Hearing Aid Benefit That’s Not All! If you or one of your family The Boston Teachers Union Health and members needs a hearing Welfare Fund also offers some unique aid, the Plan will pay up to “extras” to add to your total benefits $600 toward its purchase, once every five years. To be package. Boston Teachers Union eligible, you’ll need to have a physician’s authorization for a hearing test at an • Recreational Benefit (Teachers only) Get your exercise by playing for the Health and Welfare Fund approved facility and a prescription for a Fund’s Softball League or participating hearing aid. Contact the Fund Office at in the Fun Run. 617-288-0500 for more information. • Funeral Expense Benefit (Teachers only) If you die, the Plan will reimburse Hospitalization Income Supplement funeral expenses up to $1,000. Benefit (For Covered Teachers Only) • Medic-Alert Benefit The Plan will pay If you’re hospitalized for more than a for one medic-alert bracelet or necklace week, the Plan will pay you a benefit of if you or a family member has a medical $150 per week for up to 51 consecutive condition that needs to be identified in weeks of hospitalization to supplement an emergency situation. Contact the your income. Please refer to the Benefit Fund Office for a claim form. Plan Information Booklet for more details. • Prepaid Legal Services Benefit You and your family get a legal services ben- Supplemental Mental Health Benefit efit funded through a separate trust fund by contributions from the School To supplement the mental health coverage Committee. Contact the Fund Office for your City of Boston medical plan pro- more information and the Booklet vides, the Health and Welfare Fund offers describing this benefit. Educational and Training Seminars. Speakers cover topics such as stress man- agement and assertiveness training. Information in this brochure is accurate as of 1 August 2002. This brochure provides a brief summary of your benefits as a member of the Boston Teachers Union Boston Teachers Union Health and Welfare Fund. For specific eligibility requirements and details about your benefits, contact the Fund Office. Health and Welfare Fund 180 Mount Vernon Street The Trustees reserve the right to change or adjust the Plan benefits as they deem appropriate and they have the right to make final and binding decisions about any Plan benefits. The full plan of benefits is contained in the formal Plan documents. If there is any discrepancy Boston, Massachusetts 02125 between this summary and the formal Plan documents, those documents govern. To schedule an appointment: Schedule your eye Call the Harvard Dental Center to exam! make an appointment for you or Call the Eye Care Center at your eligible family member at 617- 617-288-5540 to make an Boston Teachers Union 432-1434 between 8:00 a.m. and 5:00 p.m., Monday through appointment. Health and Welfare Fund Saturday. Learn About Your Fund Benefits Your Plans cover: There is no annual maximum Standard Plan If you do not use a dentist who partici- Benefit Plan Information Booklet, Eye Care Benefit Other Eye Care Benefits We want you to take a few minutes to • A semi-annual dental exam amount the Plan will pay for The Plan will pay up to $1,725 per year pates in the Standard Plan, the Plan will whichever is less. Routine eye exams are an important part of • Sunglasses. If your eye learn about all of the benefits that are dental care (other than ortho- (for other than orthodontic services) for pay 80% of the dentist’s charge or 80% of your overall health. That’s why the Boston exam shows that you (or a • X-rays as required the amount listed in the Schedule of Here is a comparison of the costs of some available to you and your eligible family dontia) when you receive dental care for you and each of your cov- Teachers Union Health and Welfare Fund family member) do not • Semi-annual cleanings Covered Dental Procedures in your common dental procedures. members. services at the Harvard Dental ered family members. Your Benefit Plan offers free, comprehensive eye exams and a need prescription eye- • Dental services (other than orthodon- Center. Consult your Benefit Information Booklet shows the detailed pair of prescription glasses for you and your glasses, you may receive The Board of Trustees of your Health and tia), no annual or lifetime maximum Plan Information Booklet for amount the Plan will pay for each service. family once every two years. Dependent chil- one pair of non-prescription sunglasses