TeamstersCare 25 TeamstersCare 25

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Medical

TeamstersCare provides its under age 65 retiree members with the option to chose medical benefits through one of two HMOs or an Out of Area Option:

  • HMO Blue New England Option
  • Fallon Health Steward Community Care
  • Blue Care Elect Preferred Out of Area Option

Whether you will participate in one of the HMOs or the HMO Out of Area option will depend on where you live. The HMO Blue New England plan covers members who live in certain geographical service areas, including all cities and towns of Massachusetts, Rhode Island, Connecticut, Maine, New Hampshire and Vermont. The Fallon Health Steward Community Care HMO provides coverage primarily in cities in eastern Massachusetts.

If you are a TeamstersCare member living outside of New England, or a member with an eligible dependent living permanently outside of New England, you are covered by Blue Care Elect Preferred.

Both the HMO options and the Out of Area option cover a broad range of services, including:

  • Doctor’s care, including maternity, pediatric and well-child visits
  • Hospital care (both in- and out-patient)
  • Surgery and emergency care
  • Diagnostic x-rays and laboratory tests
  • Authorized services for rehab, acute care, home health and early intervention
  • Chiropractic care, podiatry, nutrition and ambulatory transport
  • Authorized medical equipment

HMO Blue New England Option

Your Primary Care Physician

When you enroll in HMO Blue New England, you and each family member must select an in-network primary care physician (PCP). Your PCP will direct and monitor your care, and will be the first person you call when you need routine or sick care. They will also guide you through any referrals you may need for specialized services.

Emergency Care

In an emergency, such as a suspected heart attack, stroke or poisoning, you should go directly to the nearest medical facility or dial 911 (or your local emergency phone number). You’ll pay a $100 copayment for emergency room services, though this copay is waived if you’re admitted to the hospital.

Basic Medical Benefits

TeamstersCare

*Check with HMO Blue New England for: (1) limitations that might apply to services listed above, or (2) coverage of any items not identified in this chart.

Important Note:  This summary is not meant to be a complete description of your TeamstersCare benefits. If you have questions about your own situation or a particular coverage, contact HMO Blue New England directly. For eligibility-related issues, or if you have any problems, call Charlestown Member Services.

Fallon Health Steward Community Care HMO Option

Your Primary Care Physician

When you enroll in Fallon Health, you and each family member must select an in-network primary care physician (PCP). Your PCP will direct and monitor your care, and will be the first person you call when you need routine or sick care. They will also guide you through any referrals you may need for specialized services.

Emergency Care

In an emergency, such as a suspected heart attack, stroke or poisoning, you should go directly to the nearest medical facility or dial 911 (or your local emergency phone number). You’ll pay a $100 copayment for emergency room services, though this copay is waived if you’re admitted to the hospital.

Basic Medical Benefits

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Check with Steward Community Care for limitations that might apply to services listed above, or coverage of any items not identified in this chart.

Important Note:  This summary is not meant to be a complete description of your TeamstersCare benefits.  If you have questions about your situation or a particular coverage, contact Steward Community Care directly.  For eligibility related issues, or if you have any problems, call Charlestown Member Services.

Blue Care Elect Preferred Out of Area Option

As a Blue Care Elect Preferred Member, you are not required to select a Primary Care Physician (PCP). Instead, you and your dependents have two basic options for care: (1) you can take advantage of discounted services by using a Blue Care Elect Preferred Provider or (2) you can use a non-network provider.

If you use an in-network provider, the cost of most services (less any copayment) will be covered in full. If you use a non-network provider, most expenses are covered at 80% of reasonable and customary amounts after a $250 individual/$500 family deductible. The out-of-network co-insurance maximum is $1,000 per individual/$2,000 per family.

For more information on the Blue Care Elect Preferred Provider network, call 1-800-810-2583 or visit www.bluecrossma.com/nm/teamsters-care.

Basic Medical Benefits

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(1)  of reasonable & customary expenses for covered charges. If the provider’s actual charges are greater than the usual and customary charge, the member will be responsible for the applicable cost sharing amount based on the usual and customary fee, plus the difference between the usual and customary fee schedule and the provider’s actual charges

(2) you pay $250 copay per admission, up to a maximum of four copayments per year

(3) one routine visit every five calendar years from age 19-29, one routine visit every three calendar years from age 30 through 39, one routine visit every two calendar years from age 40 to 54 and one routine visit per calendar year when age 55 or older

(4) copay waived if emergency room visit results in immediate hospitalization

Blue Cross Blue Shield Behavioral Health Benefit

Your Blue Cross Blue Shield medical benefit includes counseling and treatment for emotional difficulties, mental illness, substance abuse, family and marital problems and childhood concerns. You also have access to a variety of programs and services to help with chronic behavioral conditions.

To access outpatient behavioral health services, you simply make an appointment with an in-network provider and pay a $15 copay at the time of your visit. No referral or pre-authorization is necessary.

For new episodes of outpatient care, the first 12 visits are automatically authorized. If more than 12 visits are needed, your in-network provider will contact Blue Cross Blue Shield for additional authorizations on your behalf.

If you or your dependents have questions, you may call the Blue Cross Behavioral Health Coordination line at 1-800-444-2426 or go to www.bluecrossma.com/nm/teamsters-care.

Important Note: As a member of our Early Retiree medical plan, you also have access to behavioral health services through our in-house Employee Assistance Program.

Fallon Health Steward Community Care Behavioral Health Benefit

Fallon Health Steward Community Care offers behavioral healthcare through Beacon Health Strategies to provide mental health and substance abuse treatment to our members and eligible dependents.  Beacon Health Strategies has a large network of providers who can assist you with behavioral health needs.  Counseling and treatment are available for emotional difficulties, mental illness, substance abuse, family and marital problems and childhood and adolescent concerns.  Your behavioral healthcare must be provided through Beacon Health Strategies.  Call 1-888-421-8861 to locate a provider or go to www.beaconhealthstrategies.com. 

To access routine outpatient behavioral health services, no referral or preauthorization is necessary.  Simply make an appointment to see an in-network provider and pay your $15.00 copayment when services are received.  For inpatient in-network hospital services, you make a copay and then you’re covered 100 percent.  Your provider must contact Beacon Health Strategies for in-patient services.

Important Note:  As a member of our Early Retiree Medical plan, you also have access to behavioral health services through our in-house Employee Assistance Program.