2026 - NASI WELFARE FUND BENEFIT ANNOUNCEMENT
Thursday, December 18, 2025
December 2025
To All Participants in the National Automatic Sprinkler Industry (“NASI”) Welfare Fund
From the Board of Trustees
Introduction
This notice summarizes certain features of the NASI Welfare Fund and recent changes to the benefits it offers to participants and dependents. We encourage you to read this notice carefully and to contact the Fund Office if you have any questions.
Level 1 Coverage
In general, the 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
The NASI Welfare Fund covers certain In-Network services at 100% (instead of the standard 80% rate) with no deductible. These services include:
- MDLive (for virtual doctor visits).
- Routine annual physical examinations.
- Preventive Services required by law as listed on the Fund’s website at www.nasifund.org
- Ιn-Network Medically Necessary colonoscopies.
- In-Network mammogram screenings.
90% Coverage for PCP Visits and Urgent Care
The NASI Welfare Fund covers certain In-Network services at 90% (instead of the standard 80% rate) with no deductible. These services include:
- Medically Necessary In-Network Primary Care Physician Office Visit Claims 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. In addition, it is more cost effective for everyone––participants and the Fund––if you visit your PCP rather than an emergency room for treatment that can be provided by a PCP.
The Trustees understand that, occasionally, time is of the essence and treatment from a PCP is not feasible or appropriate under certain circumstances. Because emergency room visits are subject to higher cost-sharing levels, you could minimize your out-of-pocket expenses by visiting an Urgent Care facility—or even MDLive—rather than an emergency room.
Prescription Drug Coverage (Active & Pre-Medicare)
OptumRx is the pharmacy benefit manager for all participants with active and pre-Medicare retiree coverage. Under Level 1, OptumRx covers generic non-specialty drugs at 100%, preferred brand non-specialty drugs at 85%, preferred specialty drugs at 80%, and non-preferred drugs at 70%.
No GLP-1 Coverage for Weight Loss or Sleep Apnea
The Fund has seen a surge in expenses resulting from prescriptions for GLP-1 medications such as Zepbound. These drugs are sometimes prescribed for weight loss, obstructive sleep apnea, diabetes, and cardiovascular disease.
Effective for prescriptions filled on and after January 1, 2026, the Fund will not cover GLP-1 medications prescribed for weight loss or obstructive sleep apnea. The Fund will continue to cover Medically Necessary GLP-1 medications prescribed for: (1) diabetes when you have a documented diagnosis of Type 2 diabetes, or (2) cardiovascular disease when you have a documented risk of cardiovascular disease and a documented cardio-vascular incident, subject to prior authorization from OptumRx and all applicable Plan provisions.
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 any medication you are prescribed during the visit.
Download the mobile app and sign up now before you need it since you might not feel like doing so once you are sick. Visit MDLive.com/bcbsil or follow the MDLive link on the Fund’s website or mobile app.
Mental Health Coverage
The Trustees understand that your mental health is an important part of your overall health. Along with the mental health benefits available through Blue Cross Blue Shield and MDLive, the NASI Welfare Fund also offers additional benefits through Spring Health.
Spring Health offers access to a broad range of in-person and virtual mental health and substance use disorder specialists. Active and pre-Medicare eligible participants may receive up to 8 free therapy sessions (2 of which can be used for medication management) and 8 free coaching sessions per calendar year. If, after completing your 8 therapy sessions, you need to continue treatment, your Spring Health visits will be billed at the In-Network rate through Blue Cross Blue Shield. Please contact Spring Health at 855-629-0554 for more information about these important benefits.
For Medicare-eligible participants, Aetna® provides 100% coverage for therapists and psychiatrists who accept Medicare. Aetna® also offers mental health services available through Teladoc. Please contact RetireeFirst at 855-433-1675 if you require assistance with accessing these services.
Finally, if you 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 physician or at your local participating pharmacy. Most immunizations, including flu shots, are covered at 100% when using an In-Network provider.
Non-Medical Benefits Available Under Levels 2 and 3
The vast majority of those eligible for benefits from the NASI Welfare Fund receive Level 1 benefits, which include non-medical benefits such as dental, vision, disability, and life insurance. The NASI Welfare Fund also provides two other levels of medical benefits that 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 following: dental, vision, disability, and life insurance. Effective January 1, 2026, the hourly contribution rates associated with these benefits are as follows:
- Dental $0.73
- Disability $0.12
- Vision $0.10
- Life $0.02
Monthly Cost of Pre-Medicare Retiree Coverage
Effective January 1, 2026, the monthly self-payment amount for pensioners and beneficiaries who are not yet eligible for Medicare will increase from $980 to $1,100.
