2011-2012 Health Benefits Plan

CORRECTION: Updated 3/5/2012 - The Benefits Book is incorrect on page 54, question #15. it should read: " The only exception is that you may retain Medicare while enrolled in the Health Benefits Trust Plan and Medicare would be the secondary coverage."

For eligible Individual Providers and Agency Providers, the 
Health Benefits Trust is a nonprofit organization providing affordable health coverage focused on keeping you healthy. The health benefits offered by the Health Benefits Trust are part of a community of care that starts with the wellness of you, the Home Care Aide.

2011-2012 Benefits Plan

The Health Benefits Trust negotiated the 2011-2012 benefits – that took effect on Aug. 1, 2011 – to fulfill the following goals:

• Low out-of-pocket costs for Home Care Aides
• Emphasis on preventive care to encourage wellness
• Increased participation in health risk assessments
• Higher use of urgent care facilities in urgent situations that don’t require emergency-room care
• Encouraging lower-cost prescriptions through mail order services
• Encouraging use of in-network providers 

The 2011-2012 benefits plan accomplishes those goals and allows for the continuation of affordable, quality benefits for all eligible Home Care Aides.

How to Enroll

Individual Providers: You can enroll by logging in to 
www.myseiubenefits.org and by filling out the enrollment form. 

Agency Providers: Contact your employer for enrollment information.

Call the Member Resource Center toll-free at 1-866-371-3200 
to get answers to your questions about eligibility for benefits.

Health Plan Partners

We partner with the following health insurance providers to provide benefits for eligible Home Care Aides.

Group Health Options 

Offering you a health plan that gives you access to coordinated care and coverage that makes staying healthy easy.

Kaiser Permanente 

A large national health insurer, Kaiser provides coordinated care and innovative health care programs.

Premera Blue Cross (Dental)

Premera offers dental insurance to Health Benefits Trust beneficiaries. 

Willamette Dental Group 

Willamette is a managed dental program that provides general and specialized dental services to patients all over Washington and Oregon. 

BENEFITS BASICS

Home Care Aides get the following comprehensive benefits through 
the Health Benefits Trust:

Medical

Nobody ever plans to get sick, but the Health Benefits Trust has you covered. Depending on where you live, your medical, vision and prescription drug 
coverage will be provided by Group Health Options or Kaiser Permanente. You pay very little out-of-pocket for the following services:

• Doctor office visits
• In-patient hospitalization
• X-rays and diagnostic imaging
• Laboratory services
• Mental health
• Hearing exams
• Chiropractor visits
• Acupuncture
• Mammograms
• Allergy shots and other injections
• Routine immunizations
• Rehabilitative therapies
• Maternity services

Vision

• Routine exams
• Hardware, such as glasses and contacts

Prescription Drugs

• Generic drugs
• Brand-name drugs

Dental

The Health Benefits Trust helps with routine dental care as well as dental emergencies. Dental benefits are provided by Premera Blue Cross Dental and Willamette Dental.

Preventive care:
There is no annual deductible for preventive procedures. Covered procedures include check-ups, cleanings and X-rays. 

Basic procedures:
Covered procedures include fillings, oral surgery, 
periodontics (gum disease) and endodontics (root canals).

Major procedures:
Covered procedures include crowns, dentures and bridges

2011-2012 Medical Plan Highlights 

Thanks to effective organizing by Home Care Aides and strong negotiating by the Health Benefits Trust, the health benefits Home Care Aides will receive through July 31, 2012, remain largely unchanged. Although insurance premiums are increasing overall, the Home Care Aide cost share will remain the same at $25 per month.

The level of insurance coverage provided remains the same, with a few exceptions that encourage good use of Health 
Benefits Trust resources:

EMERGENCY ROOM

Whenever you use the Emergency Room, you will pay a $200 copay regardless of facility. However, if you are admitted to the hospital as a result of your visit to the ER, the $200 will not be charged. 

As a better alternative to the Emergency Room in most situations, Urgent Care is available and your copay will be just $10 for Group Health and $30 for Kaiser.

IN-NETWORK PROVIDERS

You do not have to pay as much when accessing an in-network group of 
providers and facilities, including purchasing your prescription drugs. 

In-network services continue to have a $0 annual deductible and $10 
office visit copay. However, preventive care now is paid in full with no copay.  

If you choose to access care out-of-network, your annual deductible will increase from $200 to $500. 

PRESCRIPTION DRUGS

The prescription drug copays are increasing slightly.  However, by using mail-order service to receive your prescriptions, you will now receive a discount on your prescription copay.

HEALTHCARE REFORM CHANGES

As a result of Healthcare Reform, your coverage will be improved in the following ways:

• There is no longer a lifetime maximum cap of benefits.
• There are no longer lifetime benefit limits for essential benefits.