Frequently Asked Questions

Send completed claim forms to:
OBA-Midwest
333 Pierce Road, Suite 410
Itasca, Illinois 60143

Call the PPO network at 1-800-810-2583 (BLUE) or click here.

A deductible is the amount you have to pay before the Plan will pay benefits. For this Plan, you have to pay the first $250 per person for most medical expenses (up to $500 per family) before the Plan will pay for benefits.

A copay is a dollar amount that you pay to the provider for healthcare services. For example, you have to pay $10 for a generic prescription at a retail pharmacy. The Plan pays the rest of the cost.

For certain covered Plan expenses you must call Med-Care Management at 800-367-1934 for pre-certification. If you do not precertify, your benefits may be reduced. Pre-certification is required for these services:

Non-emergency hospitalization and outpatient surgery – If you do not precertify, the Plan will pay 10% less (i.e., 80% for PPO hospitals or 70% for non-PPO hospitals).

• Emergency hospitalization—You must contact Med-Care Management by the next business day.
• Extended hospital stays—Your physician should call Med-Care Management to coordinate your care.
• Maternity hospitalization—Your physician should call Med-Care Management to confirm the pregnancy and for pre-admission notification.
• Home Health Care or Durable Medical Equipment—Your physician should call Med-Care Management to coordinate services.

A PPO provider, such as a doctor or hospital, has agreed to charge discounted, negotiated rates for services provided to people who have healthcare through the PPO network, such as our participants. A non-PPO provider can charge any amount they wish for services. So, when you use PPO providers, you generally save money because PPO providers charge less and the Plan pays a higher percentage of PPO provider charges.

Yes. There is an overall lifetime maximum for medical benefits and some benefits have specific annual and/or lifetime limits.

Although not required, if a dental procedure is going to be more than $100, you should ask your dentist to give the Fund Office a description of the services needed and the estimated cost. This is a dental pre-determination. The Fund Office can then provide you with an estimate of how much the Plan will pay so you have an idea of what you will have to pay.

To be eligible for retiree coverage, you must:

1. Have been continuously eligible in the Plan for the 10 years immediately before retirement;
2. Be eligible in the Plan at the time of retirement; and
3. Be at least 60 years old or Disabled and eligible for a normal retirement, regular, early retirement, or disability pension benefit from the Plumbers and Pipefitters Local 422 Pension Plan.

Yes, quarterly self-payments are required for retiree coverage.

Medical, prescription drug, dental, vision, and death benefits are the same for active and non-Medicare eligible retirees. There are no weekly accident and sickness benefits for retirees.