Alyssa Lane
1199SEIU Benefit and Pension Funds is an insurance provider for health and human service employees. 1199SEIU members can enjoy unparalleled health coverage with little to no out-of-pocket costs, while others pay modest co-pays and premiums for high-quality care. The 1199SEIU Benefit Funds cover a defined set of healthcare services, including comprehensive primary care, specialty care, outpatient laboratory and radiology, emergency care, hospitalization, and ambulatory care procedures. Members also have access to comprehensive dental coverage and full prescription coverage with no co-payments when using preferred drugs.
| Characteristics | Values |
|---|---|
| Type | Health and pension funds for health and human service employees |
| Coverage | Comprehensive primary care, specialty care, outpatient laboratory and radiology, emergency care, hospitalization, and ambulatory care procedures |
| Co-payments | No co-payments for preventive services such as annual checkups and well-child visits, and for drugs on the Preferred Drug List |
| Providers | Over 30,000 providers in New York City, Westchester and Long Island |
| Mental Health Services | Covered by phone and Teladoc |
| Dental Coverage | Available and varies by Benefit Fund |
| Life Insurance | Available and based on Wage Class |
Explore related products
![Union status & benefits of retirees [by Vincent A. Cicconi. - 1973 [Leather Bound]](https://m.media-amazon.com/images/I/61IX47b4r9L._AC_UY218_.jpg)
What You'll Learn
1199SEIU members' out-of-pocket costs
1199SEIU is a health and benefit coverage insurance provider. It offers unparalleled health coverage with little to no out-of-pocket costs. However, some members pay modest co-pays and premiums for high-quality care.
The 1199SEIU Benefit Funds cover a defined set of healthcare services known as "covered services". These include comprehensive primary care, specialty care, outpatient laboratory and radiology, emergency care, hospitalization, and ambulatory care procedures. Coverage for drugs is also provided if they are included in the 1199SEIU Benefit Funds' Preferred Drug List. The Benefit Funds have a custom participating pharmacy network that members can access for acute treatment and the first fill of a maintenance medication.
There are six benefit funds, each with its own eligibility requirements and level of benefits. The National Benefit Fund, Greater New York Benefit Fund, and Home Care Benefit Fund are examples of these funds. Members of these funds can access providers by telephone to avoid transportation and waiting rooms.
In addition to covered services, 1199SEIU also offers phone visits with providers for medical and mental health services, including COVID-19-related services. These services are covered by the Benefit Funds and do not incur out-of-pocket expenses for members.
It is important to note that services and charges not included in a member's SPD (Summary Plan Description) are considered "non-covered" and are not payable by the 1199SEIU Benefit Funds. Members are personally responsible for the costs of these services, and providers must notify members in writing before providing them.
Housekeeping Insurance: What You Need to Know
You may want to see also
Explore related products
1199SEIU Benefit Funds' covered services
1199SEIU Benefit Funds provide health insurance coverage for individuals and families. The specific services covered by 1199SEIU vary depending on the particular fund and plan. For example, the 1199SEIU National Benefit Fund offers Plan A and Plan B, each with different covered services.
Plan A covers both inpatient and outpatient drug and alcohol rehabilitation with no copay when prior authorization is received. Medication-assisted treatment may also be covered if it is part of an inpatient or outpatient treatment program, although certain medications may incur a differential charge. Sober living houses may be covered under Plan A as well.
Plan B covers inpatient rehabilitation with a $25 copay for in-network providers or a $25 copay plus provider charges for out-of-network providers. To qualify for coverage, individuals must receive prior authorization unless treatment is provided in a health emergency. In this case, authorization must be requested within 48 hours of admission. Plan B may cover up to 100% of outpatient rehab services for in-network providers, while individuals must pay the costs for out-of-network providers.
In addition to addiction treatment services, 1199SEIU Benefit Funds also cover a range of other healthcare services. For instance, the National Benefit Fund, Greater New York Benefit Fund, and Home Care Benefit Fund offer health coverage, and early retirees between 62.5 and 64 years old enjoy the same benefits as active members, except for dental coverage. Furthermore, members can access a large network of highly-rated physicians through Medicare.
To find a qualified healthcare provider, members can search for doctors and providers in the 1199SEIU Benefit Fund network. This network includes hospital-based professionals such as anesthesiologists, radiologists, assistant surgeons, co-surgeons, and labs. During the COVID-19 pandemic, 1199SEIU also covered phone visits with providers for medical and mental health services.
Huntington Bank Accounts: Are They Insured?
You may want to see also
Explore related products
Non-covered services
1199SEIU is a health insurance provider that offers its members comprehensive healthcare coverage with little to no out-of-pocket costs. While 1199SEIU covers a wide range of services, there are certain non-covered services that members may need to pay for out-of-pocket.
