Eligibility

Your eligibility for the Early Retiree Medical Program is based on four factors, all tied to the date you were last covered under the Active TeamstersCare benefit program.

Key Eligibility Factors:

  1. Your age at the time of your last coverage date.
  2. Accumulated credited service as of that date.
  3. You must have been covered by the Active TeamstersCare benefits program for at least 36 months within the past five years (60 months).
  4. Your employer must have made contributions to TeamstersCare on your behalf for at least 10 years (120 months).

Note: Contributions to the TeamstersCare Dental and Vision Program do not count toward the 120-month requirement.

Eligibility Requirements

You are eligible for the Early Retiree Medical Program if, as of your last day of coverage under the Active TeamstersCare Program, you meet one of the following conditions:

  • 15+ years of credited service and are age 60 or older.
  • 20+ years of credited service and are age 55 or older.
  • 30+ years of credited service at any age.

Note: The age requirement is waived if you have 15 or more years of credited service and are determined to be permanently and totally disabled by Social Security.

Years of credited service can include:

  • Pension credit under the New England Teamsters & Trucking Industry Pension Plan or the Central States Pension Fund.
  • Years of coverage under the Active TeamstersCare Medical Program.
  • A combination of both periods, as long as they add up to the required years.

Dependent Eligibility

Once you qualify for the Early Retiree Medical Program, your eligible dependents will also have access to medical, prescription drug, dental, vision, hearing, and behavioral health benefits. Eligible dependents include:

  • Your current spouse, or an ex-spouse who meets specific criteria (refer to the Early Retiree Medical Program Summary Plan Description for details).
  • Your children, up to the last day of the month in which they turn 26.
  • Unmarried children who are incapable of self-care due to a physical or mental disability and are dependent on you for support, subject to meeting certain criteria.

For full details on dependent eligibility, refer to the Early Retiree Medical Program Summary Plan Description.

Your Share of the Cost

TeamstersCare subsidizes a portion of your Early Retiree Medical Program costs. You will be responsible for the remaining balance through monthly payments. Your contribution amount depends on:

  • Your age at retirement.
  • Your retirement date.

The contribution requirements are as follows:

  • Retired before April 1, 2002: under age 60, or age 60-64.
  • Retired after April 1, 2002: under age 65.

Important Note: The TeamstersCare subsidy amount remains fixed. If healthcare costs rise, your retiree contribution will increase accordingly.

The specific amount of your monthly contribution is determined by healthcare costs for retirees, which are reviewed annually by the Trustees. Any changes to contribution rates will be communicated to you by mail. For current contribution amounts, please contact Charlestown Member Services.

Enrollment

To enroll in the Early Retiree Medical Program, you must provide written notification to TeamstersCare Member Services within 30 days of becoming eligible.

Most individuals choose to join the program as soon as they become eligible. However, if you are covered under another group health plan at the time of your eligibility, you may defer enrollment and reapply later, provided you meet the following conditions:

  1. You have other group health coverage (such as an employer-sponsored plan or COBRA) when TeamstersCare first offers you retiree coverage, and
  2. You submit a written deferral notice to TeamstersCare explaining that your other coverage is the reason for declining enrollment.

You may then request special enrollment in the Early Retiree Medical Program if:

  1. You become ineligible for your other health coverage, or
  2. Your COBRA coverage ends.

To request special enrollment, you must submit your application within 30 days of losing your other coverage and provide proof of termination. As long as you meet the eligibility requirements, your TeamstersCare coverage will begin no later than the first day of the month following receipt of your application.

Benefits

As an early retiree, you and your eligible dependents are eligible for TeamstersCare’s comprehensive benefits program, which includes a broad range of healthcare benefits through Blue Cross Blue Shield, Express Scripts, Davis Vision and our own in-house clinical services.

Medical

TeamstersCare offers two medical benefit options for retirees under age 65:

  • HMO Blue New England: Ideal for members living in Massachusetts, Rhode Island, Connecticut, Maine, New Hampshire, and Vermont. Members must select a primary care physician (PCP) who will coordinate their care and referrals.
  • Blue Care Elect Preferred Out of Area: Suitable for members residing outside New England. Members can choose to use in-network providers for full coverage or out-of-network providers with a deductible.

Both plans cover a wide array of medical services, including routine and emergency care, diagnostics, rehabilitation, and authorized medical equipment.

Emergency Care: In emergencies, seek immediate medical attention. A $100 copayment applies, waived if hospitalized.

Your Primary Care Physician
When you enroll in HMO Blue New England, each family member must select an in-network primary care physician (PCP). Your PCP will direct and monitor your care and will be your first point of contact for routine or urgent medical needs. They will also assist you with referrals for specialized services.

