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.

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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 protected].

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 [email protected].

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 clicking here to download a copy of the provider directory, visiting www.frontpathcoalition.com or by calling them directly at 419-891-5206 / 888-232-5800.

Frequently Asked Questions

Do I need a referral from a Family Physician to seek services elsewhere?

No.

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 a separate prescription and medical identification card?

Active and early retiree members have one card.  Your prescription information is on one side and the other side is your medical, mental health, and Vision information.  If you are a medicare retiree, you are issued a separate card for your prescription benefit.

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? Express Scripts? EyeMed? Support Linc? FrontPath?

American Health Holdings is our Medical Management Group.  Express Scripts administers the prescription drug benefit. EyeMed administers our vision program. Support Linc is our Participant Assistance Program (PAP) vendor. They will assist you in coordinating your mental health, substance abuse or personal assistance services. Please call 1-888-881-5462.  FrontPath is our network of physicians and hospitals. For the provider’s listed above contact information go to Links on this website.

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 EyeMed at 866-800-5457 or log onto www.eyemed.com.

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.