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Sheet Metal Workers' Health Plan
of Southern California, Arizona & Nevada Summary Comparison of Health Care Benefits United Healthcare / Secure Horizons of Arizona Available under the Retiree Health Plan July 2010 Important: This is not a contract. This is a summary of the benefits avaiable to you. The group agreements and Plan documents must be consulted to determine the exact terms and conditions of coverage. All benefits and self-pay contributions are subject to change. What is an EPO? EPO's (Exclusive Provider Organizations) provide quality care under a managed care environment, within a defined service area. When you enroll in an EPO plan, you must use their medical providers and hospitals for all of your medical care and prescription medication needs. No benefits are provided if you, or your eligible dependents, use non-EPO providers, except for certain medical emergencies. There are no claim forms to fill out, and the Fund pays the EPO directly for your health care needs. Health care services are provided to you for specified co-payment amounts at the time of service. There are no calendar-year deductibles and no overall lifetime maximums. United Healthcare / Secure Horizons of Arizona's service area is defined in their enrollment packet. To enroll in United Healthcare or Secure Horizons of Arizona, you must reside in and have all medical services performed within their defined service area. If you enroll in PacifiCare or Secure Horizons and frequently travel, there may be no benefits available while you are outside of your selected plan's service area. Click here to see a brief summary of the available benefits. For specific benefits available, please call UNITED HEALTHCARE CHOICE EPO PLAN 800-377-5154 SECURE HORIZONS 800-347-8600 Your Monthly Contributions Please refer to the "Retiree Self-Pay Rates for Calendar Year 2010" for your appropriate monthly contribution. These rates are current as of the printing of this material, and are subject to change. All rates are based on the Retiree's age, Years of Pension Credit and number of years retired. These rates apply only to retirees and surviving spouses who have elected and continuously maintained coverage under the Sheet Metal Workers' Retiree Health Plan. These rates do not apply to retirees or surviving spouses who have initially declined or previoulsy terminated their coverage. For current "Reinstate Rates", please contact the Administrative Office. Eligible for Medicare? If you (or an eligible dependent) are eligible for Medicare, you (or the dependent) must enroll in Medicare Parts A and B. In addition, you (or the dependent) must enroll in PacifiCare's Medicare program - Secure Horizons and assign your Medicare benefits to Secure Horizons. Doing so not only reduces your monthly premium, but also provides a reduced cost to the Retiree Health Plan. Failure to comply may result in a termination of your coverage under the Retiree Health Plan! Moving? To avoid a possible lapse in your coverage, please contact the Administrative Office immediately if you change your mailing address! We will advise you of the current options available due to your change of residence. The information contained within your enrollment packet includes the current plans available, as well as the current benefits effective July 1, 2010 All benefits and self-pay contributions are subject to change.
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