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.
Monthly Cost of Medicare Retiree Coverage
Effective January 1, 2026, the monthly self-payment amount for pensioners and beneficiaries who became eligible for Medicare before 2002 will increase from $320 to $345.
Effective January 1, 2026, the monthly self-payment amount for pensioners and beneficiaries who became eligible for Medicare after 2001 will increase from $370 to $395.
Pensioners and beneficiaries whose Local Union has a 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.
Monthly Cost for Those Participating in the NASI Welfare Fund through Participation Agreements
Effective January 1, 2026, the monthly self-payment amount for those participating in the NASI Welfare Fund through participation agreements (e.g., owners) will increase from $1,984 to $2,176.
Changes for Medicare-Eligible Participants
Effective January 1, 2026, the Aetna® Medicare Advantage Prescription Drug (MAPD) Plan for Medicare-eligible participants will transition to an Aetna® Medicare Advantage (MA) plan (medical coverage) and an Aetna® Medicare Rx plan (pharmacy coverage) offered by SilverScript. This change is being made to address the increasing cost of coverage.
Two ID Cards; No GLP-1 Coverage for Weight Loss
But for the elimination of coverage for GLP-1 medications for weight loss, your coverage will remain the same; however, you will have a separate ID card for each plan. Be sure to bring both medical (MA) and prescription (PDP) ID cards with you. You will not need new prescriptions.
Maximum Annual Payment for Prescription Drugs
During 2026, the maximum amount you can pay for covered prescription drugs will be $2,100.
Prescription Drug Out-of-Pocket Maximum Rules for Participants who Transition to Coverage with Aetna®
For 2026 and future years, the prescription drug out-of-pocket maximum for all Medicare-eligible individuals covered by Aetna® resets when transitioning to coverage with Aetna® and at the beginning of each year, without exception and without regard to whether (or when) such individuals reach the Fund’s out-of-pocket maximum for actives and pre-Medicare retirees. For example –
Example 1. If you reach the Fund’s $2,900 out-of-pocket maximum during 2025, and you transition to coverage with Aetna® as a Medicare-eligible retiree, you will not be treated as reaching your out-of-pocket maximum for 2026 and instead will be required to pay for covered medications, subject to the maximum payment amount of $2,100.
Example 2. If you reach the Fund’s $2,900 out-of-pocket maximum during 2026, and you transition to coverage with Aetna® as a Medicare-eligible retiree during 2026, your out-of-pocket maximum will reset upon transitioning to coverage with Aetna® and you will be required to pay for covered medications, subject to the maximum payment amount of $2,100.
For clarity, unlike active and pre-Medicare retiree coverage, there is no deductible, coinsurance, or copays for covered medical services.
Contact RetireeFirst for Help with Aetna®
RetireeFirst remains the member advocate for all Medicare-eligible participants covered by Aetna®. If you have an issue with your physician, prescriptions, prior authorizations, referrals, or your coverage, or if you have any questions, contact RetireeFirst at 855-433-1675 or members@laborfirst.com. RetireeFirst has informational videos available on its website, including one about prior authorizations and referrals (retireefirst.com/nasi/).
Contact the Fund Office for Help with Other Issues
You are still covered by the NASI Welfare Fund, but Aetna® is 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.
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 Designation is Current
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 designations remain 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 covered Preventive Services, can be found on the Fund’s website at www.nasifund.org.
NASI Funds Mobile App
In an effort to provide easy access to important information about your benefits, the NASI Funds offer a mobile app for handheld devices.
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 recent changes to the rules of the NASI Welfare Fund, so it does not contain all the details. In the event of a discrepancy between this letter and the official Plan document, the official Plan document, as interpreted and applied solely by the Trustees pursuant to their exclusive discretionary authority, will prevail. The Trustees reserve the right to modify the official Plan document and the benefits offered by the NASI Welfare Fund at any time. Notwithstanding the foregoing, in the event of a discrepancy between this letter and the official plan documents for Medicare-eligible participants covered by Aetna®, those official plan documents, as interpreted and applied by Aetna®, will prevail.
