Welcome to the MO-KAN Sheetmetal Workers Welfare Fund web site. We take pleasure in providing you with this web site to keep you up-to-date on your benefits. --Important Announcment Dental Benefits June 2009-- Click Here
Mo-Kan Sheet Metal Health & Welfare Fund would like to provide you with important information regarding your dental benefits. Effective immediately, all payments for covered dental services will be made directly to the dental provider. Unless your claim is received and clearly identified as paid in full, or marked as dentist does not accept assignment, payment for covered dental services will be made directly to your in-network or out-of-network dental provider. To ensure your dental provider recognizes they will be receiving payment directly for covered services, it is recommended that you share this communication prior to receiving services. If you have any questions, please contact the Fund office at 816-531-0334 or 866-531-5488.
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--Important Announcment Claims Administration-- Click Here
This notice is to inform you of a change in claims administration procedure that may affect the way your prescription drug benefits are determined. Currently, the terms of your health plan provide for coordination of prescription drug benefits (COB). This means that if you receive prescription drug benefits from another source—such as another health insurance plan—the Mo-Kan Sheet Metal Welfare Fund will work with you to ensure that you pay no more out of pocket than you would otherwise pay under the plan and that you receive no greater benefit than the discounted cost of the prescription drug. In the past, when someone presented a claim in which there was another source of health coverage, the Fund Administrator had coordinated prescription drug benefits by crediting the full cost of the drug to the individual’s medical claims deductible. This procedure for implementing the plan’s COB terms resulted in members receiving the same benefit from two health plans. In December, the Executive Committee of the Mo-Kan Sheet Metal Welfare Fund decided to end this practice. The terms of your health plan have not changed; prescription drug benefits will be coordinated in the manner intended by the plan document. If you have other coverage for prescription drugs, however, effective December 9, 2008, coordination of benefits will be carried out by crediting to your medical deductible only the portion of the prescription drug price that you pay out of pocket, after the benefit you receive from the other plan is taken into account. If you have questions about how this new claims administration procedure will affect you, please contact customer service at 816-531-0334.
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MO-KAN Sheet Metal Workers is pleased to announce a new partnership with Blue Cross and Blue Shield of Kansas City (BCBSKC). Effective January 1, 2009, we have moved to the Blue Cross and Blue Shield National Preferred Provider Organization (PPO), which will offer a nationwide network for your health benefits. Claim Administration and Customer Service will continue to be handled through the Kansas City Health and Welfare Fund office just as it is today. Pharmacy Claims will be processed through Welldyne RX West. When at the pharmacy please have the pharmacist drop the three letters in front of your ID Number when processing your claims. In the Kansas City area, enrolled members will utilize the Preferred-Care Blue PPO provider network. In other areas, this new partnership will provide us with the nationwide Blue Cross and Blue Shield PPO network. This nationwide coverage through the BlueCard PPO |
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program is available to Sheet Metal members living in – or visiting – any state in the United States. Below is information that will allow you to search to determine if your provider(s) are participating in the Blue Cross Blue Shield PPO nationwide network. Mo-Kan Sheet Metal Members To search for participating PPO providers, members should go to the website www.bcbskc.com. Once there, on the home page, follow the instructions below to look for your provider(s). Click on the link “Find a doctor or hospital” located in the upper right-hand corner of the home page. The next screen will provide a very detailed search engine where you can look up a provider by name and/or specialty in the city and state where you reside. Please note, the information on the web site is subject to change; therefore, it is important you verify provider participation in the BlueCard PPO network prior to receiving services on, or after, January 1, 2009. Within the BCBSKC service area you can also search on the www.bcbskc.com web site and click the link “BCBSKC Provider Directory” and then highlight “Preferred Care Blue” to confirm network doctors and hospitals within the Preferred Care Blue PPO network. Dental administration will also continue under this new arrangement. Effective January 1, 2009 we will utilize the Preferred-Care dental network within the BCBSKC service area. All dental claims should be sent to BCBSKC.For prescriptions, the Welldyne/RXWest website has much useful information. The Summary Plan describes the procedures to be followed for filing a claim, in addition to a listing of the benefits provided by the Plan. The Claim Forms section describes how to fill out each type of claim form for medical, dental, vision, and loss of time forms. You can follow the on-line guide and print the form you need to submit to the fund office. QualSight LASIK – Save 40% to 50% off the National Average price for LASIK eye surgery. Visit our website or Call 877-507-4448 to find a provider near you! |
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