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2021 - NASI WELFARE FUND BENEFIT ANNOUNCEMENT - (12/20/2020)

Retirement of Fund Administrator

It’s with a debt of gratitude that we announce the retirement of long time Fund Administrator, Michael Jacobson. Mike has been with the NASI Trust Funds for over 40 years and has led the organization for more than 35 years. He has always guided the Trust Funds with the utmost professionalism and with the best interest of the participants in mind. We wish Mike all the best in retirement and thank him for his exceptional years of service.

Mike will be replaced by the Assistant Fund Administrator, John Eger. John has been with the Trust Funds for more than 37 years. We are confident that he will continue the legacy that Mike has built.

The Fund Remains Financially Stable

The Board of Trustees of the National Automatic Sprinkler Industry Welfare Fund is again pleased to report that the NASI Welfare Fund continues to experience generally favorable financial conditions that permit the Fund to provide the coverage and benefits described below.

In general, the NASI Welfare Fund pays the following percentage for Level 1 benefits after you meet the individual deductible:

Fund Pays/You Pay
In-Network           80%/20%
Out-of-Network           60%/40%

100% Coverage

There are a few exceptions under the NASI Welfare Plan where 100% coverage is provided for In-Network services under all levels of NASI Welfare Plan coverage (without first applying the individual deductible). Among those exceptions are:

  • MDLive (virtual doctor’s visits)
  • Preventive Services required by law as listed in the Plan Document
  • Routine annual physical examinations
  • In-Network Medically Necessary colonoscopies

 90% Coverage for Urgent Care

One of the factors contributing to lower than expected claim expenses may be that fewer people are using a hospital emergency room for diagnosis and/or treatment that can be addressed at an Urgent Care facility or even by MDLive. The NASI Welfare Fund covers In-Network Urgent Care charges at 90% (instead of the above 80% coverage level), and there is no deductible applied to Urgent Care. The 90% coverage level also applies to In-Network walk-in clinics such as CVS’ Minute-Clinic.

MDLive

To make it even easier to access medical care for our active and retired participants who are not yet eligible for Medicare, the NASI Welfare Plan provides 100% cover-age for the telemedicine service; MDLive. MDLive gives you access to a physician, licensed in your state, any time of day or night; even on weekends and holidays. MDLive is appropriate for non-emergency ailments such as sore throat, asthma, fever, flu, as well as certain behavioral health issues. To encourage use of MDLive, the NASI Welfare Fund covers 100% of the cost of this service. While the cost of the “virtual visit” is covered in full, you will be responsible for costs arising from your “virtual visit”; things like your portion of the cost of a prescription drug that you received as a result of your telemedicine visit.

Sign up online now, before you need it. You might not feel like doing it when you are sick. Follow the link to the MDLive website you can find on the nasifund.org website or go to MDLIVE.com/bcbsil.

Telemedicine for Medicare-eligible Retirees and Beneficiaries

Physicians are now allowed to bill Medicare for telemedicine services. If your doctor provides telemedicine services, this means that instead of traveling to receive medical evaluations, mental health services, and management of medication, your doctor can provide such services to you over the phone. You should feel free to use your doctor if they are willing to speak to you by tele-phone. Medicare will cover their part of the charge for that telemedicine service, then NASI will cover its part, as if the service was provided in the office. You may still have some portion of the bill to pay (you still have to meet Medicare Part B’s deductible for example), but most Medicare-eligible folks should now be able to access their doctor’s services by telephone.

Chiropractic Benefit Improvement

Effective January 1, 2021, the NASI Welfare Fund Plan of Benefits is modified to provide coverage for up to 26 Chiropractic visits each year. This represents an in-crease, from 20, in the number of annual chiropractic visits.

Hearing Aid Benefit Improvement

Effective January 1, 2021, the NASI Welfare Fund Plan of Benefits is modified to provide coverage for medically necessary hearing aids for dependents to mitigate or reverse hearing loss attributable to a specific injury or surgical or medical procedure resulting in hearing dam-age to the dependent (subject to the cap set forth below
for Participants). In addition, effective January 1, 2021, the amount of coverage will be increased from $400 every five years to $1,200 per individual every three years.

Dental Benefit Improvement

Effective January 1, 2021, the maximum annual dental benefit payable under the NASI Welfare Plan will in-crease based on your level of coverage.

For Level 1 and Self-Pay Benefits, the maximum annual dental benefit and the lifetime orthodontia benefit will increase from $3,000 per individual to $4,000 per individual.

For Level 2 Benefits, the maximum annual dental bene-fit will increase from $2,000 per individual per year to $3,000 per individual per year, and the lifetime orthodontia benefit payable will increase from $3,000 per individual to $4,000 per individual.

Member Assistance Program

This program provides guidance and resources for those with substance abuse and other mental health issues, financial difficulties, as well as legal and other questions. There is no cost to you associated with the use of this program. Call 866-379-0895 to speak to a counseling professional who will listen to your concerns and who can guide you to the appropriate services you require. This program is available to active and retired participants and dependents, including Medicare-eligible retirees and dependents.

