Benefits

Download SBC (Summary of Benefits Coverage).

2021

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ADA Update

BENEFIT SUMMARY

2020 Benefit Summary

2021 Benefit Summary

SPD – Summary Plan Description

Summary Plan Description 1/1/2018

MEDICAL & DENTAL BENEFITS

Blue Cross and Blue Shield of Kansas City is the medical and dental network for Mokan Sheet Metal Worker’s Welfare Fund.

Locating an In-Network medical provider:

        1. Go to the Blue Cross and Blue Shield of Kansas City website at www.bluekc.com. Click on Find Care at the top of the page on the right side.
        2. Scroll down to Continue as a Guest, click Find a Doctor or Hospital as a Guest.
        3. Under “Please make a selection”, click “I have or might get a Blue KC health plan through my employer”.
        4. Under “Select a Medical Network”, click once to activate the drop down list. Click Preferred-Care Blue (PCB).
        5. On the Enter ZIP Code box, type the zip code you want to search.
        6. Click “Find a Doctor or Hospital”.
        7. Under “Hello, What are you searching for today?”, choose the option you want to search by. You can choose from the following search options:  Doctors by name, Doctors by specialty, Places by name, Place by type. Click on the option you want to search and input the information to search and press enter.
        8. A list of providers matching your search criteria will appear on the next page.

*Note: On the left side of the page, you will find several more specific/advanced options to choose from to narrow down your search.

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

Locating a Dental Provider:

        1. Go to the Blue Cross and Blue Shield of Kansas City website at www.bluekc.com. Click on Find Care at the top of the page on the right side.
        2. Scroll down to “Find a Dentist”.
        3. Click “Search for Dentists Nationwide”.
        4. Under “Enter your ZIP code”, type the zip code you want to search. You can narrow your search by completing any of the other information on the search page. Example: You can click the Specialty drop down box and click what specialty you are wanting.
          1. NOTE: If you are in the Kansas City area, you can click Search.  A list of providers matching your search criteria will appear on the next page.
          2. If you are OUTSIDE the Kansas City area, you MUST click “Advanced Search”. Then under “Network Name” drop down box, choose Dental Grid.  A list of providers in the Dental Grid Network matching your search criteria will appear on the next page.

*Register for a Blue Cross and Blue Shield of Kansas City Member Log-in and be able to access all your claims information, copies of your Explanation of Benefits, locate providers, and much more. For a step-by-step guide on how to create your Log-in, Click here.

Blue KC PPO Service Area

View Map of Counties part of the Blue KC PPO Service Area

**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.

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).

ROUTINE VISION BENEFITS

Vision benefits are through Mokan Sheet Metal Worker’s Welfare Fund. Vision claims are processed at the Fund Office. As of 4/17/20, Mokan will only reimburse the member. Members must submit a paid itemized receipt to the Mokan Fund Office. The receipt must have the provider information, patient name, date of service, and itemization of the purchase with proof of payment to the provider. Submit routine vision claims to: Mokan Sheet Metal Worker’s Welfare Fund PO Box 300019 Kansas City, MO 64130.

GRAND ROUNDS

Grand Rounds is Mokan’s Second Opinion Service:

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

Blue KC Nurse Line

Call Blue KC Nurse line 24 hours a day, 7 days a week, 365 days a year and you’ll have access to Care Advisors to help you with
symptoms or answer a health-related question.

Blue KC Nurse Line Flyer

Blue KC Virtual Care App

If you can’t wait or do not have quick access to care, telehealth can get you the care you need for common medical concerns from your phone or the Web.  Telehealth is not for emergencies. If you are experiencing severe symptoms or have a serious medical concern, go to the emergency room or call 911.

Examples of when telehealth can help:

  • Sinus pain, cold, cough, sore throat or nausea
  •  Rash, bumps, cuts, scrapes
  • Headaches
  • Minor fevers (below 104°)
  • Mild allergic reactions
  • Mild asthma
  • Sprains, strains
  • Eye swelling, irritation, redness or pain
  • Minor burns
Blue KC Virtual Care Flyer
Know Your Options Flyer

Blue KC Care Management App

Blue KC Care Management App is a new way that Plan participants can communicate with Blue KC’s Care Management Team when engaged with a Blue KC Nurse or Case Manager.  The app was rolled out effective January 1, 2021, and is a new option for participants to use either in place of, or to supplement, traditional telephone calls or written correspondence with the nurse.  Using the app is 100% optional and there is no cost to the Fund or participant to access. Download the flyer below for more information and to get the access code.

Blue KC Care Management Flyer

COVID19 Information

COVID19 Flyer