinical services including counseling, assistance in coordinating injection training, and emergency pharmacist consultation, 24 hours a day. Click here to learn more or call 1-800-237-2767.

PrudentRx
The PrudentRx program will reduce the copay for certain specialty drugs to $0. If a member is currently taking a specialty medication, PrudentRx will contact them to assist with enrolling in the program to eliminate the out-of-pocket expense for the medications. If a member is not enrolled in the PrudentRx program, they will pay 30% coinsurance for the specialty medications covered by this service.

Specialty medications not covered by this service will continue to have a $200 copay. Contact a PrudentRx Advocate at 1-800-578-4403 with any questions or assistance with enrolling in the program.

Modern Assistance Program
Modern Assistance Program (MAP) provides a full range of services for construction and trade unions throughout New England, including support for mental health, substance use, and work life balance. MAP provides the pre-authorization review for inpatient mental health and inpatient substance use admissions. This includes partial hospitalizations/intensive outpatient substance use treatment programs. MAP also processes all claims for inpatient mental health and substance use services, while BCBSMA will continue to process all substance abuse/mental health outpatient claims.

Andy Franzen, an instructor at the Local 4 Training Center, will assist members, participants, and their families access the highest care provided by MAP.

Contact Member Assistance Coordinator Andy Franzen by calling 1-781-364-6322 or via email at afranzen@local4training.org

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 modernassistance.com or call 1-800-878-2004.

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 synthetic (white) 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.

Davis Vision
The Davis Vision network includes a host of eye care professionals and many eyewear retailers.

The following services are covered through Davis Vision:

  • Annual Eye Examinations
  • Contact Lenses
  • Eyeglasses
  • Safety Eyewear

To find an in-network eye care professional or for more information, click here or call 1-800-999-5431.

EPIC Hearing Healthcare
With EPIC Hearing Healthcare (EPIC), Local 4 members have access to more than 5,500 hearing providers nationwide, along with a vast selection of hearing aids available in-person or through home delivery.

For more information, click here or call 1-866-956-5400.

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 1-508-533-1433 for more information.

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.

Smoking Cessation Program
The Plan includes coverage for all FDA-approved prescription and over-the-counter drugs for smoking cessation such as Chantix and Zyban. These drugs are available at no copay for a 180-day treatment regimen when prescribed by a health care provider. If you need additional medication during the same calendar year and have a prescription from your doctor, you can purchase additional medication using the CVS/Caremark discount, but you will pay the full discounted cost of the prescription. Each year you are eligible for up to another six months of smoking cessation medication through your CVS/Caremark benefits at no cost to you.

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 office@local4funds.org 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 office@local4funds.org.

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.

Eligible members and their covered dependents are enrolled in prescription drug benefits through CVS/Caremark. Members should call CVS at 1-866-273-8408 or visit: caremark.com for additional information, or to order new ID cards. Additionally, the Benefit Funds’ Eligibility Team can trigger new ID cards. 

The Health and Welfare Plan is collaborating with PrudentRx to offer a program that can save members money and reduce out-of-pocket costs for covered specialty medications to $0, effective January 1, 2021. Enrolling in the PrudentRx Copay Program means $0 out-of-pocket for specialty medications on the Plan’s Exclusive Specialty Drug List when filled at CVS Specialty. Participation in the program is voluntary, but if you choose not to participate you will be responsible for a 30% coinsurance on covered specialty medications. Members should enroll in the program by calling PrudentRx at 1-800-578-4403.

Eligible members and their covered dependents are enrolled in the Vision Plan with Davis Vision. 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 a Davis Vision panel provider. All Davis Vision account information is maintained under the Social Security number of the covered participant. For a list of Davis Vision providers, call Davis Vision at 1-800-999-5431 or access davisvision.com and utilize the “Find a Doctor” feature.

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:

Your medical card suffix should begin with IUH and state the “IUOE Local 4 H&W Fund.” New cards were mailed during December 2020 and will be effective on January 1, 2021.
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 or 1,800 or more hours for a non-collectively bargained employee covered under a Participation Agreement) 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.

Per the Collective Bargaining Agreement, each participating employer must remit a monthly report to the Benefit Funds Office with hours worked and payment for all fringe benefits. Employer remittance reports are due the 19th of the month following the month in which the work was performed. The Plan sends Reports of Contributions to each active member twice a year which summarizes all hours and fringe benefits reported and paid in on your behalf.

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.

In order to add your Legal Spouse and/or your Dependent Child to your health plan coverage, proper documentation validating the relationship between you and your dependent(s) is required under the provisions of the Plan. Birth certificates from the city or town of birth as well as copies of each dependent’s Social Security card are required. Hospital generated birth certificates will not be accepted.
Participants must submit a copy of their Social Security card as well as a copy of all dependent’s Social Security cards who will be covered under the Plan for IRS reporting capabilities. Please be sure that all information matches what appears on your tax filings (including legal names, dates of birth and Social Security numbers). If you do not submit copies of Social Security cards for your dependents, it may cause a delay in coverage.

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.