General

Effective January 1, 2019, the Trust Fund introduced a new, enhanced Anthem Preferred Provider Organization (PPO). This plan replaced the UnitedHealthcare (UHC) Exclusive Provider Organization (EPO) and UHC PPO, Anthem PPO and all Health Maintenance Organizations (HMOs) in all states except the Kaiser HMO in California and Colorado. Under the enhanced Anthem PPO, prescription drug benefits are administered through Express Scripts (ESI), a pharmacy benefit administrator that is separate from your medical plan. Also, the Trust Fund made some changes to the Kaiser HMO and introduced new, enhanced UnitedHealthcare dental plan options, a copayment plan and a Dental Preferred Provider Organization (DPPO). These new UnitedHealthcare dental plans will replace all former dental plan options. Note that the copayment plan will not be available in New Mexico or Texas.

The plans available to you in 2019 depend on the state in which you live:

  • If you live in any state other than California and Colorado, you will be offered the new, enhanced Anthem PPO effective January 1, 2019.
  • If you live in California or Colorado and are:
    • Enrolled in the Kaiser HMO, you will be offered the Kaiser HMO Plan, unless you elected the enhanced Anthem PPO effective January 1, 2019.
    • Not enrolled in the Kaiser HMO, you will be offered the enhanced Anthem PPO, unless you elected the Kaiser HMO effective January 1, 2019.
  • If you were eligible but not enrolled in any medical plan through the Southwest Carpenters Trust Fund, you could have completed an enrollment form to enroll in a medical plan effective January 1, 2019.

The Trust Fund offers the Kaiser HMO in California and Colorado because Kaiser:

  • Has a large provider network (most HMOs don’t), so there are lots of doctors, hospitals, labs and other healthcare facilities to choose from,
  • Has their own pharmacy (which saves participants money), plus Kaiser pharmacies are conveniently located in their medical buildings, so participants avoid a trip to a retail pharmacy, and
  • Is a non-profit organization, so the Trust Fund pays lower Affordable Care Act fees (required by the federal government).

The way your medical coverage will be affected in 2019 will depend on the plan you are currently in and the state in which you live. Find your current medical plan in the list below:

  • Current Anthem PPO: This is an Anthem plan, so your benefits will improve with the new, enhanced Anthem PPO. You also have the option to change to the Kaiser HMO during Open Enrollment if you live in California or Colorado.
  • Kaiser HMO: You can stay covered under the Kaiser HMO or you can change to the enhanced Anthem PPO during Open Enrollment. There are some enhancements and changes to Kaiser HMO coverage as well.

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