health-new-PPO-network by liwenting

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									MASSACHUSETTS LABORERS’ HEALTH                                     AND    WELFARE FUND
                                                                                                  __

                      14 NEW ENGLAND EXECUTIVE PARK ● SUITE 200
                      P.O. BOX 4000, BURLINGTON, MASSACHUSETTS 01803-0900
                      TELEPHONE (781) 272-1000 OR (800) 342-3792 ● FAX (781) 238-0703

July, 2006


Dear Member and Eligible Dependents:

Effective September 1, 2006, the Board of Trustees of the Massachusetts Laborers’ Health and Welfare Fund
is pleased to announce that members and their eligible dependents will have access to a new Preferred
Provider Organization (PPO) health care network for covered services under a new arrangement with Blue
Cross Blue Shield of Massachusetts. This new PPO network arrangement will not affect your current
plan of benefits, and will enable you to access an extensive nationwide network of providers through the
preferred provider network of any Blue Cross Blue Shield Plan.

It is important to emphasize that HealthCare Value Management (HCVM), your current PPO network, will
be discontinued as of August 31, 2006. However, it is anticipated that most of your current providers will
also participate with the local Blue Cross Blue Shield Plan’s PPO network within your state, so you should
experience little disruption in receiving your ongoing “in-network” benefits. You may also continue to
receive your health care from any provider and your out-of-network benefits will remain the same, as
discussed in your Summary Plan Description. If you receive care from a provider that is in your current
HCVM Network, but not in the new Blue Cross Blue Shield PPO Network on or after September 1, 2006,
your provider will be considered “out-of-network.”

To receive the highest benefit level (in-network benefits) under your Plan, you need to choose providers who
participate in the Blue Cross Blue Shield PPO Provider network. Blue Cross Blue Shield offers many types
of plans with different networks of providers. There are some Blue Cross Blue Shield providers who do not
participate in the PPO network. If you seek care from a Blue Cross Blue Shield provider who is not part of
the PPO network of providers, services will be considered out-of network, and will be paid at out-of-network
benefit levels.

The network is responsible for selecting qualified professionals to provide approved MEDICAL services.
The selection of the health care professionals and service providers that you use, however, is solely your
responsibility. The Trustees take no responsibility for the qualification or actions of any individual provider
of care, goods or services. Also note that the network providers may provide care that is not covered by the
Plan; consult your Summary Plan Description for a description of your benefits.

To Locate a Blue Cross Blue Shield PPO Provider in your State

You may utilize the services of any of the Blue Cross Blue Shield Plan’s Preferred Providers as “in-
network” providers. For example, if you are a Massachusetts resident, you will more than likely utilize a
Massachusetts-based provider, however, you could also use the services of any of the Blue Cross Blue Shield
preferred providers nationwide. To locate a PPO provider of any state, simply call Blue Cross Blue Shield at
1-800-810-BLUE (1-800-810-2583) or simply access their website at www.BCBS.com, or starting in
September, 2006, visit our website www.MLBF.org.

Since there are always changes occurring with the professional services network, it is strongly suggested
that you ask a provider if they are participating members of your specific state Blue Cross Blue Shield
Preferred Provider Organization, or access the Blue Cross Blue Shield website to obtain a provider’s current
network status prior to receiving care.

New Medical Identification Cards

For this new Blue Cross Blue Shield PPO network arrangement you will be receiving a new identification
card. Be sure to show this new card to all health care providers at the time of service, whether in-
network or not. This is vital to insure that your medical expenses are sent directly from the provider to the
Blue Cross Blue Shield Plan servicing your area. When you next see a health care provider that you are now
using, please be sure to point out that your network has changed and that you have a new identification
number: “UEM” followed by your Blue Cross Blue Shield identification number. It is extremely
important that your provider include the “UEM” prefix when submitting claims on your behalf to the
local Blue Cross Blue Shield Plan. For this reason, you must show the provider your new identification
card when receiving health care services.

Claims Submissions

YOUR HEALTH CARE PROVIDER MUST SUBMIT ALL CLAIMS TO YOUR BLUE CROSS
BLUE SHIELD OFFICE. The only exceptions are inpatient and/or outpatient claims incurred for
substance/alcohol abuse and nervous/mental illness, and complementary care benefits: biofeedback,
homeopathy, massage therapy, naturopathy, nutrition and Oriental medicine. As a reminder, all of the above
identified benefits must be precertified, and all concurrent substance/alcohol abuse claims and all
nervous/mental illness claims must be reviewed for utilization and case management by the Wellness
Corporation before the claim can be processed by the Fund office. The Wellness Corporation telephone
number is 1-800-522-6763. Those claims must be mailed to the Massachusetts Laborers’ Health and Welfare
Fund, P. O. Box 4000, Burlington, Massachusetts 01803-0900.

Under the new network arrangement, Blue Cross Blue Shield will review all other concurrent claims for
utilization review and case management, instead of the Wellness Corporation.

Other Benefits

There are no changes to any of the following benefits or how you receive them from providers:

      Pharmacy Benefits
      Dental Benefits
      Vision Benefits
      MAP Program

If you have any questions and need further clarification of this Preferred Provider Organization Network,
contact the Fund office directly at 1-800-342-3792.

Very truly yours,



Board of Trustees
Massachusetts Laborers’ Health and Welfare Fund

								
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