2024 - NASI WELFARE FUND BENEFIT ANNOUNCEMENT
Monday, December 18, 2023
December 2023
To All Participants in the NASI Welfare Fund
From the Board of Trustees
When the Fund Provides Better than Normal Coverage
In general, the National Automatic Sprinkler Industry (“NASI”) Welfare Fund pays the following percentage for Level 1 benefits after you meet the applicable 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 on the Fund’s website at www.nasifund.org
- Routine annual physical examinations
- Ιn-Network Medically Necessary colonoscopies
- In-Network Mammogram Screenings
90% Coverage for Urgent Care and Primary Care Physician (PCP) Visits
Consultation with a Primary Care Physician, or “PCP,” on an ongoing basis could help you better manage your health over time, prevent chronic conditions, detect potentially life-threatening issues, and improve health outcomes. Moreover, it is more cost effective for everyone––Participants and the Fund––if Participants and their families visit their PCP, when appropriate, rather than a hospital emergency room for diagnosis and/or treatment that could have been performed by their PCP. Accordingly, it is important not only for the health of the Fund, but also for your health, to identify and designate a PCP for periodic consultation.
The Trustees are proud to advise that the NASI Welfare Fund now covers all Level 1 and Level 2 In-Network PCP medically necessary usual and customary expenses at 90% coverage with no deductible. This new feature will minimize your out-of-pocket expenses for medical services while protecting the financial integrity of the Fund at the same time.
The Trustees also understand that occasionally time is of the essence and treatment from a PCP is not appropriate under certain circumstances. The NASI Welfare Fund covers In-Network Urgent Care charges at 90% and there is no deductible applied to Urgent Care. The 90% coverage level also applies to In-Network walk-in clinics too. Emergency room visits, however, are subject to the higher cost-sharing split set forth above. Accordingly, you could minimize your out-of-pocket expenses by visiting an Urgent Care facility or even MDLive rather than a hospital emergency room visit.
OptumRx:
New Pharmacy Benefit Manager
Effective January 1, 2024, OptumRx will replace Express Scripts as the pharmacy benefit manager (“PBM”) for all NASI Welfare Fund Participants with Active and pre-Medicare retiree coverage. OptumRx is providing additional information regarding the upcoming transition from Express Scripts. Be on the lookout for incoming mail from OptumRx!
In mid-December, all NASI Welfare Fund Participants with Active and pre-Medicare retiree coverage will receive new insurance cards from BlueCross BlueShield of Illinois which will include OptumRx’s information. Please use your current card through the end of this year and use your new card in 2024.
Mail order remains mandatory with OptumRx for most maintenance prescriptions. Most maintenance drugs which are currently being filled through Express Scripts’ Mail Order program will be automatically transferred to OptumRx’s Mail Order program. However, if your maintenance prescription drug is a controlled substance or no longer has any remaining refills, you will need a new prescription from your doctor to process the medication with OptumRx on (or after) January 1, 2024.
If you are currently participating in Express Scripts’ diabetes management program, Livongo, this program will end on December 31, 2023. All data collected by Livongo will be inaccessible beginning January 1, 2024. Individuals who are currently enrolled in the Livongo program will receive a welcome kit from OptumRx in the upcoming weeks (if not received already), which will include information about OptumRx’s diabetes management program and instruction on how to receive a FREE blood glucose meter.
Finally, the supply limit for specialty medications will adjust from 90 days to 30 days for specialty medications filled on and after January 1, 2024. This change is intended to limit out-of-pocket expenditures for very expensive medications and prevent waste of such medications, particularly in cases where your doctor moves you to another medication in the middle of your course of treatment.
Again, this change in PBM is for Participants and Dependents with Active and pre-Medicare coverage ONLY. Medicare-eligible Retirees and Dependents with coverage through the Medicare Advantage Prescription Drug (MAPD) plan offered by Aetna® are not affected.
Benefit Increases:
Prescription Drug Coverage
The NASI Welfare Fund is pleased to announce two benefit increases for prescription drug coverage, effective January 1, 2024, for Active and pre-Medicare Participants and Dependents with Levels 1, 2, and 3 coverage.
First, all generic (non-specialty) formulary medications filled on and after January 1, 2024 will be covered at 100%, with NO COST to the covered individual.
Second, all preferred brand (non-specialty) formulary medications filled on and after January 1, 2024 will be covered at 85%, with 15% cost to the covered individual for this same population.
Previously, both generic and preferred brand (non-specialty) formulary medications were covered by NASI at 80% for Level 1 and 75% for Levels 2 and 3. There is no change in Plan coverage for non-preferred brand and specialty medications.
Again, this increase in prescription drug coverage is for Participants and Dependents with Active and pre-Medicare coverage ONLY. Medicare-eligible Retirees and Dependents with coverage through the Medicare Advantage Prescription Drug (MAPD) plan offered by Aetna® are not affected.
