Local 807 Labor-Management Health Fund
The Health Fund provides you and your family with broad protection to help meet the costs of sickness and injury, as well as prescription drug, dental, and vision expenses.
No Surprises Act
We are providing this information to meet the requirements of the No Surprises Act. The No Surprises Act 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.
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. See the information and links below to access a list of network providers near you.
Important Reminder: Sometimes your doctor may recommend follow-up procedures or tests, including lab tests or x-rays. If this happens, first ask your doctor if the provider or facility that the doctor is recommending is in our network. Don’t assume that your doctor has thought about this or even knows. And don’t assume that just because your doctor is in the network that the provider or facility they recommend is also in the network. Then, call the Fund Office so we can help you confirm that the provider or facility is in-network. If you use an out-of-network provider or facility, it will cost you and the Fund more. The Fund Office is here to help you sort this kind of thing out. The health care system can be complicated. We’re here to help you navigate it. We’ve got your back.
If you believe that you’ve been wrongly billed, contact the Fund Office first, and then, if you need further assistance, 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.
- Empire BlueCross Blue Shield Hospital Coverage. For more information or to find a provider, visit the Empire BlueCross BlueShield website or call 800-553-9603. You can find more information about the No Surprises Act on the Empire BlueCross BlueShield website. The federal regulations require health plans and insurance carriers to disclose pricing information for certain items and services. The required information includes negotiated rates with in-network providers, as well as provider charges and amounts previously paid to out-of-network providers. The regulations require the information to be updated monthly. The information is contained in machine-readable files. These files can be opened in a spreadsheet program like Excel. They are huge files and not easy to use for the average person. HMSA is responsible for the information in the files and for keeping them up to date. To access the files, you can visit the Empire BlueCross BlueShield website. Please note that you will need the Fund’s Employer Identification Number (13-5548780) to find the files.
- MagnaCare Medical Coverage. For more information or to find a provider, visit the MagnaCare website or call 800-235-7330. The federal regulations require health plans and insurance carriers to disclose pricing information for certain items and services. The required information includes negotiated rates with in-network providers, as well as provider charges and amounts previously paid to out-of-network providers. The regulations require the information to be updated monthly. The information is contained in machine-readable files. These files can be opened in a spreadsheet program like Excel. They are huge files and not easy to use for the average person. HMSA is responsible for the information in the files and for keeping them up to date. You can access the files on MagnaCare's website.
- Express Scripts Prescription Drug Coverage. For more information or to find a network pharmacy, visit the Express Scripts website or call 800-711-0917.
Important Documents
Summary Plan Description (SPD)
Summary of Benefits and Coverage
Vaccine Coverage Summary of Material Modifications (2021)
MagnaCare Claims Processing Summary of Material Modifications (2021)
COVID-19 Treatment and Eligibility Provisions Summary of Material Modifications (2020)
Gene Therapy and Zolgensma Coverage Summary of Material Modifications (2019)
Paid Family Leave Summary of Material Modifications (2017)
HIPAA Notice of Privacy Practices
Medicare Part D Notice of Creditable Coverage
Questions?
Contact the Fund Office:
32-43 49th Street
Long Island City, New York 11103
718-274-5353
Statement of Grandfathered Status
The Board of Trustees believes that the Local 807 Labor-Management Health Fund (the Plan) is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your Plan may not include certain benefits of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other requirements in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding the benefits that apply or do not apply to a grandfathered health plan and the circumstances that might cause a plan to change from grandfathered health plan status can be directed to the Fund Office at 630-516-8008. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 866-444-3272 or dol.gov/ebsa/healthreform. This website has a table summarizing which benefits do and do not apply to grandfathered health plans.