2024 - NAS METAL TRADES WELFARE FUND BENEFIT ANNOUNCEMENT
Wednesday, December 20, 2023
December 2023
To All Participants in the NAS Metal Trades Welfare Fund
From the Board of Trustees
Increase in NAS Metal Trades Welfare Fund Contributions – May 2024
There are three Plans of Benefits provided by the National Automatic Sprinkler (“NAS”) Metal Trades Welfare Fund. The contribution rate for each of these Plans of Benefits was set effective September 1, 2014, and has not increased since that time. The current contribution rates are as follows:
- Plan A $5.10 per hour
- Plan B $4.80 per hour
- Plan C $4.25 per hour
The Board of Trustees (in reviewing the growing costs of healthcare coverage) agreed to increase the contribution rates of each NAS Metal Trades Welfare Plan by $0.50 per hour, beginning May 1, 2024. Therefore, the contribution rates for the NAS Metal Trades Plans will increase to the following rates, effective May 1, 2024, as follows:
- Plan A $5.60 per hour
- Plan B $5.30 per hour
- Plan C $4.75 per hour
The retiree medical Premium rates for the NAS Metal Trades Welfare Fund will remain the same for 2024. The retiree medical premium rates for NAS Metal Trades Plans A and B remain as follows:
- Plan A – Non- Medicare $160.00 per month
- Plan A – Medicare $140.00 per month
- Plan B – Non-Medicare $150 per month
- Plan B – Medicare $130 per month
The Trustees evaluate the Fund’s financial condition on an annual basis and determine the appropriate contribution rates.
OptumRx: New Pharmacy Benefit Manager
Effective January 1, 2024, OptumRx will replace Express Scripts as the pharmacy benefit manager (“PBM”) for all NAS Metal Trades Welfare Fund Participants with Active and pre-Medicare retiree coverage. In the coming weeks, you will receive additional information regarding the upcoming transition from Express Scripts to OptumRx.
In mid-December, all NAS Metal Trades Welfare Fund Participants with Active and pre-Medicare retiree coverage will receive new insurance cards from BlueCross BlueShield of Illinois which will include your new PBM’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, and all your data collected with this program will be inaccessible, beginning January 1, 2024. If you currently participate in the Livongo program, you should receive a welcome kit from OptumRx in the upcoming weeks (if not received already) which will include information about OptrumRx’s diabetes management program and instructions 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.
REMINDERS
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 NAS Metal Trades Welfare Fund when using an In-Network provider.
Benefits for Medicare Retirees
At the beginning of 2023, the NAS Metal Trades 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 require a reasonable copay.
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, referrals, pre-authorizations, 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 NAS Metal Trades Welfare Fund. 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®.
Annual Reminder regarding Women’sHealth and Cancer Rights Act of 1998
The NAS Metal Trades 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.
Notification Requirement upon Divorce
You must notify the Fund Office that you have been divorced 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 may recover 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.
Blue Distinction Centers
Remember to take advantage of Blue Distinction Centers. The Blue Cross Blue Shield (“BCBS”) Association has identified specific hospitals across the nation that have demonstrated expertise in delivering specialty care. Some of these facilities are close to where you live. The BCBS evaluation process involves reviewing the expertise of the medical team, the number of times the facility has performed the procedure, and the facility’s track-record for procedure results. Facilities identified as “Blue Distinction Centers” have a proven track- record for delivering better results such as fewer complications and fewer readmissions than facilities not recognized as Blue Distinction Centers.
Blue Distinction Centers delivering the following types of specialty care have been identified:
- Bariatric Surgery
- Cardiac Care
- Knee and Hip Replacement
- Maternity Care
- Spine Surgery
- Transplants
If you or someone in your family is contemplating a procedure (e.g., surgery, delivery) in one of the above medical categories, the Board of Trustees encourages you to consider doing so at a facility that specializes in that care. Finding the right facility can lead to better medical outcomes, fewer complications, less readmissions for the same condition, lower hospital acquired infection rates, and lower mortality rates. Better care is better for you and will likely result in lower medical costs to you and the Fund.
Some of the facilities identified as Blue Distinction Centers also have lower costs associated with their high-quality care. Facilities that are considerably more efficient at providing expert specialty care have been further classified as “Blue Distinction Centers +”.
Blue Distinction Center Finder
Use the “Blue Distinction Center Finder” link on the Welfare Fund’s website, www.nasifund.org. You can search for the particular specialty you need (e.g. cardiac care), and you can filter your search to the state or states you are willing to go to in order to receive the best care available. Call the Fund Office at 1-800-638-2603 for more information.
Summary of Benefits and Coverage
Summaries of Benefits of Coverage for the Plans of Benefits 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 and NAS Metal Trades Funds Mobile App
In an effort to provide additional access to your healthcare benefits, the NAS Metal Trades and 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 NAS Metal Trades 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.
