What Benefits are Available for Me?

The CLT&E Health & Welfare Plan provides benefits in the following areas; Medical, Dental, Vision, Wellness, Chiropractic, Disability and Life Insurance.

How Does the Deductible Work?

Our Medical Plan gives you two choices when you need medical care. One is to see a network doctor or use an in-network facility. The other is to see a doctor or use a facility out of network. Blue Cross Blue Shield of Nebraska manages the network in Nebraska, but the Blue Cross network can be accessed from anywhere in the country.

The deductible amount is $750 per-person, per calendar year, when you use the network, or $1500 per-person, per calendar year, when you do not use the network.

Once a person meets their deductible for the calendar year their co-insurance will start. For in the network the co-insurance is 80/20, which means we will pay 80% and the member will be responsible for 20% of the submitted charges. If you go somewhere out of the network your co-insurance will be 60/40, which means we will pay 60% and the member will be responsible for 40% of the submitted charges.

How Do I Find a Provider in the Blue Cross network?

Blue Cross provides an on-line directory for your convenience. The web-site is www.nebraskablue.com. You may also contact Blue Cross Directly at 1-800-810-2583. Also, be sure to check with the Doctor/Facility and let them know that you have Blue Cross Blue Shield.

What Are My Dental Benefits?

Our Dental Plan is simple...when you need dental care, the Plan will cover 100% of your expenses done in a dental office. The Plan will pay $2,400 (in network) and $1,200 (out of network). Eligible expenses include the routine oral exam, x-rays, fillings, crowns or even orthodontia services (braces).

What Are My Vision Benefits?

Our Vision Plan is simple also. When you need vision care, the Plan will cover 100% of your expenses up to $200 per person for you and your covered dependents.

Do I Have Short-Term Disability Benefits?

If you are unable to work because you are sick or hurt, you may be eligible to receive short-term disability benefits. Benefits are only available if your sickness or injury is not work-related. Work-related disabilities are covered under Workers’ Compensation.

What Information Will I Need to Provide to Enroll Dependents Under My Plan?

The Fund requires documentation to verify dependent eligibility and identification prior to enrollment. Participants must provide the Fund Office with the following information:

1. A completed, dated, and signed enrollment form, beneficiary card and HIPAA release form.
2. A certified copy, with embossed seal, of the marriage license
3. A certified copy, with the embossed seal, of the birth certificate of spouse and each dependent
4. The signed Social Security card of spouse and each dependent (infants do not need to sign their Social Security card.)
5. A copy of your Federal tax return for the past two years (Financial information may be blacked out)
6. And, If Applicable:
1. A copy of the court order or decree establishing paternity, marriage dissolution, or child support obligation
2. A copy of the court order, decree, or certificate of adoption
3. A copy of the court order establishing guardianship
4. A copy of the court order for Foster Care placement
5. The Dependent Enrollment Form

Does My Insurance Cover Diabetic Supplies?

Yes. Diabetic Supplies are covered under your prescription benefit. Be sure to show your Blue Cross ID Card at the pharmacy counter.