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The plan enters into contracts with network sponsors, allowing covered persons to have access to networks of hospitals, physicians and other health care providers. In general, the plan’s benefits will be highest at Carpenters Wellness Center, higher for an in-network provider and lowest for a non-network provider. Covered persons are free to choose to obtain most medical services and supplies from either an in-network provider or a non-network provider. However, certain services and supplies are covered only if obtained from an in-network provider. For the lowest out-of-pocket cost, use Carpenters Wellness Center or an in-network provider when possible.
Carpenters Wellness Center
Carpenters Health Plan is pleased to offer Carpenters Wellness Center to all active, non-Medicare Carpenters participants and their families (ages 2 and up) covered under the health plan.
Active participants: Carpenters Wellness Center can be your primary care provider and medical home for all of your healthcare needs, including preventive services, managing chronic conditions, treating injuries and helping you recover from common illnesses. With an onsite pharmacy, dental center and vision center, physical and massage therapies, as well as chiropractic care, Carpenters Wellness Center is designed to be a one-stop-shop for many of your healthcare needs at no or little cost to you.
Carpenters’ Medicare Supplement participants: Carpenters’ Medicare Supplement participants may utilize pharmacy, dental (if elected), and audiology services. Participants who utilize Carpenters Pharmacy Center report significant savings in prescription drug costs.
For more information, please visit our wellness center page.
Medical Benefit Network
The medical benefits generally provide 80% coverage after the deductible when an in-network provider is utilized. The plan’s medical network is offered through UnitedHealthcare’s Choice Plus Network. In-network benefits apply to all providers in this network, except for organ transplants (refer to Transplant Network below) and treatment covered as mental health and substance abuse, including the Member Assistance Program (available through Mercy).
Refer to the Medical Schedule of Benefits section (p.1-2) of the Plan’s full Schedule of Benefits which may be found on our Resources page.
Visit umr.com for your online personalized experience to view your benefits, look up claims, replace your insurance card, estimate healthcare costs, find tips for healthy living, and more.
Questions regarding benefits or claims? Call Carpenters’ Participant Services at 1.877.232.3863, option 1, Monday – Friday, 8 am – 4:30 pm, or by email at [email protected]. UMR customer service will be available before and after hours for support Monday – Friday, 7am – 8am, and 4:30pm – 7pm. Simply call Carpenters’ Participant Services and follow the prompts for assistance with medical claims and benefits outside normal business hours.
UnitedHealthcare Prior Authorization List
UnitedHealthcare’s Prior Authorization List is a detailed list of medical services and supplies for which prior authorization is required in most or all cases as a condition of coverage for any benefit. This requirement is stated with additional detail in Appendix B and Appendix C of our plan document, which may be found on the Resources page of this website. This detailed list including CPT codes may update from time-to-time. The prior authorization list may be found online after logging in on umr.com, or by calling UMR CARE at 1.866.494.4502 for precertification authorization requirements.
UnitedHealthcare Choice Plus Transplant Network
Transplant Resource Services helps manage the catastrophic care of transplants through access to Centers of Excellence (COEs), member support and specialized contracts. Access to COEs COE transplant providers have a goal of helping deliver better health outcomes. They’re qualified on the program level and must meet both clinical and contracting criteria. There are 180 COE facilities and 998 COE programs nationwide. The Carpenters members will work with a designated transplant nurse clinical manager to help understand their care options, make informed decisions and navigate the health care system.
Physical Therapy Services at No Cost to You
The St. Louis-Kansas City Carpenters Regional Health Plan has partnered with PEAK Sport & Spine in an effort remove barriers to exceptional care for our participants and their covered dependents in need of physical therapy services.
Effective in 2021, all PEAK Sport & Spine locations began providing physician-ordered physical, occupational and hand therapy services to all covered participants and their families with $0 out-of-pocket costs. In addition, in August 2023, a law went into effect in Missouri which allows anyone to schedule an appointment with a licensed physical therapist without the need for a physician’s referral. “Direct access physical therapy” benefits allow patients more convenience, faster care, and empowerment to control your health and wellness outcomes.
Patients or their referring physicians should call the PEAK Sport & Spine physical therapy clinic where they would like to schedule their initial appointment and identify themselves as an eligible Carpenters’ member or dependent at the time of that call. View PEAK Sport & Spine locations. Call Carpenters’ Participant Services for assistance at 314.644,4802, option 1.
Carpenters originally partnered with PEAK Sport & Spine in 2019 to manage physical therapy services in the St. Louis Wellness Center. PEAK therapists’ advanced training and specializations provide the needed skills to find the root cause of any issues and allow for individual treatment, instead of a one-size-fits-all approach. This conservative treatment plan often allows patients to manage their diagnoses themselves, often without surgery or other invasive treatments. When other treatments are required, this approach helps provide maximum benefit.
