Northwest Carpenters Health and Security Plan
Summary Plan Description
- Notice
- Statement of Purpose
- Participant Eligibility and Enrollment
- Continuation Coverage
- Dependent Eligibility and Enrollment
- Retiree Eligibility and Enrollment
- Preferred Provider Organization
- Medical Review Programs
- Schedule of Benefits
- Medical Benefits
- Acupuncture
- Alternative Care
- Ambulance Transportation
- Anesthesia
- Autism Spectrum Disorder/Pervasive Developmental Disorder
- Bariatric Surgery
- Behavioral Health Services
- Blood
- Chiropractic Care
- Dental Accidents
- Diabetic Care
- Diagnostic X-Ray and Laboratory Services
- Durable Medical Equipment
- Erectile Dysfunction
- Habilitative Care
- Hearing Aids
- Home Health Care
- Home Phototherapy
- Hospice Care
- Hospital Services and Supplies
- Infusion Therapy
- Kidney Dialysis
- Medical Supplies
- Oral Surgery
- Orthognathic Surgery
- Orthotics
- Physician Services
- Pregnancy Care
- Preventive Health Services
- Prosthetic Devices and Artificial Limbs
- Reconstructive Surgery
- Rehabilitative Care
- Skilled Nursing Facility
- Sleep Studies
- Sterilization
- Telehealth Consultations
- TMJ and MPDS Treatment
- Transplants
- Prescription Drug Benefits
- Introduction
- Formulary
- Express Scripts Retail Pharmacy Program
- Express Scripts By Mail
- Out-of-Pocket Maximum
- Nonparticipating Pharmacies
- Express Scripts Medicare Prescription Plan
- Step Therapy Program
- Retail Refill Allowance Program
- Specialty Medications
- SaveOnSP
- Claims Issue
- Limitations and Exclusions
- Summary of the Prescription Drug Programs
- Dental Benefits
- Vision Benefits
- Time Loss Benefits
- Life Insurance and Accidental Death and Dismemberment Benefits
- Retiree Health Reimbursement Accounts
- Claims Process
- How to File a Medical Claim
- Claims for Prescription, Dental, Vision, Time Loss, Life Insurance, and Accidental Death and Dismemberment
- Timely Filing Requirement
- Coordination of Benefits (COB)
- Facility of Payment
- Trust's Right to Reimbursement
- Right to Receive and Release Necessary Information
- No Waiver of Claim Paid in Error – Recovery by Trust
- Misrepresentation
- Assignment
- Glossary
- General Limitations and Exclusions
- Important Information
- Claims and Appeals Rules
- Life Insurance and Accidental Death and Dismemberment Claims Appeal Procedure
- Interpretation
- Rights Under the Employee Retirement Income Security Act (ERISA)
- HIPAA Privacy Plan Amendment
- Notice of Privacy Practices
- Amendment and Termination
- Benefits Not Guaranteed
- Nondiscrimination
- Administrative Information
- Names, Titles and Addresses of the Board of Trustees
Related Content
Partner Websites
Northwest Carpenters Health and Security Plan
Medical Annual Deductible
The $200 annual deductible is the amount of covered medical expenses you must pay each calendar year before the plan pays benefits. Each person covered under the plan has his or her own $200 annual deductible. When you and your dependents have paid a combined deductible expense of $400 in a calendar year, no further deductible is required for any family member during that calendar year. If you incur deductible expenses in the last three months of a calendar year, those expenses will also apply toward your annual deductible for the next calendar year. This is known as the deductible “carryover.”
The annual deductible applies to both network and non-network services but does not apply to preventive services or certain other services identified in this plan booklet.
Last Updated: 04/25/2023