TeleData Health & Welfare
Empowering IBEW Local 212 Members with Comprehensive Resources
Introduction to the Plan
MAJOR MEDICAL BENEFITS
All benefits will be based upon Reasonable & Customary allowances.
Network (PPO Providers)
Calendar Year Deductible
| Per Individual | Per Family |
|---|---|
| $ 500.00 | $1,000.00 |
Most eligible charges will generally be paid at 80% until the maximum out-of-pocket amount has been satisfied. After the maximum out-of-pocket amount has been satisfied, 100% payment on eligible charges thereafter for that individual for the remainder of that Calendar Year.
Maximum Out-of-Pocket Expense per Calendar Year (including the deductible)
| Per Individual | Per Family |
|---|---|
| $2,500.00 | $5,000.00 |
PRESCRIPTION DRUG BENEFITS
| Calendar Year Deductible per Individual | $25.00 |
| Maximum Out-of-Pocket Expense per Calendar Year | $2,500.00 |
| Retail Copay at a Sav-Rx Pharmacy, up to a 34-day supply | You pay 20% |
$5.00 minimum on generic
$20.00 minimum on brand
| Retail Copay at a Non- Sav-Rx Pharmacy, up to a 34-day supply | You pay 50% |
| Sav-Rx Mail Order Copay, up to 90-day supply | You pay 20% |
$5.00 minimum on generic
$20.00 minimum on brand
Plan Details
Local Union No. 82, IBEW Health and Welfare Fund.
Plan Administrator: American Benefit Corp.
Address: 5420 W. Southern Avenue, Suite 407, Indianapolis, IN 46241
Phone: 855-251-1486
Website: Contact – IBEW Local 82 (ibew82.org)
Administration
The Plan is administered by the Board of Trustees with the support of American Benefit Corp.
The Board comprises Union Appointed Trustees from IBEW Local Union and NECA Appointed Trustees from various local companies.
DENTAL BENEFITS
| Calendar Year Maximum (per individual, Class I, II and III) | $2,500.00* |
| Deductible (per individual, Class II, III and IV) | $100.00 |
| Orthodontic Lifetime Maximum | $2,500.00 per Participant |
Percentages Payable:
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