Prescription Drug Benefit Network
The plan’s prescription drug benefit is provided without additional cost to participants in the active classification and participants who are not eligible for Medicare in the non-active classification and their dependents. The prescription drug benefit covers medically necessary prescription drugs, as well as certain preventive medications.
Express Scripts is the prescription drug network for the St. Louis – Kansas City Carpenters Regional Health Plan. The prescription drug benefit has a preferred formulary and certain medications are excluded from the plan if they are determined to be ineffective medications or have better, less costly medications commonly prescribed for the condition treated.
Express Scripts also offers My Rx Choices, a program that allows you to compare lower-cost alternatives to the medication you take on an on-going basis. To compare your medication costs or to find a participating Express Scripts pharmacy in your area, contact Express Scripts at 800.939.2134 or online at www.express-scripts.com.
Refer to the Prescription Schedule of Benefits section (p.3) of the Plan’s full Schedule of Benefits, which may be found on this website’s Health Plan Resources page.
Digital Smoking Cessation Program
Pelago is a digital app that provides the tools and support to help people achieve life-changing goals like giving up smoking, vaping, or smokeless tobacco. This health benefit is available at no cost to you and your eligible dependents 18 and older.
Here’s a snapshot of what’s included in the Pelago program:
- One-to-one support from a real person. You’ll be set up with your own dedicated Quit Coach to support you with your quit journey.
- A personalized action plan tailored to you. You’ll work with your Quit Coach to build a plan to help you reach your goals.
- Progress tracking. Track your progress and see exactly how much money you’re saving throughout your journey—in the first month, most people save $238 in our program.
- Guided sessions and interactive exercises. You’ll be equipped with everything you need to understand your triggers and cravings, and how to deal with them.
Find out more and sign up on the Pelago website here.
Dental Benefit Network
The plan’s dental benefit provides coverage for a comprehensive range of dental services and encourages preventive care. The dental benefit is provided automatically to participants in the active classification and their dependents, without additional contributions or premiums.
The dental benefit is also available as optional coverage, at an additional premium, to participants and dependents in the non-active classification, including participants enrolled in the UHC Medicare Advantage Program and their dependents. The dental benefit may be elected at the time of initial enrollment in the non-active classification, or during an open enrollment period held October 1 through December 15 each year. If the dental benefit is dropped after having been elected, it may not be reinstated.
The dental benefit is self-funded by the plan. The plan has contracted with Delta Dental of Missouri to serve as network sponsor, to process dental claims, and to provide access to its dental networks. All necessary claims for dental benefits (whether from in-network or out-of-network providers) must be submitted directly to Delta Dental.
Refer to the Dental Schedule of Benefits section of the Plan’s full Schedule of Benefits which may be found in the Plan Documents section on the Health Plan Resources page.
Reduce your out-of-pocket dental expenses through our network partnership.
- A Delta Dental PPO dentist – offers the highest benefits, greatest discounts, lowest annual deductible and the least out-of-pocket expense, with no deductible for preventive services.
- A Delta Dental Premier dentist – offers discounts but not as significant as a Delta Dental PPO dentist, with a $50 deductible before preventive benefits are available.
Visit Carpenters’ Delta Dental website for more information on your dental benefits or to locate a Delta Dental PPO dentist.
You may also contact Carpenters’ Participant Services, Monday – Friday, 8 am – 4:30 pm.
Virtual Dentist Care delivered by TeleDentistry.com
Get 24/7 access to an emergency dentist care through Delta Dental – Virtual Visits when your dentist is not available. Teledentistry is included in your existing coverage and considered an oral examination under your plan. It’s a safe and effective way to receive care and avoid the emergency room. Use Delta Dental – Virtual Visits when:
- You are having a dental emergency and you do not have an established dentist
- You need access to a dentist after hours
- You need to consult with a dentist without leaving your home
Vision Benefit Network
The vision benefit is designed to provide assistance for participants and eligible dependents who need eyeglasses or contact lenses to improve their vision. This benefit is provided without additional cost to eligible participants and dependents not enrolled in the UHC Medicare Advantage Program.
The vision benefit has access to the VSP comprehensive network of vision providers. VSP provides discounted rates on vision services and equipment when you use its network. All claims for vision services (whether from in-network or out-of-network providers) must be submitted directly to VSP.
Refer to the Vision Schedule of Benefits section (p.6) of the Plan’s full Schedule of Benefits which may be found in the Plan Documents section on the Health Plan Resources page.
VSP: Your vision is their passion.
