For Participants and Covered Dependents
Effective November 2002

Good dental care is an important part of staying healthy. The Trust Fund provides this comprehensive dental benefit to all employees, retirees and dependents enrolled in the Trust Fund.

• Annual Maximum
  PPO: $2,000 per individual
  
  Non-PPO: $2,000 per individual
• Calendar Year Deductible
  PPO: No deductible
  
  Non-PPO: No deductible
  
  
• Coinsurance Rate
  PPO: Plan pays 80% of UCR for diagnostic, preventive services, restorative services, prosthodontic services, oral surgery, periodontic and endodontic services.
  
  Non-PPO: Plan pays 80% of UCR for diagnostic, preventive services, restorative services, prosthodontic services, oral surgery, periodontic and endodontic services.
• Dentists Accepting Insurance as Payment in Full*
  *See bottom of this page for rules regarding this benefit. 
  
  Michael Alterman, DDS
  Absolute Dental
  Absolute Kids
  8380 W. Cheyenne, #103
  Las Vegas, Nevada 89129
  (702) 388-8989
  
  Michael Alterman, DDS
  Absolute Dental
  Absolute Kids
  9400 S. Eastern, #101
  Henderson, Nevada 89123
  (702) 456-0009
  
  Michael Alterman, DDS
  Art Dental, Inc.
  4035 S. Durango Dr., Ste.103
  Las Vegas, Nevada 89147
  (702) 804-8888
  
  Ben Nhan Truong, DDS
  AC Dental
  1520 N. Eastern Ave., #105
  Las Vegas, Nevada 89101
  (702) 633-6339
  
  Ben Truong, DDS
  Acclaim Dental
  7260 W Lake Mead Blvd., #5
  Las Vegas, Nevada 89128
  (702) 562-8852
  
  Charles W. Ashman, DDS
  Andrew P. Shelton, DDS
  Daniel J. Oehler,DMD
  General & Family Dentistry
  208 South Rainbow Blvd.
  Las Vegas, Nevada 89145
  (702) 363-0444
  
  Scott Brown, DDS
  Michael Stafford, DDS
  Carol Rowe, DDS
  Comfort Care Dental Group
  803 S. 7th Street
  Las Vegas, NV 89101
  (702) 384-4721
  
  Ellen Piyevsky, DDS
  Lake Mead Dental
  7481 W. Lake Mead Blvd.
  Las Vegas, Nevada 89128
  (702) 304-1234
  
  Nevada Dental Associates (see SmileCare)
  5 Locations
  
  R.F. John Holtzen, DMD
  Brendan G. Johnson, DDS
  Nevada Oral & Facial Surgery
  3150 N. Tenaya Way, Suite 240
  Las Vegas, NV 89128
  (702) 360-8918
  
  R.F. John Holtzen, DMD
  Brendan G. Johnson, DDS
  Nevada Oral & Facial Surgery
  1525 Warm Springs Road, Suite 125
  Henderson, NV 89014
  (702) 433-4355
  
  North Pointe Dental
  4690 Ann Road, Suite 4
  North Las Vegas, NV 89031
  (702) 515-7737
  
  John Soumi, DDS
  Peccole Family Dentistry
  9580 W. Sahara Ave., #190
  Las Vegas, Nevada 89117
  (702) 242-4680
  
  Raymond Kim, DDS
  Pointe North Dental
  7312 W. Cheyenne Ave., Ste.3
  Las Vegas, NV 89129
  (702) 396-9924
  
  Matthew McGee, DDS
  8440 W. Lake Mead, #207
  Las Vegas, Nevada 89128
  (702) 360-4200
  
  Liem Vu, DDS
  Smile Brite Dental
  4975 S Fort Apache, #107
  Las Vegas, Nevada 89148
  (702) 248-2748
  
  SmileCare
  2660 Windmill Parkway
  Henderson, NV 89074
  (702) 990-2960
  
  SmileCare
  2047 W. Charleston Blvd., Suites 110-120
  Las Vegas, NV 89102
  (702) 382-0380
  
  SmileCare
  8445 W. Flamingo Road
  Las Vegas, NV 89147
  (702) 948-7939
  
  SmileCare
  3163 N. Rainbow Blvd.
  Las Vegas, NV 89108
  (702) 656-2301
  
  SmileCare
  1420 E. Highway 372
  Pahrump, NV 89048
  (775) 727-6647
  
  Ellen Piyevsky, DDS
  WigWam Dental Care
  2649 Wigwam Pkwy
  Henderson, Nevada 89074
  (702) 617-3333
  
