December
2002
Dear Member:
I am writing to tell you about several changes
regarding your Connecticut Carpenters Health Fund benefit plan EFFECTIVE
JANUARY 1, 2003:
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NEW ADDRESS TO MAIL HEALTH CLAIMS:
Our Preferred Provider Organization (PPO),
Health Connecticut, has a new P.O. Box Number to submit claims for active
members only:
P.O. Box 5006
Wallingford, CT 06492-7506
You and your doctors should use
this new address for all claims submitted in 2003, even if they are for
services received in 2002.
(Members on Medicare should
continue to send all claims with Medicare Explanations of Benefits (EOBs) to
the Fund Office.)
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NEW I.D. CARDS
Enclosed are new I.D. Cards for you (and
your spouse). Please STOP using the old
card after December 31, 2002. Effective
January 1, 2003, show your NEW card to your medical provider
whenever you go for health services.
The new claims filing address is on the front and the pre-certification
number is on the back of the new cards.
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NEW UTILIZATION
MANAGEMENT COMPANY FOR HOSPITAL PRE-CERTIFICATION
Hines & Associates is our new
utilization management company for all HOSPITAL and REHABILITATION
ADMISSIONS. Call them at 1-800-944-9401
for pre-admission certification. For
emergency admissions call this number within 48 hours of admission. (Participants who are on Medicare do
not need to pre-certify hospital admissions through Hines. However, they must pre-certify all
rehabilitation admissions before the 21st day of stay.) Hines will also be monitoring hospital
stays and providing large case management.
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NEW MEMBER
ASSISTANCE PROGRAM COUNSELORS
Behavioral Health Consultants will
service our Member Assistance Program (MAP). They provide free, confidential
help with personal problems for you and your eligible dependents. Just call 1-888-373-5073 to be
referred to a provider for up to six sessions for a particular problem. Enclosed you will find a Behavioral Health
Consultants MAP brochure describing their services.
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NEW CLAIMS AND APPEALS PROCEDURES
The Connecticut Carpenters Health Fund
has new Claims and Appeals Procedures for filing claims and appealing
denials. Enclosed is a detailed explanation
of the new Procedures that replace the claims and appeals procedures on page 14
of your Summary Plan Description (SPD), 2001 edition.
In addition,
please be aware of the following:
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Women’s Health and
Cancer Rights Act of 1998
Under federal law, group health plans
that provide medical and surgical benefits covering a mastectomy must provide
benefits for certain related reconstructive breast surgery. This applies to reconstruction of the breast
on which the mastectomy was performed, surgery or reconstruction on the other
breast to produce a symmetrical appearance, prostheses, and physical
complications of all stages of mastectomy, including lymphedemas. Coverage is subject to all of the Plan’s
normal rules, including co-payments, annual deductibles and coinsurance
provisions.
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Effective August 1,
2002, registered/licensed dieticians and audiologists are included as covered
providers under the Connecticut Carpenters Health Fund.
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Effective November 1,
2002, you may now access your Davis Vision exam and eye glass/contact lens
benefit on two different days within the same calendar year.
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Effective January 1, 2003, quarterly Health Statements will be
discontinued.
Active members will continue to receive
an eligibility letter every January showing their worked hours for the prior
calendar year.
Please call the Fund Office if you have any questions concerning these changes. The Trustees and the Staff of the Connecticut Carpenters Benefit Funds wish you and your families a very HAPPY and HEALTHY Holiday Season.
Sincerely,
Richard S. Monarca
Fund Director
Enclosures