MDLive
The NASI Welfare Fund continues to provide 100% coverage for telemedicine services through MDLive for the Fund’s Active and Retired participants who are not yet eligible for Medicare. MDLive provides 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. While the cost of the “virtual visit” is covered in full, you will be responsible for costs arising from your virtual visit, like your portion of the cost of a prescription drug that you received as a result of your virtual visit.
Download the mobile app and sign up now before you need it since 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.
Flu shots and other Immunizations
Remember to get your seasonal flu shot from your Blue Cross Blue Shield participating physician or at your local participating pharmacy. Most immunizations, including flu shots, are covered at 100% by the NASI Welfare Fund when using an In-Network provider.
Hinge Health Program
Hinge Health is a virtual musculoskeletal program that gives you the tools needed to conquer back and joint pain, recover from injuries, prepare for surgery, and stay healthy and pain free. Hinge Health’s programs are available for Active members and non-Medicare retirees, and eligible Dependents at no cost. Plus, you can complete your customized care plan anywhere, any time. Contact Hinge Health at (855) 902-2777 or www.hingehealth.com.
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 provides 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, 2024, the hourly contribution rates associated with these benefits are as follows:
- Level 2 Medical Benefits $8.64
- Level 3 Medical Benefits $8.54
- Dental $0.72
- Disability $0.12
- Vision $0.10
- Life $0.01
Pensioners and Beneficiaries who do NOT have Medicare Coverage – NO PREMIUM INCREASE IN 2024
The current monthly self-payment amount for Pensioners and Beneficiaries who are not yet eligible for Medicare will NOT increase in cost from $925. The cost for this population will remain $925 per month in 2024.
Pensioners and beneficiaries whose Local Union have 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.
Pensioners and Beneficiaries WITH Medicare – NO PREMIUM INCREASE IN 2024
The current monthly self-payment amount for Pensioners or Beneficiaries who became eligible for Medicare before 2002 will NOT increase in cost from $320. The cost will remain $320 per month in 2024.
Similarly, for those Pensioners or Beneficiaries who become eligible for Medicare after 2001, the current monthly self-payment cost for coverage will NOT increase in cost from $370. The cost will remain $370 per month in 2024.
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
Effective January 1, 2024, the monthly premium for the NASI Welfare Fund for those participating in the Fund through participation agreements (e.g. owner members) will be $1,905.60.
Benefits for Medicare Retirees
At the beginning of 2023, the NASI Welfare Fund enrolled all Medicare-eligible retirees and Dependents into a comprehensive Medicare Advantage Prescription Drug (MAPD) plan offered by Aetna®. These benefits will remain the same for the 2024 Plan Year. Eligible medical benefits are covered at 100%, with no out-of-pocket expense, and coverage for prescription medications remains at 80% for the majority of generic, preferred formulary, and specialty medications. Non-formulary medications are covered at 70%.
Importantly, the Fund has retained Retiree First, a company that specializes in the ongoing member service of MAPD plans. If you have any issues with your physician, pre-authorizations, referrals, your prescriptions, or your coverage, or if you have any questions about the Aetna® MAPD plan, please contact Retiree First at 855-433-1675 or members@laborfirst.com. Also, Retiree First has posted informational videos available to you on their website (https://retireefirst.com/nasi/), including one relating to referrals/pre-authorizations.
You are still covered by the NASI Welfare Fund, but Aetna® may now be responsible for administering your health and pharmacy benefits. The Fund Office remains responsible for eligibility issues, retiree premiums, and all other benefits such as dental and vision. In the next few weeks, all Medicare-eligible retirees and Dependents should be receiving new insurance cards from Aetna®.
REMINDERS
Notification Requirement upon Divorce
You must notify the Fund Office that you have been divorced within 60 days of the 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 may 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
Forms to designate or change a Beneficiary for your NASI Welfare Fund life insurance benefit, NASI Pension Fund Death Benefit (for Pensioners and Active Single Participants), and SIS Pension Fund death benefit are available on the Funds’ website, www.nasifund.org or by calling the Fund Office. Please ensure your Beneficiary designation is up-to-date.
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
Summaries of Benefits and Coverage for all Levels as well as a list of Preventive Services required by the Affordable Care Act effective January 1, 2024, can be found on the Fund’s website at www.nasifund.org.
New NASI Funds Mobile App
In an effort to provide additional access to your healthcare benefits, the NASI Funds have launched a new mobile app for Members to easily view their benefit information from their mobile devices.
Please use the QR code, above, or visit your device’s app store and search for “NASI Benefit Plan” to download the app.
This letter is intended as a non-technical summary of certain features and changes to the NASI Welfare Fund and its Plan Document and Summary Plan Description (“Plan”), so it does not contain all the details. In the event of a discrepancy between this letter and the official Plan documents, the official Plan documents will prevail. The Board of Trustees, in its sole discretion, may interpret, amend, or terminate the Plan and any of its provisions, in whole or in part, at any time.