  
  Accepting Insurance as Payment In Full
  
  Teamsters Local 14 has made arrangements with several dental care providers who have agreed to accept Teamsters insurance as payment in full for services rendered. (Cancellation fees for missed appointments are not covered by this agreement.) Local 14 members eligible for Teamsters Local 14 dental coverage will not have to pay co-pays or deductibles for plan-covered services through these providers. Before using any of these providers you should take the following steps:
  
  1. Identify yourself to the provider as a Teamster Local 14 member covered by the Teamsters Security Fund for Southern Nevada dental plan.
  
  2. Before any work begins, ask if the provider is still waiving the co-pays and deductibles for covered services rendered under the Teamsters Security Fund for Southern Nevada. If they are not, you may wish to contact another provider on the list for service and contact our offices with this information as soon as possible.
  
  This list is in no way intended to indicate this office's endorsement for any of the following providers, nor is it intended to imply anything other than the fact that these providers have all agreed to waive the deductibles and co-pays on covered services. Should you or any member of your family encounter any difficulties with any of these providers, please advise our office at your earliest convenience.

  > Printable List of Dentist Accepting Insurance as Payment in Full_ Updated October 1, 2005 (1.2 MB)
  

• Diversified Dental Services, Inc.

  Diversified Dental Services, Inc., is an independent Preferred Provider Organization (PPO) serving Nevada since 1995. Diversified Dental Services, Inc. contracts with dentists to provide their services at a discount from their normal fees. Clients receive dental services at discounted rates when they seek dental care from a PPO dentist.
  
  Visit this website for a complete list of providers and services.

• How the Dental Benefit Plan Works
  The dental benefit plan is a network plan. You may see any dentist you prefer, whether of on Diversified Dental Services providers list or not. This means the trust will pay only 80% of the rates contracted with Diversified Dental Services, Inc., any cost a dentist outside the Diversified Dental Services providers list may charge above these contracted rates you will be responsible for. When you see the dentist, you pay the dentist for the service (or make arrangements with the dentist for payment), and once you have paid the dentist, submit the receipt to the Fund Administrative Office with a claim form for reimbursement.
  
• Orthodontia Lifetime Maximum Benefit

  PPO: $1,200 lifetime maximum benefit for children under 19 (this benefit is available for each participant under age 19 after 9 full months of coverage under this Plan)
  
  Non-PPO: $1,200 lifetime maximum benefit for children under 19 (this benefit is available for each participant under age 19 after 9 full months of coverage under this Plan)
  
  The Calendar Year and Lifetime Maximum Orthodontic Benefit that will be paid for a covered dependent child under age 19 for orthodontic treatment is shown in the Schedule of Benefits. (A covered dependent must have accumulated 9 full months of coverage prior to the commencement of orthodontic work.) The amount of benefits for Orthodontic Charges will be paid as follows: 

  1. $300 - banding
  2. $300 - first six months of adjustments
  3. $300 - second six months adjustments
  4. $300 - third six months of adjustments
• Orthopaedic Specialists of Nevada

  Please note that effective OCTOBER 11, 2007, Orthopaedic Specialists of Nevada no longer participates in the Beech Street Provider Network. As a result, any routine services or follow up care receievd after this date wil be paid at the non-PPO level of benefits under the Teamsters Security Fund for Southern Nevada Plan. Emergency care rendered by this provider will continue to be paid at the PPO level.

  Should you have any questions, please contact Zenith Administrators, Inc. at (702) 734-8601.

"Serving Members Since 1952"

• Additional Products
  
  
  • Direct Deposit
  
  
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  • ATM/Point of Sale Cards
  
  
  • Check Guarantee/Point of Sale Cards
  
  
  • Credit Life Insurance on Loans
  
  
  • Credit Disability Insurance on Loans
  
  
  • MemberCONNECT Supplemental Insurance
  
  
  • Health Insurance
  
  
  • Life Insurance
  
  
  • Accidental Death and Dismemberment
  
  
• Additional Services
  
  
  • Plus Phone Audio System
  
  
  • Notary Service
  
  
  • Wire Transfer (Incoming and Outgoing)
  
  
  • Quick File Tax Return Service
  
  
  • Travelers Checks
  
  
  • Corporate Checks
  
  
  • Money Orders
  
  
  • Blue Books
  
  
  • Federal Tax Deposits (TT&L)
  
