2025 - NASI WELFARE FUND BENEFIT ANNOUNCEMENT
Monday, December 30, 2024
December 2024
To All Participants in the National Automatic Sprinkler Industry Welfare Fund
From the Board of Trustees
Retirement of Fund Administrator
With a debt of gratitude for his many years of service, the NASI Trust Funds announce the upcoming retirement of the Fund’s Administrator, John Eger in January 2025. John has worked for the NASI Trust Funds for over 40 years. Prior to becoming Administrator of the Funds in 2020, John served as the Funds’ Assistant Administrator for almost 19 years. John’s professionalism, knowledge, and guidance throughout his career have been a true asset of the NASI Funds. We wish John all the best in retirement and thank him for his exceptional years of service.
John will be replaced by the Assistant Fund Administrator, Anna Bosmans. Anna has been with the Trust Funds for close to 15 years.
Level 1 General 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
The NASI Welfare Fund also has specific in-network services which are covered at 90% (as opposed to the typical 80% coverage) with no deductible. These services include:
- Medically-necessary claims from an In-network Primary Care Physician for Levels 1 and 2
- In-network Urgent Care claims
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-threating 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 own health, to identify and designate a PCP for periodic consultation.
The Trustees also understand that occasionally time is of the essence and treatment from a PCP is not appropriate under certain circumstances. While emergency room visits are subject to the higher cost-sharing and deductible set forth above, you could minimize your out-of-pocket expenses by visiting an Urgent Care facility or even MDLive rather than a hospital emergency room visit.
Prescription Drug Coverage:
Active and Pre-Medicare
Beginning in 2024, OptumRx became the new pharmacy benefit manager (“PBM”) for all NASI Welfare Fund Participants with Active and pre-Medicare retiree coverage. With the change in PBMs, the NASI Welfare Fund Trustees also increased the coverage for generic and preferred brand coverage in 2024 for Levels 1, 2, and 3 where these Participants and Dependents now receive generic medications at 100% coverage and preferred brand non-specialty medications at 85% coverage.
2025 OptumRx Changes for GLP-1 Users
The NASI Welfare Fund (along with many other prescription drug plans) has seen a surge in new prescriptions for GLP-1 medications which are used for the treatment of Type 2 diabetes, weight loss, and heart conditions. Popular GLP-1 medications which you may have heard include Ozempic and Wegovy.
Many of these medications have multiple dosage changes for calibrating appropriate tolerance for treatment. In an effort to curb the waste of these prescriptions, the NASI Welfare Fund will (beginning in January 2025) limit the first 3 fills of new GLP-1 prescriptions to a 30-day supply. Any change in dosage will initiate a new 30-day supply limitation on the first 3 fills of that dosage. At the 4th refill of a specific GLP-1 dosage, you may then refill as a 90-day supply.
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 downloading the app once you are sick. Follow the link to the MDLive website found on the nasifund.org website, NASI’s mobile app, or on MDLIVE.com/bcbsil.
Mental Health Coverage
The NASI Board of Trustees understands that your mental health is an important part of your overall health. Along with the benefits available through in-network mental health providers, NASI also provides to Active and pre-Medicare Participants additional mental health benefits at no cost through not only MDLive, but also through our newest provider, Spring Health.
Spring Health provides free access to both in-person and virtual mental health and substance use disorder providers. As an active or pre-Medicare NASI Participant, you and your eligible family members will receive 8 free therapy sessions (2 of the 8 can be used as medication management) and 8 free coaching sessions each calendar year through Spring Health with a wide network of mental health specialists. If, after completing your 8 therapy sessions, you need to continue care with your therapist, Spring Health will help transition your therapy to in-network care. Reach out to Spring Health at 855-629-0554 to set up your evaluation and care plan.
For NASI’s Medicare Participants, AETNA’s MAPD plan provides 100% coverage for therapists and psychiatrists who accept Medicare. There are also mental health services available through AETNA’s telehealth services – Teladoc. Please reach out to Retiree First (855-433-1675) if you are enrolled in AETNA’s MAPD program and need assistance accessing mental health services.
If you find yourself or someone you know is experiencing a mental health crisis, help is available. The national suicide and crisis hotline can be reached by calling or texting 988.
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, 2025, the hourly contribution rates associated with these benefits are as follows:
- Level 2 Medical Benefits $9.03
- Level 3 Medical Benefits $8.92
- Dental $0.73
- Disability $0.12
- Vision $0.10
- Life $0.02
Pensioners and Beneficiaries who do NOT have Medicare Coverage
The current monthly self-payment amount for Pensioners and Beneficiaries who are not yet eligible for Medicare will increase in cost from $925 in 2024. The cost for this population will increase to $980 per month in 2025.
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. All locals have authorized RESA subsidy increases for their pre-Medicare Pensioners and Beneficiaries to cover some or all of the $55 premium increase in 2025.
Pensioners and Beneficiaries WITH Medicare – NO PREMIUM INCREASE IN 2025
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 2025.
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 2025.
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, 2025, the monthly premium for the NASI Welfare Fund for those participating in the Fund through participation agreements (e.g. owner members) will be $1,984.00.
Important Changes for Medicare Participant Coverage
Beginning in 2025, Federal regulations are changing the maximum amount individuals with MAPD coverage can pay out of pocket on prescription medications to $2,000. However, this new change does not adjust the $2,900 Maximum Out-of-Pocket limitation of the NASI Welfare Plan.
What that means for our Medicare-Eligible Retirees and Dependents: NASI Plan rules state that if an individual meets the Plan’s Maximum Out of Pocket limitation in one calendar year, that individual will receive 100% coverage for the following Plan Year after satisfaction of their deductible for the year. Those covered NASI Welfare Fund Pensioners and Beneficiaries who are currently eligible for Medicare on January 1, 2025, will never reach the Plan’s Out of Pocket Maximum of $2,900 because the new federal regulation will only allow individuals to pay a maximum of $2,000 (or less) out of pocket for prescriptions before prescription claims are covered at 100% for the remainder of the year. Since these individuals will not meet the Plan’s Out of Pocket Maximum in a Calendar Year, their individual Out of Pocket Maximum will reset at the beginning of each Plan Year.
Those Medicare-eligible Participants who have met the Plan’s Maximum Out of Pocket ($2,900) for 2024 will have 100% coverage in 2025. This new regulation only relates to Maximum Out of Pocket limitations for years 2025 forward.
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 2025 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%. As noted previously, the Inflation Reduction Act has now lowered the maximum amount NASI’s Medicare retirees will pay to no more than $2,000 per year.
Retiree First remains the NASI Welfare Fund’s member advocate for all NASI retired members and dependents enrolled in the Aetna® MAPD plan. 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.
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, 2025, can be found on the Fund’s website at www.nasifund.org
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.
