IBEW-NECA Sound & Communications
Benefits Web site
IBEW-NECA Sound & Communications
Benefits Web site
| ANNUAL COPAYMENT LIMIT | |
|---|---|
| For each member | $1,500 |
| For each Family Unit | $3,000 |
| PROFESSIONAL SERVICES (Plan Provider Office Visits) | |
| Primary & specialty care visits (includes routine and Urgent Care appointments) | $15 per visit |
| Routine preventive physical exams | No per visit |
| Well-child preventive care visits (0-23 months) | No per visit |
| Family planning visits | $10 per visit |
| Scheduled prenatal care and first postpartum visit | $15 per visit |
| Routine preventive refraction exams | $0 charge |
| Routine preventive hearing tests | $0 charge |
| Physical, occupational, and speech therapy visits | $15 per visit |
| OUTPATIENT SERVICES | |
| Outpatient surgery | $15 per procedure |
| Allergy injection visits | $10 per visit |
| Allergy testing visits | $15 per visit |
| Immunizations | No charge |
| Physical, occupational, and speech therapy visits | $15 per visit |
| X-rays and lab tests | No charge |
| HOSPITAL INPATIENT CARE | |
| Hospital room and board, surgery, anesthesia, X-rays, lab tests, and medications | No charge |
| Skilled Nursing Facility (up to 100 days per benefit period) | No charge |
| PRESCRIPTION DRUGS | |
| Covered items in accord with our formulary when obtained at Plan pharmacies: | |
| Generic | $10 up to a 100-day supply (or 3 cycles for oral contraceptives) |
| Brand name or compounded drugs | $25 up to a 100-day supply (or 3 cycles for oral contraceptives) |
| Drugs related to the treatment of sexual dysfunction disorders (episodic drugs are limited to 27 doses in any 100-day period) | 50% Coinsurance up to a 100-day supply |
| MENTAL HEALTH SERVICES | |
| Inpatient psychiatric care (up to 45 days per calendar year) | No charge |
| Outpatient visits: | |
| Up to a total of 20 individual and/or group therapy visits per calendar year | |
| Individual therapy visits | $10 per visit |
| Group therapy visits | $5 per visit |
| Up to 20 additional group therapy visits that meet Medical Group criteria in the same calendar year | $5 per visit |
| Note: Visit and day limits do not apply to severe mental illnesses and serious emotional disturbances of children. | |
| CHEMICAL DEPENDENCY SERVICES | |
| Inpatient detoxification | No charge |
| Outpatient group therapy visits | $5 per visit |
| Outpatient individual therapy visits | $10 per visit |
| Transitional residential recovery Services (up to 60 days per calendar year, not to exceed 120 days in any five-year period) | $100 per admission |
| OTHER SERVICES | |
| Ambulance Services | No charge |
| Durable medical equipment in accord with our formulary | 20% Coinsurance |
| Health education for specific conditions: | |
| Individual visits | $10 per visit |
| Group visits | No charge |
| Home health care | No charge |
| Hospice care | No charge |
| EMERGENCY CARE | |
| Emergency Department visits | $50 per visit (waived if admitted directly to the hospital) |
KAISER Member Service Call Center
800.464.4000 (ENGLISH)
800.788.0616 (SPANISH)