  
• Credit Union Advantages
  
  
  • Member Owned
  
  
  • Low Minimum Deposit Required
  
  
  • High Competitive Savings Yields
  
  
  • Low Competitive Loan Rates
  
  
  • Worldwide ATM Access
  
  
  • Free Personalized Service
  
  
  • Each Account Insured up to $500,000
  
  
  • Full Service Financial Savings and Loan Programs
  
  
• Locations & Hours

  Jones Branch
  1900 South Jones Blvd.
  Las Vegas, NV 89146
  
  Winterwood Branch
  5105 East Sahara Ave.
  Las Vegas, NV 89142
  
  Sunset Branch
  1090 West Sunset Rd.
  Henderson, NV 89014
  
  Member Service Center
  (702) 871-4746
  
  Toll-Free (outside LV area)
  (877) 871-4746
  
  Plus Phone
  (702) 871-4746 (press 1)
  
  Lobby Hours
  Mon - Fri: 9:00 am - 5:00 pm
  Saturday: 9:00 am - 1:00 pm

  Drive Thru/Call Center Hours
  Mon - Fri: 8:00 am - 6:00 pm
  Saturday: 8:00 am - 2:00 pm

  Closed Sundays and for posted Holidays.

  VISIT YOUR CREDIT UNION AT THEIR WEBSITE

The Trust Fund provides life and accidental death and dismemberment insurance to all active employees, and retirees who are not yet eligible for Medicare. Dependents of active employees (but not retirees) are covered by the life insurance policy. This benefit is underwritten and fully insured by a commercial insurance carrier.

• Benefits for Active Employees & Retirees Not Eligible for Medicare
  
  
  • Death Benefit: $9,000
  
  
  • Accidental Death & Dismemberment Benefits: $9,000
  
  
  • Accidental loss of two limbs, two eyes, or one limb and one eye: $9,000
  
  
  • Accidental loss of one limb, or one eye: $4,500
  
  
• Dependent Benefits - for Active Employees Only

  • Death Benefit for Spouse: $1,000
  • Death Benefit for Children Age 6 Months But Less Than 19 Years
    (Or Until 26th Birthday If A Full Time Student): $1,000
  • Death Benefit for Children Age 14 Days to Six Months: $250

• Submitting Claims for Benefits
  If you or your beneficiary(ies) have a claim from the plan, contact the Fund Administrative Office and they can provide you with the claim forms and help you complete the forms and answer any questions.
  
  If your claim for a plan benefit is denied, you have the right to appeal the decision. The rules for appealing denied claims are described under Claims Appeal Procedure on page 61 of the Trust’s Summary Plan Description.

Teamsters 14-995 Security Fund
Office Location
Zenith Insurance Administators
2250 S. Rancho,Suite 295
Las Vegas, NV 89102

Phone (702) 734-8601
Fax (7020 734-8619

*The benefits listed are representative of those offered under Teamsters Local 14's Indemnity Plan. Please refer to the Summary Plan Description for the rules governing these benefits and the procedures that you must follow to obtain benefits.

• Ambulance Services
  Ground Ambulance
  
  PPO: $50 per trip co-payment
  
  Non-PPO: $50 per trip co-payment
  
  Air Ambulance
  
  PPO: $50 per trip co-payment. Limited to a max of $7,500 once every two calendar years
  
  Non-PPO: $50 per trip co-payment. Limited to a max of $7,500 over every two years.
• Beech Street Corporation

  "Celebrating over 50 years in the healthcare industry, Beech Street Corporation is dedicated to providing the latest, most technologically advanced products and services for healthcare consumers. We are focused on meeting the needs of our consumers, payors and providers by providing them with the customer service they deserve, and the quality of care they have come to expect."
  
  Bill Hale
  President & CEO
  Beech Street Corporation
  
  Visit this website for a complete list of options and services.

• Chiropractic Services
  PPO: $15 per visit co-payment, $500 maximum per calendar year
  
  Non-PPO: 50% UCR after deductible, $500 maximum per calendar year
• Deductibles - Medical Plan
  Calendar Year
  
  PPO: $250 per individual, max of $750 per family
  
  Non-PPO: $1,000 per individual
  
  This deductible is in addition to the per impatient admission deductible (listed below) and any co-payments for network services that may apply. The maximum annual deductible for network services can be satisfied by multiple family members and does not require that three (3) separate individual deductibles be met.
  
