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 Transform Diabetes Care®, Livongo for Hypertension, and Hinge Health for musculoskeletal ailments.
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.
Transform Diabetes Care® is a program that helps members manage their diabetes and overall health. Transform Diabetes Care lets members know about things they can do to improve their health, such as sending medication reminders or possibly advising them of overdue screenings. Transform Diabetes Care will give members the right amount of guidance and coaching based on their specific needs—at no cost. Call us 1-855-238-3624 if you have any questions. We’re here from 9 a.m. to 9 p.m., ET.
If you need a meter and want to begin testing, visit Caremark.com/TDC/Manage to place your order for the meter and supplies online. Your meter and supplies are offered by the manufacturer (subject to availability) at no cost to you.
NOTICE (1): CVS Caremark will request a prescription for the corresponding test strips and lancets from your doctor and then CVS Caremark will mail them to you unless you opt out of this option, whereby you will need to request a prescription from your doctor for test strips and lancets.
Support for reversing Type 2 diabetes is available through Virta Health. With a nutrition plan tailored to your lifestyle, coaching support, and ongoing medical monitoring, Virta can help you lower your blood sugar levels, lose weight, and reduce medications. Virta is available at no cost for qualified members through your Blue Cross Blue Shield of Massachusetts benefit. See the attached link for more information and to see if you qualify. Virta for Blue Cross Blue Shield of Massachusetts (virtahealth.com)
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.
The Livongo for Hypertension Program
Livongo offers online coaching services to help manage chronic conditions such as hypertension at no added cost to participants. The Livongo for Hypertension Program is 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.
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.
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.
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 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 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.
Effective August 1, 2022, 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.
The Livongo for Hypertension Program is 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 learn more, visit Get started – Livongo Health – Registration or call 800-945-4355. The plan registration code is LOCAL 4.
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.
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.
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.