Emergency Care
In emergencies, such as a suspected heart attack, stroke, or poisoning, go directly to the nearest medical facility or dial 911 (or your local emergency number). A $100 copayment applies for emergency room services, which is waived if you are admitted to the hospital.

Basic Medical Benefits

Annual Deductiblenone
Benefit LevelPlan pays 100%
some $5 and $15 copays required
Annual Maximum
out-of-pocket		none
Dependent Coverageuntil child turns 26
Inpatient Care
including maternity		Plan pays 100% after $250 copay per admission
$1,000 maximum inpatient copays per year
Preventive Care
routine adult physical
well-child care
allergy testing & treatment
annual gynecological exam
mammogram		$5 copay per visit
$5 copay per visit
$15 copay per visit
$5 copay per visit
Plan pays 100%
Outpatient
office visits for specific treatment
diagnostic lab and x-ray
outpatient surgery
preadmission testing
home health care
skilled nursing facility		$15 copay per visit
Plan pays 100%
Plan pays 100%
Plan pays 100%
Plan pays 100%
Plan pays 100%
Emergency Room Visit$100 copay (waived if admitted or observation stay)
Notify your HMO within 48 hours of delivery of emergency
services. Follow-up care must be arranged by your PCP.
Behavioral Health Care
(Mental Health/Substance Abuse)		In-network benefit only
Out-patient treatment: $15 copay per visit
In-patient treatment: Plan pays 100% after $250 copay per
admission. $1,000 maximum inpatient copays per year

Please check with HMO Blue New England for any limitations that may apply to the services listed above or for coverage details of any items not identified in this summary.

Important Note: This summary is not a complete description of your TeamstersCare benefits. For questions about your specific situation or coverage, contact HMO Blue New England directly. For eligibility-related issues or other concerns, 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). You and your dependents have two basic options for care:

  1. Use a Blue Care Elect Preferred Provider for discounted services.
  2. Use a non-network provider.

If you choose an in-network provider, most services (less any copayment) will be covered in full. For non-network providers, 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 Teamsters Union 25 HSIP.

Basic Medical Benefits for Retirees

BenefitBlue Care Elect PreferredNon-network
Annual Deductiblenone$250/individual
$500/family
Benefit LevelPlan pays 100%
Some $5/$15 copays required		After the deductible,
the Plan pays 80% ¹
Dependent Coverageuntil child turns26
Inpatient Care ²
including maternity		Plan pays 100% after $250
copay ²		Plan pays 80% ¹
after $250 copay ²
Preventive Care
routine adult physical ³
(see schedule below)
well-child care
allergy testing & treatment
annual gynecological exam
mammogram		$5 copay per visit
$5 copay per visit
$15 copay per visit
$5 copay per visit
Plan pays 100%		After the deductible,
Plan pays 80%¹
Outpatient
office visits for specific treatment
diagnostic lab and x-ray
outpatient surgery
preadmission testing
home health care
skilled nursing facility		$15 copay per visit
Plan pays 100%
Plan pays 100%
Plan pays 100%
Plan pays 100%
Plan pays 100%		After the deductible,
Plan pays 80% ¹
Emergency Care
doctor’s office
hospital emergency room		$15 copay per visit
$100 copay per visit 4		After the deductible,
Plan pays 80% ¹
Behavioral Health Care (Mental
Health & Substance Abuse)		Out-patient treatment: $15
copay per visit; inpatient: Plan
pays 100% after $250 copay ²		After the deductible,
Plan pays 80%
Calendar Year Coinsurance
Maximum		None$1,000/individual
$2,000/family
  1. Covered expenses are based on reasonable and customary charges. If a provider’s actual charges exceed the usual and customary fee, you are responsible for the applicable cost-sharing amount, plus the difference between the usual and customary fee and the provider’s actual charges.
  2. A $250 copayment per admission applies, with a maximum of four copayments per year.
  3. Routine visits are covered as follows:
    • One visit every five calendar years from ages 19-29
    • One visit every three calendar years from ages 30-39
    • One visit every two calendar years from ages 40-54
    • One visit per calendar year for those aged 55 or older
  4. The copayment is waived if an 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 various programs and services for chronic behavioral conditions.

To access outpatient behavioral health services, make an appointment with an in-network provider and pay a $15 copayment 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, call the Blue Cross Behavioral Health Coordination line at 1-800-444-2426 or visit Teamsters Union 25 HSIP.

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.

Pharmacy

As an Early Retiree Member of the TeamstersCare plan, you and your family members can access your pharmacy benefits in the following ways:

Option #1: Walk-in Service

You and your dependents can obtain up to a 90-day supply of prescription medications at either the Charlestown or Stoughton TeamstersCare in-house pharmacies. The cost is $5 for generic medications and $15 for brand-name medications (if no generic is available).