  Inpatient Admission
  
  PPO: $100 per admission
  
  Non-PPO: $1,000 per admission
• Dependent Coverage
  Teamsters Security Fund of Southern Nevada Local 14 is pleased to announce the following benefit enhancements effective January 1, 1999:
  
  Members covered by the Trust who wish to have their grandchild(ren) covered may do so if they grandchild(ren) is deemed to be a dependent under the following criteria: The grandchild must be legally adopted or the grandparent appointed by the court as the legal guardian; and the grandchild must be principally dependent on the grandparent for support and live with the grandparent.
• Emergency Services
  Emergency Room
  
  PPO: $25 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Emergency Room Doctor
  
  PPO: $25 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Urgent Care Facility
  
  PPO: $15 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
• Hearing Aids
  PPO: $50 per device co-payment, maximum of $600 per ear in a five-year period
  
  Non-PPO: 50% UCR after deductible, maximum of $600 per ear in a five-year period
• Home Health Care
  Home Visit
  
  PPO: $10 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  IV Therapy
  
  PPO: $10 per visit co-payment. Limited to 40 visits per calendar year.
  
  Non-PPO: 50% UCR after deductible. Limited to 40 visits per calendar year.
• Hospice Care
  Inpatient Care
  
  PPO: $100 deductible per admit, 90% of next $5,000, then 100% thereafter
  
  Non-PPO: $600 deductible per admit, 50% for next $5,000, then 100% of UCR thereafter
  
  Outpatient Care
  
  PPO: $10 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Family Counseling
  
  PPO: $20 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Bereavement Counseling
  
  PPO: $20 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
• Hospital Inpatient Services
  Hospital Admission Room & Board
  
  PPO: $100 deductible per admit, 90% of next $5,000, then 100% thereafter
  
  Non-PPO: $500 calendar year deductible plus $1,000 admit deductible, 50% of UCR with no out-of-pocket annual maximum
  
  Routine Nursery Care
  
  PPO: $100 deductible waived, 90% of first $5,000, then 100% thereafter
  Non-PPO: Deductibles waived, 50% of UCR
  
  Newborn Extended Stay
  
  PPO: $100 deductible per admit, 90% of next $5,000, then 100%
  
  Non-PPO: $250 calendar year deductible plus $600 per admit, 50% of UCR with no out-of-pocket annual maximum
• Inpatient Physician Care
  Primary Care Provider
  
  PPO: $10 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Specialist
  
  PPO: $15 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
• Inpatient/Out Surgical Services

  In Doctor's Office
  
  PPO: $15 co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Outpatient Facility
  
  PPO: $50 per visit co-payment
  
  Non-PPO: 50% UCR after deductible

• Lifetime Maximum Benefit Per Individual
  PPO: $1,000,000.00
  
  Non-PPO: $1,000,000.00
• Out of Pocket Maximum
  Individual
  
  PPO: $500 plus hospital deductible & applicable co-payments
  
  Non-PPO: No limit on out of pocket maximum for non-ppo providers. Plan pays 50% of UCR after deductible
  
  Family
  
  PPO: $1,500 plus hospital deductible & applicable co-payments
  
  Non-PPO: No limit on out of pocket maximum for non-ppo providers. Plan pays 50% of UCR after deductible
• Physician Office Visit
  Primary Care
  
  PPO: $10 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Specialist
  
  PPO: $15 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
• Pre-Admission Testing
  PPO: No co-payment
  
  Non-PPO: 50% UCR after deductible
• Pre-authorization Required
  Many services require pre-authorization from the Utilization Review Organization. When pre-authorization is not obtained when required, benefits payable by the Fund are reduced by 50%.
• Prepaid Health Plan Option or Indemnity Plan Option
  When you become eligible for coverage for the first time, you must complete enrollment designating the Health Plan Option of your choice:
  

  
  A. Prepaid Health Plan Option, or
  B. Indemnity Plan Option

  
  A. PREPAID HEALTH PLAN OPTION
  If you select the Prepaid Health Plan Option, you and your eligible dependents will be provided hospital-medical care and prescription drug benefits under an agreement with Health Plan Nevada. Under this plan, you are required to use the doctors, medical clinics and hospitals which are a part of the Health Plan Nevada.
  
