Spouse Physical Exam
The Board of Trustees is pleased to announce that, effective 11/1/2007, the Health Plan will cover physical exams not only for the member, but also for their spouse. If you have any questions regarding this benefit, please call the Fund office at 419-666-4450 or email us at firstname.lastname@example.org.
New Benefit for Families with Autistic Children
The Board of Trustees is pleased to announce an enhancement to the Health Plan. A $4500.00 maximum yearly benefit is available for children diagnosed with Autism who are age 12 and younger. This benefit covers therapies not previously covered by the Health Plan. If you have an autistic child, please contact us at at 419.666.4450 or by email at email@example.com.
Preferred Provider Network
Frontpath Health Coalition is the PPO network chosen by the Trustees to service our participants beginning October 1, 2003. The Frontpath network includes all Toledo Area hospitals and includes more physicians and facilities than our previous PPO.
You can minimize your out-of-pocket expenses, and those paid by the Plan, by utilizing Frontpath providers whenever possible. You may continue to receive care from non-contracting providers, however you will be responsible for charges in excess of the Plan's Usual, Customary, and Reasonable amount. You may locate contracting providers by visiting www.frontpathcoalition.com, or by calling 419-891-5206 or 888-232-5800.
Summary of Benefits
A Summary of Benefits brochure with updated plan changes is available. The document is provided as a summary of the benefits available to the eligible members of the Toledo Electrical Welfare Fund. It is not a complete document, nor does it contain all provisions of the plan. Please refer to the Summary Plan Description for important information and complete details.
Frequently Asked Questions
- Do I need a referral from a Family Physician to seek services elsewhere?
- Do I have to get a prior authorization?
- Many services do require a pre-certification. We suggest you call American Health Holdings at 855-248-1858
- How do I get a new identification card?
- Call the Benefits Office at 419.666.4450
- Do I need separate Prescription and Medical identification cards?
- No. One side of your card says AmWins Rx which is your prescription coverage. The other side has your Medical, Mental Health and Vision information.
- What do I need to do if I have a change in family status, such as Marriage, Birth, Divorce?
- It is your obligation to contact the Benefits Office to report ANY change in status. Marriage, Births, Divorce must be reported with proper documentation. Enrollment, and Beneficiary forms must be maintained with your current status.
- Why do you need this "Green" claim form completed?
- When a member/dependent has any injury, we request information on how that injury happened. The Fund is not always liable for payment and we look for the order of responsibility.
- Who is American Health Holdings? AmWins Rx? VSP? SupportLinc? FrontPath?
- American Health Holdings is our medical management group. They are a group of licensed nurses and doctors that precertify health care services for appropriateness. AmWins Rx administers the prescription drug program for active and early retirees. Retiree RxCare administers the prescription drug program for Medicare primary participants. VSP (Vision Service Plan) administers our vision program. SupportLinc is our Participant Assistance Program (PAP) vendor. They provide access to a variety of services and will assist you in accessing things like short term counseling addressing marriage or family problems, substance abuse, stress or other behavioral health concerns. Additional benefits include legal and financial consultations, Please call 1-888-881-LINC (5462). FrontPath is our network of physicians and hospitals. Visit our providers websites by going to Links.
- Am I entitled to "Short Term Disability" compensation?
- If you have an illness or injury that requires you to be off work and you are not drawing social security disability, workers compensation or unemployment, you may be entitled to a disability benefit.
- Why do you require my spouse to carry her own insurance?
- Most employers that provide a Health Care Program, require the spouses to participate in separate programs to have the health care programs share the cost of the health care services.
- Am I eligible for an eye exam?
- To find out if you are eligible for an eye exam you need to contact Vision Service Plan at 800.877.7195 or at www.vsp.com and click on the member link.
- Do I have to use a specific provider?
- If you use a provider in the FrontPath network-you will save yourself and the Fund money. You can access the directory at www.frontpathcoalition.com. Or call the funds office and we can mail you a directory.