The UNITE HERE HEALTH — Health Center is a FREE primary care practice and pharmacy just for eligible Local 1 and Local 450 Union members and their adult dependents. The Health Center is located at:
Whenever you visit a healthcare provider, tell them you’re part of Blue Cross Blue Shield’s Blue Choice network.
Be sure to use a Green or Blue network provider for care. If you don’t, the Fund usually pays nothing (which means you have to pay the entire bill). Except in emergencies or as otherwise required by federal law, the Plan does not cover non-network care (see below for exceptions).
The Green Network gives you great care at the best prices and includes the following providers: Ascension Illinois, AdventHealth, Saint Anthony Hospital in Chicago, and Little Company of Mary in Evergreen Park.
When you travel outside Illinois or have a dependent living outside Illinois, the Blue Card program provides access to a national network of doctors, hospitals and other healthcare providers.
| Other important contact info | |
|---|---|
| UNITE HERE HEALTH - Health Center | (312) 736-3397 Free Pharmacy (312) 768-5500 Health Center www.uhh.org/chc |
| Call to get prior authorization for certain benefits (see HealthCheck 360 list inside) |
(844) 462-7812 |
| Get medical help 24/7 with HealthCheck 360’s free Nurse Line | (866) 823-9827 |
| Find a True Choice network pharmacy (hospitalityrx.org) | (844) 813-3860 |
| Enroll in mail order (WellDyneRx) | |
| Get specialty drugs (WellDyne Specialty Pharmacy) | (800) 373-1879 |
| Find a network dentist (Delta Dental) | (800) 323-1743 deltadental.com |
| Find a network vision provider (Davis Vision) | (800) 999-5431 davisvision.com |
Remember!
Primary care, associated lab services, and prescriptions are FREE at the UNITE HERE HEALTH — Health Center!
Major Medical Benefits - What You Pay
Green Network Providers
Blue Choice (In Illinois) Blue Card (Out of State)
Non-Network
Calendar Year Deductible
$0
$0
$0
Safety Net Out-of-Pocket Spending Limit
Copays, deductibles, and coinsurance you pay for medical and pharmacy
$6,350 per person and $12,700 per family
$6,350 per person and $12,700 per family
Not applicable
Office Visits
Preventive Care
$0
$0
Not covered
Primary Care Provider Office Visits
including all care provided during the office visit
$0
$10
Not covered
Specialist Care Office Visits
$10
$20
Not covered
Acupuncture Services
up to 12 visits per person per calendar year
$10
$10
Not covered
Chiropractic Services
up to 40 visits per person per calendar year
$10
$10
Not covered
Routine Podiatry
to 4 visits per person per calendar year
$10
$10
Not covered
Podiatric Orthotics
up to $500 per person every 24 months
$0
$0
Not covered
Diabetes Education
$0
$0
Not covered
Nutritional Counseling
up to 4 visits per person per calendar year
$0
$0
Not covered
Emergency and Urgent Care
Urgent Care Clinic
$30; $0 copay at Illinois Physicians Immediate Care (PIC) locations
$30; $0 copay at Illinois Physicians Immediate Care (PIC) locations
Not covered
Emergency Room Services
(copay waived if admitted)
$100
$200
$200
Ambulance Transportation
to a hospital (copay waived if admitted)
$50
$50
$50
Ambulance Transportation
between hospitals
$0
$0
$0
Lab & Imaging Services
Laboratory Services
$0 Non-hospital $30 Hospital
$0 Non-hospital $30 Hospital
$0 ONLY services billed by an independent lab are covered
Radiology
x-ray, ultrasound, and fetal monitoring
$0
$10 Non-hospital $50 Hospital
Not covered
Diagnostic Imaging, Cardiac Testing and Radiation Therapy
$0
$100 Non-hospital $150 Hospital
Not covered
Sleep studies
$50
$50
Not covered
Outpatient Services
Outpatient Surgery
$0
$100 Non-hospital $200 Hospital
Not covered
Physical, Speech, and Occupational Therapy
$0 Non-hospital $30 Hospital
$10 Non-hospital $30 Hospital
Not covered
Infusion Medication, Chemotherapy and Kidney Dialysis
$0 Non-hospital $100 Hospital
$0 Non-hospital $100 Hospital
Not covered
Inpatient Services
Hospitalization
including all care provided during the hospitalization
$150 per day (up to $300 per admission)
$250 per day (up to $500 per admission)
$250 per day (up to $500 per admission) ONLY emergency treatment is covered
Skilled Nursing Facility Care
up to 60 days per person per calendar year
$50 per day (up to $250 per admission)
$100 per day (up to $500 per admission)
Not covered
Mental Health and Substance Abuse Treatment
Office Visits
including medical management visits
$0
$10
Not covered
Hospitalization
including all care provided during the hospitalization
$150 per day (up to $300 per admission)
$250 per day (up to $500 per admission)
$250 per day (up to $500 per admission) ONLY emergency treatment is covered
Partial Hospitalization, Intensive Outpatient Treatment, or Ambulatory Detoxification
$0
$0
$0
Other Care and Expenses
Home Healthcare
up to 60 visits per person per calendar year
$10
$20
Not covered
Hospice Care
$0
$0
Not covered
Medical Equipment for Home Use; Artificial Limbs and Organs; All Other Covered Expenses
(After you spend $2,500 in a calendar year, you pay nothing)
20%
20%
Not covered
Mandatory Prior Authorization—You or your healthcare provider must call HealthCheck360 at (844) 462-7812 before you get any of the types of care listed below. If you don’t, your claim may be denied.