  

  • Election to be Covered Under the Prepaid Health Plan
    (Health Plan of Nevada)
    If you live within the service area of Health Plan of Nevada, and you are otherwise eligible for coverage under the active Eligible Member Plan, you may elect to be covered under Health Plan of Nevada in lieu of being eligible for the Medical Expense Benefits described in this booklet. Even if you elect the prepaid health plan option, you will still be eligible for the Life, Accidental Death and Dismemberment, Dental, and Vision benefits, your dependents will still be eligible for Life, Dental and Vision benefits.
  
  
  
  • Rules for Electing and Revoking Election of Prepaid Health Plan Coverage
    If you live within the service area of Health Plan of Nevada, you will have an opportunity annually to elect or revoke the prepaid health plan coverage.

  
  B. INDEMNITY PLAN OPTION
  The Indemnity Plan provides you with the greatest flexibility of provider selection. When you obtain covered medical services from a PPO Provider, you will receive greater benefits with lower out-of-pocket costs. In addition, you can obtain covered medical services from a Non-PPO Provider of your choice, but you will have higher out-of-pocket costs, and will be responsible for any changes in excess of what the Plan considers Usual, Customary and Reasonable (UCR).
  
  PPO PROVIDER
  PPO or contract providers are paid at a contracted rate schedule (CRS), which is the negotiated rate for Contract Providers. You will not be responsible for charges in excess of the discounted negotiated rate for medical services provided by a PPO Provider.
  
  NON-PPO PROVIDER
  Non-PPO or NON-Contract Providers are paid at USUAL, CUSTOMARY AND REASONABLE (UCR) rates, which are based on the fees most frequently made to the majority of patients for the same service or procedure. The charge must be within the range of charges most frequently made in the same or similar medical service area for the service or procedure as billed by other physicians.  You will be responsible for charges in excess of what the Plan considers in excess of UCR.
• Prosthetic & Orthopedic Device & Durable Medical Equipment
  Prosthetic & Orthopedic
  
  PPO: $50 per device co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Durable Medical Equipment
  
  PPO: $50 per device co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Medical Supplies
  
  PPO: No co-payment
  
  Non-PPO: 50% UCR after deductible
  
• Routine Mammogram
  PPO: $15 per procedure, limited to once per calendar year
  
  Non-PPO: 50% UCR after deductible
• Short Term Rehab Services
  Outpatient
  
  PPO: $15 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Inpatient
  
  PPO: $100 admit deductible, 90% of next $5,000, then 100%
  
  Non-PPO: 50% UCR after deductible, $600 admit deductible, 50% of next $5,000, then 100%
  
  Skilled Nursing Facility
  
  PPO: 100% admit deductible, 90% of next $5,000, then 100%
  
  Non-PPO: $600 admit deductible, 50% of next $5,000, then 100%
• Sterilization
  Tubal Ligation
  
  PPO: $200 co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Vasectomy
  
  PPO: $100 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
• Surgical Services
  Surgeon
  
  PPO: $50 co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Assistant Surgeon
  
  PPO: No co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Anesthesia Services
  
  PPO: $100 co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Obstetrical Care Physician
  
  PPO: $100 co-payment
  
  Non-PPO: 50% UCR after deductible
• Temporomandibular Joint Treatment (TMJ)
  PPO: 50% of contracted rate up to a $4,000 lifetime maximum
  
  Non-PPO: 50% UCR after deductible, not to exceed $4,000 lifetime
• Well Baby Care
  Primary Care: 0-12 months
  
  PPO: $10 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Specialists: 0-12 months
  
  PPO: $15 per visit co-payment
  
  Non-PPO: 50% UCR after deductible

For Participants and Covered Dependents
Effective April 1, 2003

• About Benefits
  The prescription drug benefit is provided to help you pay for take home prescription drugs you purchase from a pharmacy or through mail order. To combat the escalating cost of prescription drugs, the Trustees have selected the RxAmerica network for prescription drug coverage. The prescription drug benefit will cover any drug that:

  • Is prescribed by a licensed physician;
  • Must be obtained by prescription;
  • Has been approved by the Food and Drug Administration for general marketing by RxAmerica;
  • Is dispensed bya licensed pharmacist.

  When you enroll in the indemnity medical plan, you are automatically covered by this prescription drug benefit. If you are enrolled in the HMO, you will be covered under the HMO prescription drug benefit.
  
  Generic - $8
  
  Brand with no generic available - Formulary - $20
  
  Brand with no generic available - Non-Formulary - $30
  
  If brand name drug is dispensed when a generic exists, participant pays $8 generic payment, plus the difference in cost between brand name and generic.
  