Visit VSP online to check your benefits or find a VSP doctor near you, or call VSP at 800.877.7195. Schedule an appointment with one of the VSP network doctors and let them know you have VSP. It’s that simple.
Mental Health And Substance Abuse Network
Mental health and substance abuse services are provided by UnitedHealthcare’s Mental Health network. Call Carpenters’ Participant Services at 1.877.232.3863, option 1, for questions regarding this benefit or to find a mental health or substance abuse counselor who meets your needs.
Mercy’s Member Assistance Program (MAP) is the plan’s network for counseling services. Like the mental health and substance abuse network (available through UMR/UnitedHealthcare’s Choice Plus Network), Mercy MAP services are free and confidential for you and covered dependents. Treatment beyond the scope of MAP is coordinated through your Mental Health and Substance Abuse network, your medical benefit, or community services.
UnitedHealthcare Group Medicare Advantage PPO
UnitedHealthcare Group Medicare Advantage PPO provides coverage for all Carpenters’ Medicare retirees and their Medicare eligible dependents. This plan is referred to as Carpenters’ Medicare. Carpenters’ Medicare offers significant benefits, such as 24/7 NurseLine, Renew Active, HouseCalls, hi HealthInnovations hearing aid discounts and more. For assistance with Carpenters’ Medicare, call UnitedHealthCare’s Group Medicare Advantage PPO Customer Service at 800.758.4885, Monday – Friday 8 am – 8 pm Local Time, or find them online at www.UHCRetiree.com. Visit the Flyers section of the Health Plan Resources page on this website for UHC’s Medicare Advantage PPO’s current Plan guide. Everything you need to know about your Group Medicare Supplement benefits is in your plan guide.
NurseLine was designed specifically to help you get more involved in your own health care and to make your health decisions simple and convenient. Registered nurses are available any time, day or night. Call NurseLine services at 877.365.7949, TTY 711. NurseLine flyer
As a participant under the UHC Medicare Advantage PPO program, Renew Active is available at no extra cost. Renew Active is the gold standard in Medicare fitness programs for the bond and mind and includes:
- Free gym membership from the UHC Med Supp nationwide network
- Social activities
- Online Fitbit Community
- AARP Staying Sharp
To learn more about Renew Active today, visit UHCRenewActive.com. Once you become a member, you will need a confirmation code. Sign into your plan website, go to Health & Wellness and look for Renew Active or call the number on the back of your UHC member ID card to obtain your code.
Please note: Renew Active replaces SilverSneakers. SilverSneakers is no longer available through UHC Medicare Advantage PPO.
Hearing loss is the third most common chronic condition, affecting 1 in 5 Americans age 12 and older. As a member of this plan, you are able to purchase digital hearing aids at a discount through hi HealthInnovations, potentially saving you thousands of dollars. hi HealthInnovations flyer
You are eligible for life insurance and AD&D benefits if you are a participant eligible for medical benefits under the plan or enrolled in the UHC Medicare Advantage Program through Carpenters. However, you are not eligible for either life insurance or AD&D benefits if you are a participant in a non-bargained office employee group, a participant with COBRA continuation coverage, or a participant in the non-active classification class covered under the restatement provisions of the plan.
A dependent who dies while eligible for medical benefits or while enrolled in the UHC Medicare Advantage Program is eligible for life insurance but not AD&D benefits. Exceptions to this rule are the following dependents, who are not eligible for either life insurance or AD&D benefits:
- An individual who lived outside the United States or Canada at the time of death;
- A stillborn or unborn child;
- An individual in whom the insurance company determines that the related participant had no insurable interest; or
- A dependent in the non-active classification who is covered under the reinstatement provisions of this plan.
No person is entitled to additional benefit amounts by virtue of being the dependent of more than one participant.
Level Of Death Benefits
Life insurance and AD&D death benefits are payable in the amounts shown in the following table:
|Insurance on life of participant
|Insurance on life of eligible dependent
|AD&D death benefit (participants only)
The life insurance benefit is payable on account of death from any cause. The death benefit under the AD&D policy is payable only for accidental death. The AD&D death benefit, when payable under the terms of the AD&D policy, is payable in addition to the life insurance benefit. Benefits payable will not exceed the applicable amount shown in the chart above, except for interest that may become payable after death under the terms of the policy.
MetLife provides the life insurance benefits for all covered Carpenters’ participants and their covered dependents. Refer to the plan’s Summary Plan Description (PDF) on the Health Plan Resources page of this website for additional information on life insurance benefits and the AD&D policy.
MetLife also provides benefits for living Carpenters’ participants and covered dependents. Visit this website’s Health Plan Resource’s page.
To use the website linked to the left (MetLife logo), use the following information:
For more information on any of these MetLife Living Value Add Benefits, please contact Carpenters’ Participant Services.