Welfare Benefit Information

This is a broad and general overview of the plan of benefits. It is strongly recommended that you read your Summary Plan Description thoroughly, as well as any Summary of Material Modifications (SMM) that may be issued. If you should have any questions regarding your plan of benefits, the Fund Office is happy to assist you.

The SEIU Local 1 & Participating Employers Health Trust has a unique Plan of Benefits. Under this plan, you have Health coverage through Union Health Service, Inc. (UHS). As long as you are under the care of a Union Health Service physician, you have 100% coverage of covered expenses. The main medical center is located at 1634 W. Polk Street (at Ashland) in Chicago, Illinois. Refer to Union Health Service on this site to access more information including a list of additional UHS care centers and their hours of operation.

Continuation of Coverage (COBRA)

Should you lose eligibility, it is possible under certain circumstances to continue coverage in this plan by electing COBRA and following the self-payment procedure outlined in the Summary Plan Description.

Dental Services

Dental services are provided by Blue Care Dental HMO Plan 740. Please refer to BlueCare Dental on this site for more information.

Disability Benefits

Provided when a member is considered to be totally disabled, the maximum period that benefits are payable per period of disability is 26 weeks. The benefit is $200.00 per week for the first 13 weeks, and then the benefit is reduced to $100.00 per week for the remaining 13 weeks. FICA taxes are withheld from this benefit and remitted directly to the federal government. Your employer pays the matching FICA tax amounts.

Please be advised that there are specific plan exclusions and limitations. Be sure to review these in your Summary Plan Description or contact the Fund Office if you have a question.

Eligibility

You will become initially eligible on the first day of the Benefit Month corresponding to the Work Month in which you first accumulate at least 173.32 Credited Hours of employment for which an employer or employers are required to make a contribution to the Fund on your behalf. For example, if your employer makes contributions for you of at least 173.32 Credited Hours for work performed in January, your coverage will start on April 1.

Once you become eligible, you will remain eligible if you meet the requirements described below. The minimum Credited Hour requirement for continuing eligibility during a Work Month is 173.32 hours per month. The following table shows how Work Months correspond to Benefit Months.

Emergency

• If you develop a serious medical problem, call Union Health Service at (312) 423-4200. There is a 24-hour, 7 days a week answering service to help you. Give your name, Social Security Number or chart number, telephone number, your UHS doctor’s name if you already have one, and explain what the emergency is. Your doctor, or a UHS doctor who is “on call,” will call you back and tell you what to do.
• If you have a life-threatening emergency and it is not medically possible to contact UHS before getting treatment, go to the nearest hospital emergency room or other medical facility for immediate treatment. Then, you (or someone acting for you) must contact UHS as soon as it is medically possible so that a UHS doctor can supervise the treatment and follow-up care.

Eye Care

Available to all eligible family members only at the Polk Street and 2800 W. 87th Street UHS Centers. These services include eye exams, prescriptions for eyeglasses and contact lenses, and treatment of eye diseases. Discounts for eyewear can also be obtained at specific vendors at your expense.

Hospitalization

If hospitalization is required as a result of the emergency, UHS must be contacted by you or someone acting for you. If it is not medically possible to contact UHS before admission, UHS must be contacted as soon as possible.

Should you choose to receive medical care that is not provided or referred by a Union Health Service physician, substantial deductibles and co-payments will apply.

Physician Services

All routine primary and many specialty physician services are provided at UHS. Other specific specialties may be handled via a referral from UHS. If you do not wish to use a Union Health Service physician, you will be responsible for all physician costs.

Prescription Drugs

Union Pharmacy Service is a pharmacy plan provided by Union Health Service. You may take your UHS prescription to the pharmacy at the Polk Street center or any other participating pharmacy.

UHS also uses a pharmacy service called OptumRx: OptumRx participating pharmacies include Jewel Osco, CVS, Mariano’s, Costco and many others.

Click here to access Formulary (list of covered drugs) and list of participating pharmacies.

Polk Street Pharmacy Phone: 312-423-4260

OptumRx Customer Service: 1-866-207-5623