  Maintenance Drugs can be purchased through mail-order provider. A three month supply can be ordered for cost of one month of applicable payment, i.e. three months of a formulatory prescription would cost $20, etc.

• Co-payment Schedule: Mail Order Pharmacy, 90-day limit
  (Do remember these costs are for a 90-day mail order supply of medications.)

  • Network Pharmacy - Generic Drug: No co-payment
  • Network Pharmacy - Brand Drug No Generic Available (formulary):  $30
  • Network Pharmacy - Brand Drug Generic Available (non-formulary): $60
  • Non-Network Pharmacy:  Not Covered
• Co-payment Schedule: Walk In Pharmacy, 30-day limit
  
  
  • Network Pharmacy - Generic Drug: No co-payment
  
  
  • Network Pharmacy - Brand Drug No Generic Available (formulary):  20% (minimum of $20) of the retail cost
  
  
  • Network Pharmacy - Brand Drug Generic Available (non-formulary): 45% (minimum $45) of the retail cost
  
  
  • Non Network Pharmacy:  Not Covered
  
  
• Drug Formulary
  A drug formulary is a list of preferred medications published by the prescription drug network service provider, RxAmerica, which offers the best value without sacrificing quality of care. A formulary is developed and maintained by a panel of practicing pharmacists and physicians. This panel, called a Pharmacy & Therapeutics Committee, meets quarterly to review new drugs, and maintain the integrity of the formulary.
  
  Studies show that the choice of the most appropriate drug through the use of a formulary results in fewer treatment failures, reduced hospitalizations, a fewer side effect. Efficient and effective use of a drug formulary helps to keep overall medical costs down.
• Mail Order
  The prescription drug benefit has a convenient mail-order program through American Diversified Pharmacies (mail order provider through RxAmerica). You can receive a 90-day supply (rather than a 30-day supply) for one co-payment, i.e. three months of a formulatory prescription would cost $20, etc. This is particularly convenient when taking drugs on a regular, long-term basis, such as drugs for high blood pressure, arthritis or diabetes.
  
  To order prescriptions by mail order, follow these steps:
  

  
  
  • Ask your doctor to prescribe necessary medications for up to 90-days, plus refills.
  
  
  • Complete the initial order form, which includes a patient information questionnaire with your first order only.  This allows the mail order pharmacist to make sure you are not taking medications that could conflict with other medications or conditions you have. Be sure to answer all of the questions for yourself and your covered dependents.  To obtain an initial order form and patient information questionnaire, call the Fund Administrative Office. Refills may be called into the mail-order pharmacy at 800-568-2155.
  
  
  • Send the completed Patient Information Questionnaire and your original prescription(s) to American Diversified Pharmacies using the preaddressed order envelope. Enclose the appropriate co-payment.
  
  
  • Refills may be called into the mail-order pharmacy at 800-568-2155, American Diversified Pharmacies (mail order provider through RxAmerica). RxAmerica Help Desk: 800-700-8014.
  
  
• On-Line Services

  Refills may be ordered on-line.
  
  Go to the American Diversified Pharmacies website.

• RxAmerica

  "As an industry leader, RxAmerica is dedicated to provide quality pharmacy benefits management services, improve the health of patients, and reduce costs for our clients.
  
  RxAmerica has proven experience in successfully controlling the medical loss ratio associated with pharmaceutical care while delivering operational excellence, exceptional provider support and complete consumer satisfaction. ”
  
  John Gardynik, President RxAmerica L.L.C.
  
  Visit this website for more information on our services.

• Walk In Network Pharmacy

  Present your ID card to the participating pharmacy. Provided your name is included in the list of eligible participants in the prescription drug plan, you pay the applicable
  co-payment. (If your name is not on the list, contact the Fund Administrative Office.)
  
  The plan pays for prescriptions only when purchased at a network pharmacy.  Here is a partial list of network pharmacies in Nevada:

  • Albertson’s
  • Costco
  • Longs
  • Medicine Shoppe
  • Safeway
  • Sav-on
  • Shopko
  • Smith’s Food and Drug
  • Vons
  • Walgreen’s
  • Rite Aid

  Call the Fund Administrative Office at 702-734-8601 for a complete list of network pharmacies.

AFL-CIO Community Services
ULAN, a non-profit agency, is a joint venture of the Nevada AFL-CIO and the United Way.

