The Medical Plan provides medical coverage to help pay the cost of health care for you and your qualified dependents. The Plan’s medical coverage reimburses you for all or part of a broad range of medical expenses you or your qualified dependents incur.
The Plan partners with CareFirst BlueCross BlueShield as a Preferred Provider Organization (“PPO”). If you use providers within the PPO network, you will be reimbursed at higher rates and both you and the Medical Plan will save money.
The Medical Plan also partners with OptumRx to provide you with prescription drug benefits.
Depending on where you live, you and your eligible dependents may choose medical coverage under an Alternate Medical Plan instead of the MEBA Medical Plan Coverage. The Medical Plan’s actuary will provide an actuarial rate that represents the maximum amount the Plan would pay to an Alternate Medical Plan. You will have to absorb any additional premium costs. If you live near any of the following areas, you may be eligible to sign up for coverage under an Alternate Medical Plan:
When you are covered by an Alternate Medical Plan, you have no medical coverage under the MEBA Medical Plan. You also have no other type of coverage under the MEBA Medical Plan if the same type of coverage is provided by the Alternate Medical Plan.
If you enroll in an approved Alternate Medical Plan, your enrollment is binding for one year. Unless you notify the Plan Office in writing before the end of the one-year period, your enrollment automatically will be renewed at the end of each year.
Please note that Concentra offers only employment-related physicals; Concentra physicals do not take the place of a complete physical with a primary care provider, and the Concentra doctors do not fill the role of a primary care provider. Thus, in addition to offering the once- a-year Concentra USCG physical (with or without benzene labs) at no cost to the participant, the Medical Plan will continue to cover the annual physical with a CareFirst/BCBS provider or (other provider). This means that a member who is eligible for medical benefits from the Medical Plan will be entitled to one Concentra-provided USGC physical and one CareFirst/BCBS or other annual physical each year.
We strongly recommend that you contact your employer to confirm if there are any specific tests or vaccinations that may be required. This is especially important as testing requirements may vary based on company policy. Your proactive approach in verifying and completing any necessary paperwork your company requires will expedite the certifications necessary to seek employment.
If you receive notification of an investigation, complaint or any other action instituted by the U.S. Coast Guard that may adversely affect the status of your U.S. Coast Guard License, you may be entitled to representation by legal counsel provided by the Plan. If you wish to use this benefit, you must contact the Plan Office for a referral to a Plan-designated attorney. The Plan will not honor any claim for payment of attorneys’ fees from an attorney not designated by the Plan. For additional information about this benefit, see your Summary Plan Description or the Plan Rules and Regulations.
The Plan provides dental coverage to help pay the cost of dental services for you and your qualified dependents while you are eligible for active employee coverage.
The Plan’s dental coverage is provided by Delta Dental. Dentists participating in Delta Dental do not charge you for their services except for co-pays and deductibles. The co-pay is 20% of the reasonable and customary charge for the services provided. The annual deductible is $100 per calendar year per person, $300 per year per family. Participating dentists bill Delta Dental and are paid by Delta Dental directly. You pay only your co-pay and deductible.
If you wish, you may receive treatment from out of network dentists. If you do, Delta Dental will reimburse you an amount equal to 80% of the reasonable and customary charge for the services rendered, minus the deductible. You are responsible for paying your entire dental bill to the non-participating dentist, which may include charges in excess of the reasonable and customary charge.
The maximum benefit is $5,000 per calendar year per person. The maximum benefit is based on the total payments for services by participating dentists plus the amounts reimbursed to you by Delta Dental for services by non-participating dentists. The maximum does not apply to your dependents under age 19.
For more information about the Plan’s dental coverage, see your Summary Plan Description as well as the Dental Program Supplement from Delta Dental.
Note: Dental coverage is not available to pensioners or their qualified dependents.
Orthodontic Coverage
Orthodontic coverage is not provided by Delta Dental, but is provided by the Medical Plan. You should file your orthodontic claims with the Plan Office in Baltimore. The Plan reimburses you for the reasonable and customary charges for orthodontic treatment by the orthodontist of your choice, up to a maximum lifetime orthodontia benefit of $2,250 per person.
Delta Dental Resources
If you become physically or mentally disabled so you are unable to perform your duties as a licensed officer and you require the care of a licensed physician, you are eligible for disability benefits under the Plan.
You must submit to examinations required by the Trustees to determine whether you are disabled. If the Trustees determine you are disabled, the amount of the disability benefit is equal to $170 for each week you are disabled, up to a maximum benefit of $6,630 (i.e., 39 weeks).
You will not receive a disability benefit until you have been disabled for seven consecutive days, unless you are confined to a hospital during that time. You will not receive disability benefits or credit toward the seven-day waiting period if you are on the payroll of an Employer.
If you are entitled to payments for disability or Worker’s Compensation under any state law, you will only receive the difference, if any, between the $170 and the payment under state law for each week you are disabled, up to the maximum 39 weeks.
The Medical Plan provides Life and Accidental Death and Dismemberment (AD&D) Benefits that can help you and your family if you die or if you’re seriously injured in an accident.
Covered medical expenses include:
For a full description of covered expenses and coverage levels, as well as pre-certification requirements, see your Summary Plan Description.
If you retire and continue coverage under the Medical Plan, your Life Benefit coverage is $1,500. There is no Supplemental Coverage and there are no Accidental Death and Accidental Dismemberment Benefits for retirees.
This benefit protects you if you do not receive earned wages because of the bankruptcy or insolvency of the contributing Employer for whom you work. If your Employer is insolvent, bankrupt or otherwise unable to pay your earned wages, the Plan may pay you an amount equal to 90% of your uncollected earned wages (minus required withholding taxes and social security taxes on such amount), provided that the required documents and proof are furnished to the Plan. However, if you continue to work for an Employer after notice from the Plan that wage insurance benefits will not be available after the date of notice, you will not be entitled to benefits from the wage insurance program for wages earned after the date you receive this notice. For additional information about this benefit, see your Summary Plan Description or the Plan Rules and Regulations.
