Upstate New York Engineers Health Fund
The purpose of the Upstate New York Engineers Health Fund is to provide certain medical benefits to participants and their eligible dependents. Following is a summary of benefits offered by the Fund. For detailed information about the Plan, please refer to the Summary Plan Description.
The Fund provides major medical and hospital benefits. Many of the service providers, including hospitals, outpatient facilities, home health care programs, durable medical equipment providers, and other medical specialty providers are participants of the Plan’s Preferred Provider Organization (PPO). Aetna has established contractual agreements with many of the medical service providers in upstate New York. These contractual agreements may provide substantial reductions in charges and fees charged by the service provider. This in turn saves the Fund money and also may reduce your out-of-pocket costs. To find a provider participating in the Aetna network, visit www.aetna.com/docfind. Under “Guest” enter the Zip code or City/State in which you would like to find a provider. You may adjust the distance from zero to 100 miles.
Active participants, retirees participating in the Early Retiree Buy-In Plan, the Normal Retiree Buy-In Plan, Widowed Spouse Buy-In Plan, Disability Buy-In Plan and their eligible dependents are eligible for vision benefits. In addition, active participants are eligible for one pair of safety glasses during any 12 consecutive month period. The Vision Benefits are administered by Davis Vision (Empire Vision Works). If you have any questions about the vision benefit, please contact Davis Vision Member Services at 800-999-5431 or at [email protected].
The Fund’s dental benefits are administered through a contract with Delta Dental. You are not required to use a Delta Dental Provider; however, choosing a Dentist that is within the Delta Dental Provider network saves money for both you and the Plan, because Delta Dental providers have agreed to a fixed fee schedule. For questions about your covered dental benefits or to find a Dentist within the Delta Dental network, you may call the Delta Dental Customer Services Line toll-free at (800) 932-0783 or visit their website at www.deltadentalins.com.
Prescription Drug Benefit
The Fund offers a Prescription Drug benefit to eligible participants and dependents which is administered by Optum Rx. Many national pharmacy chains and independent pharmacies are included in the Optum Rx network. For a complete list of participating pharmacies, use the Optum Rx Pharmacy Locator tool on the Optum Rx App, at Optumrx.com or call Optum Rx customer service at 1-855-295-9140. In addition, Optum Rx offers a Mail Order Service for eligible participants and dependents who are using maintenance prescription drugs. To start mail order home delivery for maintenance medications log in to OptumRx.com, use the Optum Rx App or call 1-855-295-9140.
Medicare Supplement Plan
The Fund offers supplemental coverage to eligible Medicare participants. This Plan will reimburse the Medicare Part A and Part B deductibles and the 20% of the Medicare “approved charges” that Medicare does not reimburse directly to the service providers. For questions about Medicare Supplement Claims, contact the Fund Office at (315) 492-1796 and choose option "3".
Teladoc is available to all active participants. As a member of Teladoc, you will have access to a national network of Board-Certified physicians to diagnose and treat non-emergency conditions. The Teladoc service is available 24/7 to assist you and can be accessed by phone or video. Set up your account today at https://www.teladoc.com/aetna or call 1-855-TELaDOC (835-2362).
Please contact the Fund Office if you change your address, acquire a new dependent, or change your marital status — (315) 492-1796, Ext. 1337