• AFL-CIO & United Way
  ULAN is the only labor sponsored United Way funded community services agency in Nevada with special emphasis on assisting union members and their families.
  
  ULAN provides various programs to assist union members and their families who have been victims of an accident, illness, layoff, disaster or any situation that has caused a hardship. These include information and referral to access existing community services such as counseling, education and training, food, shelter, clothing, financial, medical and legal aid. ULAN also provides emergency assistance, food baskets, clothing and household items and citizenship assistance. To receive assistance from ULAN, union members must be referred by their union.
• Citizenship Assistance
  Through donations and fund-raising, ULAN is able to provide on-site emergency assistance to prevent homelessness, hunger, utility turn-offs, and to aid in obtaining health care needs, clothing, household items and employment fees.
• Contact Us
  United Labor Agency of Nevada (U.L.A.N.)
  1201 N. Decatur Suite 106
  Las Vegas, Nevada 89108
  Phone: (702) 648-3500
  Fax: (702) 648-3509
• Direct Assistance
  Through donations and fund-raising, ULAN is able to provide on-site emergency assistance to prevent homelessness, hunger, utility turn-offs, and to aid in obtaining health care needs, clothing, household items and employment fees.
• Holiday Food Baskets
  During the Thanksgiving and Christmas Holidays, ULAN provides special holiday foods to needy union members so they can prepare a nice holiday dinner for their families.
• How does ULAN work?
  When members of local unions and their families are referred to ULAN, they are interviewed by ULAN staff who will assess their needs. These needs are met by referrals to appropriate off-site agencies or through the direct assistance programs provided on-site by ULAN. All discussions held with the ULAN staff remain confidential. There is no fee for ULAN's assistance.
• ULAN Programs
  ULAN locates available resources, prescreens for eligibility and makes referrals to appropriate human and health services. ULAN works with other non-profit, government and private agencies to facilitate potential solutions.

The Trust Fund provides vision benefits through Vision Service Plan (VSP). Vision Service Plan (VSP) provides eye exams, and, if your vision needs to be corrected, lenses and frames or contact lenses through their network of VSP Doctors who include licensed ophthalmologists, opticians and optometrists. The Trust Fund provides this vision benefit plan to all employees, retirees and dependents who are enrolled under the Trust Fund.

• Contact Lenses
  Medically Necessary Contact Lenses
  One pair every 12 months if necessary instead of frames and lenses
  
  Elective Contact Lenses
  $105 allowance for one pair every 12 months, if necessary instead of frames and lenses
• Cost of Vision Benefits
  When you or your enrolled dependents select a doctor from the VSP list, the vision benefit covers examination, professional services, lenses, and a wide selection of frames at no expense to you, except a $15 deductible. Copayments are to be paid to the VSP Doctor at the time of examination. Any additional care, services and/or materials not covered by the vision benefit may be arranged between you and your doctor.
• Deductible - Vision Plan
  PPO: $15 co-payment
  
  
• Frames
  PPO: 1 set every 24 months, if necessary.
  
  Non-PPO: Up to $45
• How the Vision Plan Works
  VSP has a network of vision care providers (ophthalmologists, optician and optometrists) from which you can choose. Follow these steps:
  
  1. Obtain a list of VSP Doctors in the area from the Fund Administrative Office.
  
  2. Select a VSP doctor from the list.
  
  3. When you call to make an appointment inform the VSP Doctor that you are a VSP participant.
  
  4. The VSP Doctor will contact Vision Service Plan for your eligibility status and a benefit form.
  
  5. Pay the $5 copayment to the VSP Doctor when you receive the service.
  
  6. Payment for any additional (non-covered) services can be arranged between you and your doctor.
  
• Lenses
  Single Vision, Bifocals, Trifocals, Lenticular
  
  PPO: 1 pair every 24 months, if necessary.
  
  Non-PPO: Up to $40
• Seeing Non-VSP Providers
  You or your eligible dependents may obtain services from a non member optometrist, ophthalmologist or dispensing optician. You and your enrolled dependents that follow this course must still obtain a benefit form, which you can obtain from the Fund Administrative Office. You should pay the doctor his or her full fee. You will then be reimbursed by VSP according to the reimbursement schedule for non-providers provided in the full Summary Plan Description.
• Vision Exam
  PPO: 1 exam every 12 months by VSP provider
  
  Non-PPO: Up to $40