Welfare Fund provides you with a gener- exact copayments for services. Standard Plan* (Harvard Plan) You will pay the difference between what dren are eligible for an eye exam and eyeglass- once every two years. ous and valuable package of benefits. your dentist charges and what the Fund Average Dentists’ Fund Payment Schedule Member es, if required, once each year. Adults age 40 • Dental services (other than orthodon- The chart below compares your coverage • Replacement glasses. Covered Your health and well-being are important pays. Charge Responsibility and over are entitled to an eye exam each tia), up to a maximum of $1,725 per under both Plans. It’s your choice! Teachers can receive a replacement pair to us, and that’s why we designed the year, and, if required, a change of lenses only. year (Standard Plan) of glasses at no charge if the glasses are Fund’s health and welfare benefits to sup- Cleaning $65.00 $56.58 $8.42 • Orthodontia—for adults and children, Your Dental Coverage At-A-Glance lost or stolen while the teacher is on plement your City of Boston medical plan To receive your eye care, you must visit the up to a lifetime maximum benefit of school property or involved in a school- coverage, giving you outstanding health Harvard Faculty Group Standard Plan Two Surfaces Filling $110.00 $73.62 $36.38 Boston Teachers Union Eye Care Center, $2000 related function. Original glasses must benefits. Practice Benefit located at 180 Mount Vernon Street in Root Canal $700.00 $496.53 $203.47 have been obtained through the Eye Each June you have the opportunity to Boston (Dorchester). Call 617-288-5540 for Annual Maximum No maximum applies $1,725 per person per year. Care Center. This is a one-time benefit. Dental Care change your choice of dental option at an appointment. the Fund Office. Your new choice will Benefit* After that, you are responsible for Full Single Crown $780.00 $540.42 $239.58 The Fund offers great den- take effect on 1 September. any dental expenses you incur tal coverage that allows you Your Eye Care Coverage At-A-Glance to choose how you and Harvard Dental Center -Convenience, Preventive (oral exams, No copayment The Plan pays the fee schedule Eye Care Benefit Who's Eligible? How Often? your eligible family mem- Care and Quality cleanings, x-rays) amount. Your copayment is the Harvard Faculty Group Practice Benefit bers receive dental care. Through the Harvard Dental Center, you difference between what your den- Eye Exam Covered Teachers and Once every two years You can choose between: tist charges and the Plan Harvard Dental Fund Payment Schedule Member spouses under 40 can take care of all of your dental needs Center Discounted Responsibility in one convenient location. General den- payment • The Harvard Faculty Group Practice Fee Covered Teachers and Once every year (if required) Benefit—The Harvard Dental Center, tists, specialists and hygienists are all on Other Dental Procedures Subject to a copayment. The Plan pays the fee spouses 40 and over a state-of-the-art facility and a world- site at the Harvard Dental Center, where Check your Benefits Plan schedule amount. Your Cleaning $47.78 $47.78 $0.00 the dentists are also faculty members of Eligible dependent children Once every year (if required) class staff in Boston; or Information Booklet for the copayment is the difference the Harvard School of Dental Medicine. amount of your copayment between what your dentist Two Surfaces Filling $82.88 $73.88 $9.00 Prescription Eyeglasses Covered Teachers and Once every two years • The Standard Plan, which allows you Outstanding quality and a world class dependents charges and the Plan payment to choose from network dentists or dental staff too! Root Canal $641.55 $570.55 $71.00 non-network dentists. With this Plan, Lifetime Maximum $2,000 per person $2,000 per person $100 toward the purchase Covered Teachers and spouses Once every two years you’ll pay more out of pocket costs. Benefit for Orthodontics Full Single Crown $776.10 $550.10 $226.00 and fitting of contact lenses (only if a further expense is (only if required for correction authorized and incurred) *Other than orthodontia benefits *This example is shown for illustrative purposes only. The charges represent average charges submitted to the Standard Plan. Under the Standard Plan, your actual costs of a medical eye problem) Eligible dependent children Once every year will vary depending on the providers' charge and specific procedure codes for services provided.