Northwest Carpenters Health and Security Plan
Summary Plan Description
- Notice
- Statement of Purpose
- Participant Eligibility and Enrollment
- Continuation Coverage
- Dependent Eligibility and Enrollment
- Retiree Eligibility and Enrollment
- Preferred Provider Organization
- Medical Review Programs
- Schedule of Benefits
- Medical Benefits
- Acupuncture
- Alternative Care
- Ambulance Transportation
- Anesthesia
- Autism Spectrum Disorder/Pervasive Developmental Disorder
- Bariatric Surgery
- Behavioral Health Services
- Blood
- Chiropractic Care
- Dental Accidents
- Diabetic Care
- Diagnostic X-Ray and Laboratory Services
- Durable Medical Equipment
- Erectile Dysfunction
- Habilitative Care
- Hearing Aids
- Home Health Care
- Home Phototherapy
- Hospice Care
- Hospital Services and Supplies
- Infusion Therapy
- Kidney Dialysis
- Medical Supplies
- Oral Surgery
- Orthognathic Surgery
- Orthotics
- Physician Services
- Pregnancy Care
- Preventive Health Services
- Prosthetic Devices and Artificial Limbs
- Reconstructive Surgery
- Rehabilitative Care
- Skilled Nursing Facility
- Sleep Studies
- Sterilization
- Telehealth Consultations
- TMJ and MPDS Treatment
- Transplants
- Prescription Drug Benefits
- Introduction
- Formulary
- Express Scripts Retail Pharmacy Program
- Express Scripts By Mail
- Out-of-Pocket Maximum
- Nonparticipating Pharmacies
- Express Scripts Medicare Prescription Plan
- Step Therapy Program
- Retail Refill Allowance Program
- Specialty Medications
- SaveOnSP
- Claims Issue
- Limitations and Exclusions
- Summary of the Prescription Drug Programs
- Dental Benefits
- Vision Benefits
- Time Loss Benefits
- Life Insurance and Accidental Death and Dismemberment Benefits
- Retiree Health Reimbursement Accounts
- Claims Process
- How to File a Medical Claim
- Claims for Prescription, Dental, Vision, Time Loss, Life Insurance, and Accidental Death and Dismemberment
- Timely Filing Requirement
- Coordination of Benefits (COB)
- Facility of Payment
- Trust's Right to Reimbursement
- Right to Receive and Release Necessary Information
- No Waiver of Claim Paid in Error – Recovery by Trust
- Misrepresentation
- Assignment
- Glossary
- General Limitations and Exclusions
- Important Information
- Claims and Appeals Rules
- Life Insurance and Accidental Death and Dismemberment Claims Appeal Procedure
- Interpretation
- Rights Under the Employee Retirement Income Security Act (ERISA)
- HIPAA Privacy Plan Amendment
- Notice of Privacy Practices
- Amendment and Termination
- Benefits Not Guaranteed
- Nondiscrimination
- Administrative Information
- Names, Titles and Addresses of the Board of Trustees
Related Content
Partner Websites
Northwest Carpenters Health and Security Plan
Sleep Studies
90% Network and 80% Non-Network
Benefits are provided for services and supplies related to sleep studies performed to diagnose illness or syndromes related to sleep, performed in sleep disorder centers or laboratories for evaluating sleep-related breathing disorders, which may be hospital affiliated or free standing.
Last Updated: 04/25/2023