  • To fill a new prescription:
    You can walk in during pharmacy hours, or your doctor can phone, fax, or e-prescribe your medication.
  • To refill a prescription, choose one of the following options:
    • Phone: Call the Charlestown or Stoughton pharmacy and use the automated Telemanager for refill requests.
    • Online: Use our Prescription Refill order form.
    • PocketRx App: Download the PocketRx app on iTunes or Google Play to refill your prescription on the go.

Note: Make sure you have your prescription available, as you’ll need the six-digit refill number.

Option #2: Mail-Order Service

You can obtain up to a 90-day supply of your prescription medication through the Express Scripts mail order program. The cost is $5 for generic medications and $15 for brand-name medications (if no generic is available).

  • To fill a mail-order prescription:
    Mail your prescription and copay along with the Prescription Order Form, available by calling Express Scripts at (877) 543-7097 or visiting www.Express-scripts.com.
  • To refill a mail-order prescription, choose one of the following options:
    • Log on to www.Express-scripts.com and click “Order Status.”
    • Call the Express Scripts automated phone service at 1-877-543-7097.
    • Mail a Refill Request Form along with a refill slip or prescription label to Express Scripts.

Option #3: Retail Pharmacy

You can obtain either a 30-day supply or a 100-unit supply of your prescription through a retail pharmacy in the Express Scripts TeamstersCare network, according to the following cost schedule:

  • Generic medication: $15 + 20% of the remaining cost
  • Brand name medication (no generic available): $25 + 20% of the remaining cost
  • Brand name medication (generic available): $25 + 20% of the remaining cost + the cost difference between the brand name and generic

Please note that Walgreens, Walmart, and Sam’s Club are not part of the Express Scripts TeamstersCare retail pharmacy network. If you use an out-of-network pharmacy, you will be responsible for the full cost of the prescription (including the copay) and must submit a claim to Express Scripts for reimbursement. You will receive a check based on network rates for the drug, minus your copay.  Click here to download claim form.

Specialty Medications

For prescriptions of specialty medications (certain high-cost drugs for complex conditions), you must fill your prescription through either of our in-house TeamstersCare pharmacies (walk-in service) or through Accredo, the Express Scripts Specialty Pharmacy (mail-order only). The copayment is $15 for up to a 30-day supply.

For more information about your pharmacy coverage, including a list of medications not covered by your plan, please refer to your Early Retiree Medical Program Summary Plan Description.

Dental

TeamstersCare Dental Services for Early Retirees

As an Early Retiree member of TeamstersCare, you and your dependents can access a wide range of dental services at any of our three in-house dental offices located in Charlestown, Chelmsford, and Stoughton.

TeamstersCare Dental Offices Offer:

  • Preventative care: dental exams, x-rays, fluoride treatment, cleanings, and scaling
  • Sealants
  • Fillings, root canals for select teeth, and simple extractions
  • Full or partial dentures, including repairs and relines
  • Mouth guards
  • Second opinions
  • Emergency care (during office hours)

Vision

TeamstersCare has contracted with Davis Vision to provide you and your family with benefits to protect your vision and eye health. With a national network of participating providers, you may visit any Davis Vision eye specialist for a broad range of eye care services and supplies – often at no cost to you.

For a list of participating providers, call Davis Vision at 1-800-999-5431 or visit www.davisvision.com. You may also contact TeamstersCare Member Services for a list of New England providers.

To view vision benefits please click here.

Important Note: When choosing either eyeglasses or contact lenses, you must make your full selection at the time of your examination. If you go to a provider who only provides an exam, you must order glasses through another provider within 30 days of your vision exam.

Hearing

Once every year, you and your family members are eligible to receive a comprehensive hearing test at our Charlestown Audiology Office. Ordinarily, hearing care services and equipment are covered only when they are provided at our TeamstersCare Audiology Office.

All routine hearing examinations, diagnostic evaluations and middle ear analyses are provided at no cost to you. Services include:

  • Ear examinations
  • Diagnostic hearing evaluations
  • Middle ear analysis
  • Hearing aid analysis, fitting and follow-up, as appropriate

To schedule an appointment for a hearing exam for you or your eligible dependents (ages 3 and up), contact our Charlestown Appointment Desk.

Employee Assistance Program

TeamstersCare provides an Employee Assistance Program (EAP) benefit for our members and their dependents who are in need of advice and guidance for a behavioral health issue. This confidential service is provided at no cost to you and is available in person or by phone.

Services include:

  • Short-term counseling sessions (up to 3 visits)
  • Assessments and referrals
  • Case management
  • Addiction issues
  • Advice or guidance with personal problems, family and relationship issues, financial and legal concerns, anxiety, grief counseling, job stress, etc.

Call TeamstersCare EAP at 1-800-851-8326 to speak to a clinical provider or to schedule an appointment.

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