Anthem Blue Cross and Blue Shield PPO

Medical Benefits provide important financial protection in the event you or a covered family member needs medical care for non-occupational illness or injury.

The Fund’s comprehensive medical benefit provides you and your dependents with coverage when you need it most. Below are just some of the benefits included under the medical coverage:

• Office Visits (including Primary Care, Specialist, Urgent Care and Telehealth)
• Preventive Screenings and Exams
• X-Rays and Laboratory Expenses
• Hospital Room and Board
• Emergency Medical Treatment
• Inpatient and Outpatient Surgeries
• Chemotherapy
• Chiropractic & Podiatry Care
• Mental Health and Substance Abuse
• Organ Transplant
• Physical, Occupational and Speech Therapies
• Hospice Care

In-Network vs. Out of Network

The Fund uses the Anthem Blue Cross and Blue Shield PPO provider network, giving you the flexibility to see any provider you choose without requiring a referral to visit a specialist or designating a Primary Care Physician before receiving care. Anthem has negotiated rates with participating providers nationwide, which means when you use an in-network provider, you receive the highest level of benefits available under the Plan and generally pay lower out-of-pocket costs.

To locate an in-network doctor, hospital, or other healthcare provider, visit Anthem’s provider directory and search the BlueCard PPO network. Anthem’s extensive national network provides access to participating providers throughout Ohio and across the United States, making it easy to find in-network care whether you are at home, traveling, or residing outside Ohio. You may also contact Anthem Member Services using the phone number listed on your ID card for assistance in locating a participating provider or verifying network participation before receiving services.

Benefit Exclusions and Limitations

While the Plan covers most medically necessary and preventive care, there are several procedures that are specifically excluded by the Plan. These include things that are cosmetic in nature, weight loss or infertility treatments, work related illnesses and the like. Please check the list of exclusions for your specific plan by referencing the Summary Plan Description (SPD) booklet. If you do not have a copy readily available, check the Documents page of our website or contact the Fund Office.