Iron Workers DC of New England Welfare Fund
The Iron Workers District Council of New England Health and Welfare Fund provides benefits for you and your eligible dependents and it is a self-insured Fund. The SPD linked below describes benefits for Active Employees, Self-Pay Employees, and Retired Employees. There is also a Special Basic Buy-in plan for employees who prefer a less expensive Plan with limited coverage. If you are an active employee, you are eligible to participate in the Medical, Dental, Vision, Prescription Drug, Alternative Care Benefit, Physical Exam, Home Health Care, Hearing, and Weekly Accident and Sickness benefits. To be considered an active employee you must work either a minimum of 600 hours per eligibility period, 1200 hours during the last two periods, or 2400 hours (beginning on the August 1,2008 eligibility period) over the last three periods. Retirees and their families under age 65 and not eligible for Medicare may obtain coverage. Coverage in the Retiree Plan is not automatic; you must enroll and make monthly premium payments to the Health and Welfare Fund Office. Retirees do not have Dental, other than one cleaning/exam per year, Weekly Accident and Sickness or Alternative Care coverage. Please refer to the SPD below or the copy supplied to you by the Fund Office for additional information on your Health & Welfare benefits.

Frequently Asked Questions

How many hours do I need to become eligible?

Your eligibility for benefits from this Plan is determined twice a year—on February 1 and August 1.

You are eligible if:

  • You’ve worked 600 hours in the six-month work period immediately prior to the effective date; or
  • You’ve worked 1200 hours in the 12-month work period immediately prior to the effective date; or
  • You’ve worked 2400 hours in the 18-month work period immediately prior to the effective date.

 

Who do I contact with questions about my health benefits?

You should contact the Iron Workers Fund office at 617-265-3757 with questions on member eligibility, vision benefits, disability benefits and life insurance.

You should contact Iron Clad Insurance at 617-436-3500 with questions on medical and dental claims, prescription benefits and dependent eligibility.

How do I find a doctor covered under the plan?

The Health and Welfare Fund offers benefits and care from a network of doctors and hospitals through Cigna CareAllies and Tufts CareLink Health Plan. You may contact them at CareAllies: 1-800-768-4695.
www.tuftshealthplan.com/carelink/ironworkers

What is the copayment for a physician's office visit?

In network providers: A $20 copayment per visit will apply, then the visit is paid at 100% of the PPO rate, no deductible applies.

Out of network providers: You will pay 40% of Reasonable and Customary charges after the yearly deductible has been met.

What is the annual deductible?

Individual $300.00
Family $600.00

What are the copayments for pharmacy benefits?

The Plan provides coverage for prescription medication that you purchase from a retail pharmacy. You may receive a 34-day supply. Your copayment is based on the type of drug prescribed:

  • $15 copayment for generic drugs;
  • $30 copayment for preferred brand-name drugs;
  • $45 copayment for non-preferred brand name drugs.

You can receive up to a 100-day supply of maintenance medication at one time from the mail order service prescription program. When you use the Mail Order Program, your copayments are:

  • $30 copayment for generic drugs;
  • $60 copayment for preferred brand-name drugs;
  • $90 copayment for non-preferred brand-name drugs.

Who do I contact to use my vision benefits?

Vision benefits covered by the Plan are administered by Davis Vision. You can contact them for a list of providers and for benefit information at 1-800-999-5431 or atwww.Davisvision.com.

When you or your dependents need vision care services, call the network provider of your choice and schedule an appointment. You should identify yourself as an Iron Workers District Council of New England Welfare Fund member and the provider’s office will verify your eligibility for services.

Should you choose to use a non-participating provider you must pay for services in full and file your own claim form with Davis Vision. Reimbursements are made according to a schedule.

What are the disability benefits covered under the plan?

Disability benefits are covered for active member coverage only.

The Plan pays a $250 weekly disability benefit if you become totally disabled due to an illness or a non-work related injury and are unable to work while you are covered by this Plan up to a maximum of 26 week for any one continuous period. This benefit also includes hours posted toward Health & Welfare eligibility and Pension credits. Please contact the Fund office for an application and eligibility questions.

The Plan provides coverage for Long Term Disability of $1000.00 per month after a 120 day waiting period. The Long Term Disability plan is administered by Standard Insurance Company, please contact the Fund Office for an application and eligibility questions.

If you have been injured due to a Work related injury, please contact the Fund Office about your benefits, you may be eligible for Long Term Disability benefits and pension credited hours.

 

What are the life insurance benefits?

Life Insurance benefits are covered for active member coverage only.

The Plan provides coverage for a $30,000 Life Insurance policy and an additional $30,000 Accidental Death and Dismemberment Coverage policy. Life insurance benefits are administered by Aetna Insurance Company. In the event that this benefit becomes payable, beneficiaries should contact the Fund office.

Beneficiary forms are provided at the time of eligibility and can be updated at any time. Please be sure to keep your beneficiary forms up to date, signed original forms should be submitted to the Fund Office.

Documents and Forms