Benefits

Download SBC (Summary of Benefits Coverage).

2019

2018

2017

2016

2015

2014

2013

Gym Membership Reimbursment
ADA Update

2020 Grand Rounds Benefits Guide

Grand Rounds Benefits Flyer – Click here to find out more information about the benefits of Grand Rounds
Grand Rounds Experience – Click here to find out about the Grand Rounds Experience.
Grand Rounds Guide – Click here for the How-To-Guide

Locating an In-Network provider for Preferred Care Blue, Blue Card and Dental Network of America.

        1. Go to the Blue Cross and Blue Shield of Kansas City website at www.bluekc.com. Click on Find a Doctor in the upper middle of the page.
        2. Click on the magnifying glass for SEARCH
        3. Under the Choose a health plan box, you will see it shows All Plans, Click on Medical Networks. Select your current insurance plan from the drop-down box. For medical services this will be the Preferred Care Blue Network option, for dental it will the Dental-Preferred Care Network option.
        4. Under Start your search here, put in the type of provider you trying to locate i.e. doctor- last, first name, hospital name, or special such as Rheumatologist.
        5. A list of providers matching your search criteria will appear on the next page.
        6. Click Search. This will automatically take you to another page listing either that provider or type of provider with a 25 mile radius of your location. You may change this radius to the left of the page if you choose to do so.

*Note: On the left side of the page, you will find several more specific/advanced options to choose from to narrow down your search. Advanced (Advanced Searches allows for searching for a provider based on location, gender, language, patient age, specialties, group affiliations and admitting privileges.)

**Additional Note: You can contact Blue Cross Blue Shield of Kansas City to verify the current provider status.

If then
you know the provider’s name
  • enter the last and first name;
  • click Go.
you don’t know the provider name
  • select the Search By Specialty option under Find a Doctor or Hospital;
  • Click the letter that starts with the Specialty you are searching for (such as “F” for Family Practice);
  • click the name of the Specialty you want under that letter;
  • click Go.


Medical Providers outside the Kansas City Area (BlueCard):

        1. Go to the Blue Cross and Blue Shield of Kansas City website at www.bluekc.com. Click on Find a Doctor in the upper middle of the page.
        2. Click on the magnifying glass for SEARCH
        3. Under the Choose a health plan box, you will see it shows All Plans, Click on Medical Networks. Select your current insurance plan from the drop-down box. For medical services this will be the Preferred Care Blue Network option, for dental it will the Dental-Preferred Care Network option.
        4. Under Choose Search Location, type in your City & State or Zip Code.
        5. Under Start your search here, put in the type of provider you trying to locate i.e. doctor- last, first name, hospital name, or special such as Rheumatologist.
        6. Click Search. This will automatically take you to another page listing either that provider or type of provider with a 25 mile radius of your location. You may change this radius to the left of the page if you choose to do so.

*Note: You will want to contact Blue Cross Blue Shield of Kansas City to verify the current provider status.

If then
you know the provider’s name
  • enter the last and first name;
  • click Go.
you don’t know the provider name
  • select the Search By Specialty option under Find a Doctor or Hospital;
  • Click the letter that starts with the Specialty you are searching for (such as “F” for Family Practice);
  • click the name of the Specialty you want under that letter;
  • click Go.
Register for a Blue Cross and Blue Shield of Kansas City Log-in and be able to access claims information, benefits, and copies of your Explanation of Benefits. For a step-by-step guide on how to create your Log-in, Click here.

2020 Benefit Summary

The following notice is required each year under the Women’s Health and Cancer Rights Act (WHCRA).

Under the Women’s Health and Cancer Rights Act, group health plans that provide medical and surgical benefits in connection with mastectomy, like this Plan, must provide benefits for certain reconstructive surgery. This benefit covers reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction on the other breast to produce a symmetrical appearance, and prostheses and treatment of physical complications of all states of mastectomy, including lymphedemas. This coverage is subject to the plan’s deductible and coinsurance provisions which are described in Your Summary Plan Description (SPD).

View Summary chevron_right

View Map of Counties Covered


**When obtaining services from a provider not contracted with Mo-Kan Sheet Metal Workers Welfare Fund, you may be responsible for charges in excess of Allowable Charges, as determined by Mo-Kan Sheet Metal Workers Welfare Fund. Additional service area restrictions may apply.

Prescription Drug Plan

We provide benefits for smoking cessation. Benefits are payable for one treatment cycle per calendar year and are subject to the lifetime max shown in the Benefit Summary. The one course of treatment must be prior authorized with Medtrak PA at 1-800-771-4648.
Brand name you pay 50 % up to $65, retail generic $15.00 co-pay, Mail – order generic $25.00, Mail- order Brand is 50% up to $130.00

Your drug plan through Medtrak is as follows:
Out-of-Pocket Maximum:

Medtrak RX Brochure

The maximum amount you’ll pay out-of-pocket for prescription drugs in a calendar year is $1,500 per member or $3,000 per member for family coverage.

Summary Plan

Summary Plan Details – Download the summary plan details
Working Spouse Incentive Summary – View the Working Spouse Incentive Program Summary. Please also download the Member letter with FAQ.
Gym Membership Reimbursment

1-866-531-5488.

Spousal Reimbursement

Mo-Kan Sheet Metal Workers Welfare Fund

P.O. Box 300019, Kansas City, MO 64130-0019

(816) 531-0334 or Toll Free at (866) 531-5488

Dear Member:

On January 01, 2011 the Fund implemented a new benefit entitled the “Working Spouse Incentive Program”.  This program allows a working spouse who has voluntarily elected to have primary coverage with his/her current employer to receive a quarterly reimbursement of employee contributions paid by that spouse.  This benefit has been extended to the 2018 plan year due to its utilization and cost savings to the Fund.

