Health Fund

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Medical | Prescription Drugs | Dental | Vision | Life and AD&D Insurance

Medical

Your medical plan, provided to you by the Trust Fund, is a preferred provider organization (PPO) plan. The Fund uses Anthem Blue Cross Blue Shield’s PPO network, which gives you access to health care providers nationwide and a hospital network servicing southern Nevada.

Our Self-Funded Plan

Your health benefits are valuable and affordable. However, the cost of health care rises every year. We have a self-funded plan, which means that the Fund—not Anthem Blue Cross Blue Shield—is responsible for paying claims. While you should always feel comfortable getting the high-quality care you deserve, the Fund relies on you to make good decisions about where you receive care.

Here are some tips to limit the impact of health care costs for yourself and for the Fund:

Visit in-network providers. Doctors, hospitals, and other medical facilities in the Anthem Blue Cross Blue Shield network charge our members discounted rates. Out-of-network care is covered, but it costs you and the Fund more.
Go to the right place for care. Flu-like symptoms don’t feel good, but they generally don’t require you to go to the emergency room. You don’t need an urgent care facility for a cold.
Get prior authorization for your care. For medical prior authorization, contact Nevada Health Solutions before receiving diagnostic tests or outpatient surgeries. In the event of an inpatient hospital admission, contact Nevada Health Solutions as soon as you can. Nevada Health Solutions will visit you during your inpatient stay to act as your patent advocate and will assist with your transition of care when you leave the hospital. The can also assist you with your treatment plan and handle provider issues. For prior authorization of behavioral health care (mental health), contact Harmony Health Care. They can review and approve your upcoming inpatient or outpatient treatment and perform ongoing reviews to ensure the appropriateness of your care. Please remember: You must contact Nevada Health Solutions or Harmony Health Care before receiving care, as the Plan might not cover your care without prior authorization.
In emergencies, all bets are off. Go to the closest emergency room if you’re experiencing a life-threatening medical issue. Your care will be covered at in-network rates, even at an out-of-network facility.

LiveHealth Online

Free, on-demand care is only a few clicks away through LiveHealth Online. When you need care for common, non-emergency medical issues or behavioral health, use LiveHealth Online to connect with a board-certified health professional in minutes. LiveHealth Online doctors can even write prescriptions and connect with your primary care physician to follow up.

Getting started is as easy as downloading the app. Just go to the App Store or Google Play.

Coverage for Common Expenses

In-Network

Out-of-Network

Deductible

None

$500 per person / $1,500 family

Annual out-of-pocket maximum

$5,200 per person

Unlimited

Preventive care, tests, and screenings

Fully covered

40%, no deductible

Primary care physician visit

$15 copay

40% coinsurance

Specialist visit

$30 copay

40% coinsurance

Urgent care visit

$20 copay

$40 copay, no deductible

Diagnostic tests*

$15 copay

40%*

Emergency room visit

$75 copay (waived if admitted)

$75 copay, no deductible (waived if admitted)

Hospital stay*

Facility fees: $400 copay
Physician/surgeon fees: $100 copay per surgery
Anesthesia: $100 copay

40% coinsurance

* Requires prior authorization. You pay the full cost of services or a 50% benefit reduction if prior authorization isn’t obtained.

For a complete list of covered services and a summary of what the Plan pays, review the Health Fund Summary Plan Description.

No Surprises Act

The No Surprises Act took effect on January 1, 2022. This law protects you from balance billing if you get treated by an out-of-network provider from an in-network hospital or emergency room. Balance billing happens when an out-of-network provider charges you the difference between the total cost of your care and what your health plan agreed to pay.

Sometimes, in-network emergency rooms and hospitals employ out-of-network doctors. In these cases, you might receive care from an out-of-network provider, through no fault of your own. Also, you might not have time to choose between an in- or out-of-network provider in a medical emergency. The No Surprises Act is designed to ensure that you aren’t balance billed if you receive care under these circumstances. It protects you from paying extra when the circumstances are beyond your control.

You should still use network providers whenever possible. Visit your insurance carrier’s website to find a list of network providers near you:

Anthem Blue Cross Blue Shield (medical)
Sav-Rx (prescription drugs)

If you believe that you’ve been wrongly billed, contact the Employee Benefits Security Administration (EBSA) at (866) 444-3272 or through their website.

The above summary is not a complete description of your rights under the No Surprises Act. For more detailed information about the No Surprises Act, read this notice.

Prescription Drugs

Along with your medical coverage, you have access to prescription drug coverage through Sav-Rx, which offers you convenient and affordable access to the medications you need.

Prescription drugs are only covered when filled at network Sav-Rx retail pharmacies or the Sav-Rx mail order facility. Just present your ID card at a network pharmacy to receive discounted rates on your medications.

