Retiree Health & Welfare
Health & Welfare Plan
Full Health Plan Options
SPD Navigation
The Fund offers four full health plans:
- Operating Engineers PPO Plan: This Plan is the same plan offered to Active and non-Medicare Retirees.
- UnitedHealthcare Group Medicare Advantage PPO: This plan allows you to use any provider that accepts Medicare. This means there is no in and out of network differences. All benefits are the same no matter what provider you use.
- Kaiser Permanente Senior Advantage Plan: This plan requires that you use Kaiser providers. This Plan is only available to Participants in Kaiser services areas in California.
- Health Plan of Nevada HMO: This plan requires that you use providers in the HMO. This Plan is only available to Participants who reside in Nevada.
Both Medicare Advantage plans, UnitedHealthcare Group Medicare Advantage PPO and Kaiser Permanente Senior Advantage Plan, include coverage for medical, hospital, prescription drug and vision benefits. They include all of the benefits of Medicare as well as some additional benefits and lower out-of-pocket expenses than traditional Medicare. All of your benefits are provided by the plan you choose, so there is no need for coordinating benefits between Medicare and your Operating Engineers coverage.
Dental benefits are provided by the Fund, as outlined in Dental Benefits.
Retiree Death Benefits provided by the Fund, are outlined in Retiree Death Benefits.
Coverage for Dependents
Operating Engineers PPO Plan: If you elect this Plan, your dependents will automatically be covered by this Plan.
UnitedHealthcare Group Medicare Advantage PPO: If you elect this Plan, your dependents age 65 or older will automatically be covered by this Plan. Your dependents under age 65 will be covered by the Operating Engineers self-funded PPO as outlined in PPO Plan Benefits.
Kaiser Senior Advantage Plan: If you elect this Plan, your dependents must also be enrolled in a Kaiser Plan.
Health Plan of Nevada HMO: If you elect this Plan, your dependents must also be enrolled in a Health Plan of Nevada Plan.
Coverage for Full Health Plan Options
| Item | Kaiser Senior Advantage HMO Plan |
UnitedHealthcare (The following benefits are effective July 1, 2017) |
Operating Engineers PPO Plan |
|---|---|---|---|
| Deductible |
None
|
None
|
None
|
| Annual Out-of-Pocket Maximum | $1,500 per individual/ $3,000 per family |
None
|
$6,000 per individual/ $12,000 per family per calendar year |
| Professional Services | Kaiser Senior Advantage HMO Plan |
UnitedHealthcare Medicare Advantage PPO Plan (The following benefits are effective July 1, 2017) |
Operating Engineers PPO Plan |
|---|---|---|---|
| Office Visits | $5 co-pay per visit |
No charge
|
Generally not to exceed $15 co-pay per visit |
| Routine Physical | No charge: 1 per calendar year |
No charge for Medicare covered services | No charge; Plan pays difference between Medicare allowance and their paid amount |
| Lab and X-ray | No charge |
No charge
|
No charge; Plan pays difference between Medicare allowance and their paid amount |
| Therapy (Physical, Occupational, and Speech) | $5 co-pay per visit |
No charge
|
No charge; Plan pays difference between Medicare allowance and their paid amount |
| Chiropractic | $5 co-pay per visit for manual manipulation of spine | No charge for manual manipulation of spine; No charge for up to 26 visits per year for routine chiropractic care |
No charge for up to 26 visits per year; Plan pays difference between Medicare allowance and their paid amount |
| Outpatient Surgery | $5 co-pay per visit |
No charge
|
No charge; Plan pays difference between Medicare’s allowance and their paid amount |
| Inpatient Hospital | No charge |
No charge
|
No charge; Plan pays the Medicare Inpatient Deductible |
| Other Services | Kaiser Senior Advantage HMO Plan |
UnitedHealthcare Medicare Advantage PPO Plan (The following benefits are effective July 1, 2017) |
Operating Engineers PPO Plan |
|---|---|---|---|
| Ambulance | No charge |
No charge
|
No charge; Plan pays difference between Medicare allowance and their paid amount |
| Emergency Care | $20 co-pay per episode |
No charge
|
No charge; Plan pays difference between Medicare allowance and their paid amount |
| Urgent Care | $5 co-pay per visit |
No charge
|
No charge; Plan pays difference between Medicare allowance and their paid amount |
| Durable Medical Equipment | No charge, including diabetic testing supplies |
No charge
|
No charge; Plan pays difference between Medicare allowance and their paid amount |
| Skilled Nursing Facility | No charge up to 100 days | No charge up to 100 days | No charge up to 100 days |
| Hearing Benefits | $5 co-pay per exam | No charge for one routine hearing exam, every 12 months; Plan pays up to $1,000 for one hearing aid per ear every 3 years |
Plan pays $1,000 for one hearing aid per ear, every 3 years |
| Mental Health | No charge for inpatient; $5 co-pay per visit for individual outpatient evaluation and treatment; $2 co-pay per visit for group outpatient treatment |
No charge (subject to 190 day inpatient stay lifetime maximum); No charge for outpatient treatment |
No charge; Plan pays difference between Medicare allowance and their paid amount |
| Chemical Dependency | No charge for inpatient detoxification; $5 co-pay per visit for outpatient evaluation and treatment |
No charge
|
No charge; Plan pays difference between Medicare allowance and their paid amount |
| Prescription Drugs | $5 per prescription (walk in or mail order up to a 100-day supply |
Walk-in Pharmacy (30-day supply):
Mail Order (90-day supply):
|
Walk-in Pharmacy (30-day supply):
Mail Order (90-day supply):
|
| Vision Benefits | Kaiser Senior Advantage HMO Plan |
UnitedHealthcare Medicare Advantage PPO Plan (The following benefits are effective July 1, 2017) |
Operating Engineers PPO Plan |
|---|---|---|---|
| Routine eye exams | $5 co-pay | No charge: One exam every 12 months | $15 co-pay: One exam every 12 months |
| Eyewear | Up to $150 allowance every two years | Up to $130 eyewear allowance every two years; Up to $175 contact lens allowance in lieu of eyewear every two years |
$25 co-pay: Lenses, frames, or contacts, once every 24 months |
Additional Benefits Under UnitedHealthcare Medicare Advantage PPO
- Nurseline: You may call the Nurseline 24 hours a day, 7 days a week to speak to a registered nurse about your medical concerns and questions. There is no charge for this service. The Nurseline phone number is on your UnitedHealthcare identification card.
- Fitness Program: The SilverSneakers fitness program provides free membership at network fitness centers. If you live more than 15 miles from a network fitness center, you are entitled to the SilverSneakers Steps at Home program which provides general fitness, strength,
walking or yoga in your home at no charge. - Routine Foot Care: The Plan provides up to 6 visits per year for routine foot care. You pay $30 for each visit.
- Pharmacy Saver: Hundreds of prescription drugs can be obtained with co-pays as little as $1.50 when obtained from many of the national and regional pharmacy chains.
Revised 12/2022