This list changes from time to time. Contact the Fund at (800) 419-4373 for the most up-to-date information.
Prescription Drug Benefits - What you pay for formulary drugs
At the Chicago Health Center and free pharmacy at Ascension Rx – Resurrection Pharmacy
Per Prescription up to a 90-day supply
At network retail pharmacies and mail order
Retail Pharmacy up to a 34-day supply
Mail Order up to a 90-day supply
Preventive healthcare services drugs
FREE!
Preventive healthcare services drugs
$0
$0
Generic drugs
FREE!
Generic and some brand drugs
$5
$5
Brand drugs
FREE!
Preferred drugs
$15
$15
Select brand drugs*
50%
Non-preferred drugs
$30
$30
Non-formulary prescription drugs and supplies
Not covered, unless an exception is approved
Select specialty and select biosimilar drugs*
Not covered
Generic: $5 | Brand: 25%
*Current pharmacy benefit provider will actively manage and determine drugs in tier. Specialty drugs are only available through the specialty mail order pharmacy. However, if you take specialty medications as part of your HIV treatment plan, you may be able to receive an exception to use your network retail pharmacy instead of the specialty pharmacy.
DENTAL BENEFITS—What you pay
Delta Dental PPO Network Providers
Delta Dental Premier Dentists and Non-Network Providers
Calendar Year Deductible
Applies to some non-orthodontic services
$50 per person; $150 per family
$50 per person; $150 per family
Calendar Year Maximum
$2,000 per person (includes up to $1,000 for Delta Dental Premier Dentists or non-network providers)
$2,000 per person (includes up to $1,000 for Delta Dental Premier Dentists or non-network providers)
Diagnostic and Preventive Services
$0
83%
Minor Restorative Services
(includes fillings)
$0
83%
Major Restorative Services
(includes endodontics, periodontics, oral surgery, prosthodontics and crowns)
15% after deductible
91% after deductible
Orthodontia
$5,000 lifetime maximum for orthodontic services
50%
Not Covered
VISION—What You Pay
At network providers, you pay...
At non-network providers, you pay...
Eye Exams
$0
$0
Frames
$0 for Fashion, Designer & Premier levels in Davis Vision Collection | $150 allowance for other frames plus 20% off balance; no copay
1) Pay provider at time of service 2) Submit a claim to Davis 3) Get reimbursed: $75 maximum for an exam and $175 maximum for all materials, evaluations, and fittings combined
Lenses
$0
1) Pay provider at time of service 2) Submit a claim to Davis 3) Get reimbursed: $75 maximum for an exam and $175 maximum for all materials, evaluations, and fittings combined
Cosmetic Contacts
(instead of glasses)
$0 for Davis Vision Collection | $150 allowance for other contacts plus 15% off balance; $60 allowance for evaluation & fitting; no copay
1) Pay provider at time of service 2) Submit a claim to Davis 3) Get reimbursed: $75 maximum for an exam and $175 maximum for all materials, evaluations, and fittings combined
Retinal Imaging
$20 per exam
Not covered
SHORT-TERM DISABILITY BENEFIT (employees only)
Weekly Benefit
(Benefits begin 1st day due to injury, 8th day due to sickness; 15-week maximum for any one period of disability)
$325
LIFE AND ACCIDENTAL DEATH BENEFIT
Employee Life
$20,000
Dependent Life
$10,000 spouse and child(ren) age 6 months and older; $3,000 child(ren) from live birth to age 6 months
Employee AD&D
$20,000
The mission of UNITE HERE HEALTH, a Taft-Hartley labor management trust fund, is to provide health benefits that offer high-quality, affordable health care to our participants at better value with better service than is otherwise available in the market. We believe our success depends on innovation and on engaging our participants.
UNITE HERE HEALTH 2715 Jorie Boulevard, Suite 200, Oak Brook, IL 60523