Coverage

Network Retail Pharmacy (30-day supply)

Sav-Rx Mail Order Facility (90-day supply)

Generic

$7 copay

$14 copay

Preferred brands

$30 copay

$60 copay

Non-preferred brands

$50 copay

Not covered

Brand with generic alternative

$7 copay plus cost difference between brand and generic

$14 copay plus cost difference between brand and generic

Details

The amount you pay out of pocket for prescriptions depends on a few things. Here’s how you can limit your out-of-pocket costs:

Fill your prescriptions at Sav-Rx network pharmacies. Prescriptions filled at out-of-network pharmacies aren’t covered.
Use the Sav-Rx mail order facility for prescription drugs that you take on a long-term basis. In many cases, you’ll get a 90-day supply of your medication for the price of two 30-day supplies.
When possible, take generic versions of the drugs prescribed to you.

Sav-Rx separates drugs into three categories: generic, preferred brand, and non-preferred brand. Generic drugs are lower-cost, chemically equivalent alternatives to more expensive brand-name drugs. Preferred brand drugs are brand-name drugs that Sav-Rx covers at discounted rates. Non-preferred brand drugs aren’t discounted as much and cost you the most out of pocket.

The last category, brand with generic alternative, refers to a prescription you fill for a brand-name drug when a generic alternative was available. You’re responsible for a copay plus the full cost difference between the brand-name drug and the generic alternative.

Get your prescription delivered to your door.

Call Sav-Rx at (866) 912-7425, or go to their website.

Dental

Keeping your teeth and mouth healthy is essential to your overall health. You become eligible for dental benefits through the Health Fund at the same time you become eligible for medical benefits.

Highlights

The Health Fund has an agreement with LIBERTY Dental Plan. When you receive care from dentists who participate in the LIBERTY Dental Plan network, you pay less. You can receive care from out-of-network dentists, but you’ll pay the difference between the dentist’s usual and customary fee and the amount that the Plan covers.

Preventive care from in-network dental providers is 100% covered with no cost to you. Some basic services are also fully covered when you visit in-network dentists.

For a complete list of services, in-network copays, and out-of-network Plan payments, see the Liberty Dental Schedule of Benefits.

Coverage

Details

In-Network
(You Pay)

Out-of-Network
(Plan Pays)

Deductible

None

$50 per person
$150 per family

Annual maximum benefit

None

$2,000

Preventive exams

$32

Teeth cleaning

$0 (two per year)

$40 (child)/$55 (adult)
(two per year)

Fillings

$42–$87

Extractions

$45–$67

Root canals

$0–$60 copay

$118–$269 (initial)
$17–$64 (planing and grading)

Crowns

$66–$73 copay

$269–$370

Bridges

$69–$73 copay

$269–$395

Dentures

$93 copay

$420

Implants

Services covered only in Nevada. See Schedule for copay

Not covered

Orthodontia*

Child: $1,350
Adult: Not covered

Not covered

* Orthodontic services don’t apply to the annual maximum. Some orthodontic services aren’t covered under the program, including (but not limited to) the loss or breakage of appliances, retreatment of orthodontic cases, extraction of teeth or other surgical procedures, and orthodontics for temporomandibular joint (TMJ) issues.

Use network dentists

Receiving care from network dentists will make you smile. You pay significantly less for in-network care.

Find a dentist

Vision

Your vision coverage helps you see clearly without breaking the bank. You become eligible for vision benefits at the same time you become eligible for medical benefits.

Highlights

You have vision coverage through VSP. You can visit any eye care provider, but you’ll enjoy better benefits for exams, frames, lenses, and contacts—and a seamless claims process—when you visit VSP network providers.

Coverage

In-Network (Each Benefit Once Every 12 Months)

Out-of-Network

Exams

$0 (one per year)

$45 allowance per year

Frames

$160 allowance
$180 allowance (featured brands)
20% off amount over allowance

$70 allowance per year

Lenses

Standard progressive: $55 copay
Premium progressive: $95–$105 copay
Custom progressive: $150–$175 copay
Average of 20%–25% off other options

Single vision: $30 allowance
Bifocal and progressive: $50 allowance
Trifocal: $65 allowance

Contacts

$160 allowance for contacts and exam (fitting and evaluation)
15% off contact lens exam (fitting and evaluation)

$105 allowance

Find a VSP network eye care provider

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Employee Assistance Program

Challenges are a part of life, but everyone needs a helping hand to get through them. The Employee Assistance Program (EAP) is here to see you through.

You and your family members receive up to three free, confidential counseling sessions per issue, per year through the Anthem EAP. The EAP can work with you on anything on your mind, including:

Stress
Anxiety
Depression
Marital or family issues
Grief or loss
Substance abuse
Financial difficulties

No matter what you’re battling, the EAP is a great first step to address the problem. Call the EAP, available 24/7 at (800) 999-7222, or visit the EAP website for resources.

Life and AD&D Insurance

If you die or are seriously injured due to an accident, your life and AD&D benefit pays a $15,000 lump sum to your designated beneficiary. Call Zenith American Solutions to learn more about your life and AD&D benefit, or to change your beneficiary information.