Your Benefits

blue distinction pic2What are health benefits?

According to the United States Department of Labor, health benefits are, “A group health plan is an employee welfare benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise.”

Schedule of Benefits 

Is a brief summary outlining what health services and treatments are covered under your plan and how much it costs.

To obtain a copy of your Summary of Benefits and Coverages (SBC), please call 800.433.1204

Explanation of Benefits (EOB’s)

An Explanation of Benefits (EOB) lets you know that your claim has been processed for payment from a health care provider.

You should carefully review your EOB every time you receive one. Your EOB provides information about the health care services you have received, how much your insurance company has paid for your health care and any charges that are not paid for by your insurance that you are required to pay.  An EOB is not a bill, but it may explain how much your health care provider can bill you.

Click here to see an image of an EOB.

What’s covered under your health benefits?

Your health insurance benefits cover medical, dental, vision, prescriptions, wellness resources, and wellness educational tools.

Summary Plan Description (SPD)

The Summary Plan Description (SPD) is a booklet intended as a summary of the Rules and Regulations, and insurance policies that govern Heartland Health & Wellness Fund (the “Fund”). The SPD provides a description of Fund coverages and benefits, and limitations and exclusions to help Participants understand the Fund.

The SPD describes the medical, dental, vision, life, accidental death and dismemberment, and accident and sickness benefits for employees. It also outlines how employees can qualify for these benefits if they do not yet have them.

To obtain your Summary Plan Description, please call 800.433.1204.

Pre-certification

If your medical provider suggests or prescribes any type of medical surgery, treatment, therapy or drug therapy, etc., click HERE to learn your responsibility.