While this Incentive Program is strictly voluntarily, the Fund strongly encourages all spouses of Mo-Kan SMW members who are offered health insurance benefits through a qualified health plan at their place of employment elect to take that plan as their primary health insurance coverage.

The reason behind the implementation of this benefit was simple, more and more corporate and public employers are shifting the liability of health insurance coverage to union health plans.  Many employers offer their employees incentives to not enroll in their employer sponsored plan.  When employers do this, they are shifting millions of dollars of liability from themselves to union health plans.  After careful review, the cost savings of this program has been upwards of $850K and Mo-Kan believes that by offering this incentive program will keep the rising cost of health care benefits to the Fund at a reasonable level.

Exceptions: The following are circumstances under which spouses will not be required to enroll in employer sponsored health coverage.

      • Spouses who are not employed.
      • Spouses who are covered with the member by non-active coverage (Retired, Disabled).
      • Spouses who are “Self-Employed”. Self-employed is defined as having no employees.
      • Working Spouses who work “Part-Time”. Part-time is defined as “less than or equal to 24 hours worked per week”. The employer must verify.
      • Working Spouses who are in a “Waiting-Period” required by the employer. The employer must verify.
      • Working Spouses whose employer requires the employee to pay 100% of the health premium for employee-only coverage. The employer must verify.
      • Working Spouses whose employer either does not offer health coverage at all or the health plan offered is not considered a “Qualified plan”. The employer must verify.

A list of frequently asked questions is enclosed for your review.  If you have any questions, please contact a Fund Representative at 816-531-0334 or toll-free at 866-531-5488.

Sincerely,

Board of Trustees

Frequently Asked Questions

      1. Who must complete a spousal verification form?
      2. All spouses of covered members that carry their own insurance through their own employer must complete a spousal verification form to update their employer and insurance information with Mokan.
      3. What is considered a “qualified health plan”?
      4. A “qualified health plan” means an insured or self-insured plan recognized by the insurance industry or other governing body and subject to regulations issued by the IRS, ERISA, DOL and state or federal authorities. It is a plan that offers industry recognized “standard benefits” to include coverage for hospitalization, medically necessary surgery, medical outpatient and physician services and prescription drugs. A plan that offers “standard benefits” is typically referred to as a PPO, HMO or POS plan. If the employer offers a variety of plan choices, a PPO, HMO or POS plan must be selected before a high-deductible plan.
      5. What is “dual coverage”?
      6. Dual coverage – some patients have two insurers because both spouses receive coverage through their employer. Dual coverage doesn’t mean that your benefits are doubled. What it does mean is that you will likely enjoy lower out-of-pocket costs for you healthcare. Two plans work together to ensure that the combined amount by the plans does not exceed the total amount charged by a provider.

***Example:  Suppose that both your plans provide benefits for out-patient medically necessary surgery.  If the provider charges $10,000, your primary insurance carrier will process the claim first.  Let’s say your primary carrier has a calendar year deductible of $1000.00 and once met processes all claims at 80%.  The primary carrier would pay $7200.00, leaving the patient responsible for $2800.00.  That same claim would then be sent to the secondary carrier for payment.  Your secondary insurance carrier has a $500.00 calendar year deductible and then pays 80%.  If the secondary carrier would have paid first their benefit would have been $7600.00.  Since the secondary carrier would have paid more than $2800.00 as the primary carrier the secondary carrier will pay the entire $2800.00, leaving you responsible for zero.

      1. Is my spouse required to enroll other family members into his/her employer sponsored coverage?
      2. No. However, if the spouse chooses to cover other family members the birthday rule for coordination of benefits (COB) will apply. If the spouse is primary on the child/ren due to the birthday rule, Mokan will reimburse at the employee plus child/ren rate and the premium benefit rate summary would be required to determine the rate for employee plus child/ren coverage.
      3. When my spouse signs up for other coverage, how is coverage with the Fund affected?
      4. How is prescription coverage affected?
      5. Your spouse’s coverage will be the primary payer on their claims and the Mo-Kan Plan will pay as secondary. In most situations, this will result in 100% coverage.
      6. How are vision and dental coverage affected?
      7. In order to receive the Working Spouse Incentive benefit, the spouse only needs to enroll for primary Medical and Prescription coverage. However, if there is other dental and vision coverage, Mo-Kan will pay secondary.

The Working Spouse Incentive Program at Mo-Kan Sheet Metal Workers Welfare Fund was implemented in January 2011 and has saved the Fund and its members a considerable amount of money over the 7 years it has been offered as a benefit.  If you are an actively working sheet metal worker and a member of Mo-Kan Sheet Metal Workers Welfare Fund and your spouse has or has access to a qualified medical health insurance plan through his/her employer, you can benefit from this program.  The cost savings is proven in two ways: those actively working member spouses who participate are getting 100% of their primary medical health insurance premium reimbursed up to $200.00 a month, and because these spouses have another insurance company paying primary on their medical health expenses, the Fund is saving money as well.   To learn more about this program and the details of eligibility, please contact the Mo-Kan Fund office at 816-531-0334.

If you currently participate in the program you are aware of the awards.

To participate in the program for the first time, please complete and return the spousal verification form which can be found on our website and included with this letter.  Certain medical plans are not eligible for the benefit so this form will help us determine if a members plan qualifies.