Before providing non-covered services, providers are required to notify the member in writing. This notification must specify the services that are not covered, list the associated costs, and obtain the member's written consent to incur these costs.
Some examples of commonly denied non-covered services include:
- Services related to an illness or injury where the legal responsibility for payment lies with another entity, such as another insurance company, a workers' compensation carrier, or an uninsured motorist fund.
- Services that have not been approved in advance by the Benefit Fund's Plan Administrator. Certain covered services may require prior approval, and it is important for members to understand these requirements to avoid unexpected costs.
It is important to refer to the member's specific SPD to determine a comprehensive list of non-covered services, as the coverage may vary depending on the member's chosen Benefit Fund. Members can also utilize the automated Interactive Voice Response (IVR) system or online platforms like NaviNet to verify their coverage details and understand any applicable co-payments.
Congress vs Private Insurance: Who Regulates the Regulators?
You may want to see also
Explore related products
1199SEIU Benefit Funds' prescription coverage
1199SEIU is a healthcare union that provides insurance coverage for its members. The 1199SEIU Benefit Funds offer comprehensive health coverage, including prescription drug coverage, to over 200,000 members.
The prescription coverage provided by the 1199SEIU Benefit Funds includes drugs prescribed according to their Preferred Drug List. Members must obtain their prescriptions electronically, as per New York State law, and can access their medications through the Benefit Funds' custom participating pharmacy network. For acute treatment and the first fill of a maintenance medication, members can visit any pharmacy in this network.
Maintenance medications, which are typically taken for chronic conditions, are supplied in three-month increments through the Benefit Funds' pharmacy benefit manager (PBM). Members can obtain these medications by mail or at a participating pharmacy. On the other hand, specialty medications requiring injection or special administration are supplied in 30-day increments through a specialty pharmacy mail-order service.
The 1199SEIU Benefit Funds also cover other healthcare services such as comprehensive primary care, specialty care, outpatient laboratory and radiology, emergency care, hospitalization, and ambulatory care procedures. These services are considered "covered services" and are payable by the Benefit Funds. However, it is important to note that specific services may require prior approval, and coverage can vary depending on the member's chosen Benefit Fund, as outlined on their Health Benefits ID card.
In addition to prescription coverage, the 1199SEIU Benefit Funds also provide access to phone and Teladoc visits with 1199SEIU providers for medical and mental health services, including those related to COVID-19. This ensures that members can conveniently access the healthcare they need without incurring additional costs.
Overall, the 1199SEIU Benefit Funds strive to provide comprehensive prescription coverage and healthcare services to their members, ensuring they can access the necessary medications and treatments with little to no out-of-pocket expenses.
ASU Student Insurance: What Coverage Do You Get?
You may want to see also
Explore related products
1199SEIU Benefit and Pension Funds
Healthcare
1199SEIU members enjoy comprehensive health coverage with little to no out-of-pocket costs. The coverage includes primary and specialty care, outpatient laboratory and radiology services, emergency and hospitalization services, and ambulatory care procedures. In addition, members have access to dental and vision care, prescription drugs, and mental health services. During the COVID-19 pandemic, 1199SEIU also covered phone and telemedicine visits for medical and mental health services.
Pension
The 1199SEIU pension funds serve over 200,000 members, primarily in New York City and its surrounding areas. The pension funds aim to provide a secure retirement income for members and their families.
Education and Family Care
1199SEIU also provides benefits to help members and their families with education and childcare. These benefits include assistance with earning high school and college degrees, skill development for the evolving job market, and placement services for those who are laid off. Additionally, the funds offer a range of programs for children, including daycare, after-school care, mentoring, camps, and holiday programs.
Eligibility and Coverage
Each of the six benefit funds has its own eligibility requirements and levels of benefits. Members can verify their coverage through NaviNet or the automated Interactive Voice Response (IVR) system. Co-payments may apply for certain services, and these are listed on the member's Health Benefits ID card.
The 1199SEIU Benefit and Pension Funds are dedicated to enhancing the well-being of their members through comprehensive healthcare, pension plans, and supportive services that cater to a range of personal and professional needs.
Private Insurance: Who's Keeping It and Why?
You may want to see also
Frequently asked questions
1199SEIU is a Benefit and Pension Fund for Health and Human Service Employees. It offers health coverage with little to no out-of-pocket costs, as well as prescription coverage and dental coverage.
Covered services include comprehensive primary care, specialty care, outpatient laboratory and radiology, emergency care, hospitalization, and ambulatory care procedures. Phone and Teladoc visits with 1199SEIU providers are also covered for all medical and mental health services.
You can verify coverage by logging into NaviNet or calling the Benefit Funds’ automated Interactive Voice Response (IVR) system at (888) 819-1199.
