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					                      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.

				
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posted:11/18/2011
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