Diabetes Care Management Program

A number of diabetics will be invited to participate in the Livongo Diabetes Remote Monitoring program. The goal of this program is to help these individuals lower their Hemoglobin A1C levels and, in doing so, avoid, minimize, or delay medical complications often associated with Diabetes. Participants in this program will receive a special glucose meter and unlimited test strips and lancets as well as access to coaches by telephone or, if preferable, by text. There will be no cost to those participating in this program.

Flu shots and other Immunizations

Remember to get your seasonal flu shot from your Blue Cross Blue Shield participating physician or at your local pharmacy that participates with Express Scripts. Most immunizations, including flu shots, are covered at 100% by the NASI Welfare Fund when using an In-Network provider.

Level 2 and Level 3 Benefits

The great majority of those eligible for benefits from the NASI Welfare Plan enjoy Level 1 benefits which include non-medical benefits such as dental, vision, disability, and life insurance. The NASI Welfare Plan also pro-vides two other levels of medical benefits which have different deductible, co-insurance, and out-of-pocket maximum expense levels. Groups who have bargained for Level 2 or Level 3 medical benefits can also choose to bargain for some or all of the “additional” benefits: dental, vision, disability, and life insurance.

Effective January 1, 2021, the hourly contribution rates associated with these benefits are as follows:

  • Level 2 Medical Benefits $7.78
  • Level 3 Medical Benefits $7.37
  • Dental $0.69
  • Disability $0.07
  • Vision $0.10
  • Life $0.01

Pensioner Medical Coverage

Retirees with medical coverage pay a premium that is deducted from their monthly pension benefit. The amounts retirees pay are designed to cover 50% of the cost of retiree coverage.

Pensioners and beneficiaries who do NOT have Medicare Coverage

The monthly self-payment amount for pensioners or beneficiaries who are not yet eligible for Medicare will increase from $910 per month in 2020 to $915 per month beginning January 1, 2021.

Pensioners and beneficiaries whose Local Union has a Retired Employee Subsidy Account (RESA) and who are eligible for their local union’s RESA will continue to benefit from their Local Union’s subsidy of the cost of their coverage. If your Local Union determines that your RESA will not pick up the additional cost by increasing its subsidy to its covered members, you will be advised in a separate announcement.

Pensioners and Beneficiaries WITH Medicare

The monthly self-payment amount for pensioners or beneficiaries who became eligible for Medicare before 2002 will NOT increase in cost from $320 per month in 2020. The cost will remain $320 per month in 2021. Similarly, for those pensioners or beneficiaries who be-come eligible for Medicare after 2001, the monthly self-payment cost for coverage will NOT increase in cost from $370 per month in 2020, but will remain $370 per month in 2021.

Medicare-eligible Pensioners and Beneficiaries who are eligible for their Local Union’s Retired Employee Subsidy Account (RESA) will continue to benefit from their Local Union’s subsidy of the cost of their coverage.

Monthly Cost for Those Participating in NASI Welfare Fund through Participation Agreements

The monthly premium for the NASI Welfare Fund for those participating in the Fund through participation agreements (e.g. owner members) will be $1,688.00.

REMINDERS

 Retiree Benefits and Medicare

Medicare is the primary coverage for Pensioners, Dependents of Pensioners, and Beneficiaries. The NASI Welfare Plan requires that individuals who are eligible for Medicare Part B benefits sign up for those benefits. Additionally, if an individual is not entitled to cost-free Medicare Part A, that individual must also purchase Part A coverage from Medicare when they become eligible to do so at age 65.

Since Medicare does not pay for hospital or medical services outside of the United States, in order to have coverage for such services when traveling or living out-side the United States, you need to purchase travel insurance or other medical insurance. The NASI Welfare Fund will not provide primary medical coverage for Medicare-eligible individuals; instead, the Plan will limit its coverage to the amount the Plan would have paid on your behalf had you received those services in the United States. For example, if you are hospitalized in the United States, Medicare Part A pays all of the cost of the hospitalization except for the deductible ($1,452 in 2020). If you are, instead, hospitalized outside of the United States, the Plan will process your claim assuming your medical expense was $1,452 (i.e., the amount that would not have been covered by Medicare if the expense was incurred in the United States), and you will be responsible for the remainder of the charges unless you have travel insurance or other coverage.

Notification Requirement upon Divorce

Notice of your divorce must be provided to the Fund office within 60 days of your divorce.
If notice of your divorce is not provided to the Fund Office in this time frame, and as a result, benefits are paid to an ineligible Dependent, the Fund can recover those benefits by treating such benefits as an advance to you and deducting such amounts from benefits which become due to you until the entire amount of benefits erroneously paid is recovered.

Make Sure Your Beneficiary is Up-to-Date

Be aware that your divorce does not invalidate your Beneficiary designation. Forms to designate or change a Beneficiary for your NASI Welfare Fund life insurance benefit (for active participants), NASI Pension Fund Death Benefit, and SIS Pension Fund death benefit are available on the Funds’ website, www.nasifund.org or by calling the Fund office.

Annual Reminder (as required by federal law) regarding Women’s Health and Cancer Rights Act of 1998

The NASI Welfare Plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services, including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema.

Call the Fund Office at 1-800-638-2603 for more information.

Summary of Benefits and Coverage

The pages that follow this announcement are designed to meet requirements of the Affordable Care Act.

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