4. Stakeholders
4.2. Mapa genérico de Stakeholders de cada uno de los participantes
The Carpenters Assistance Program (CAP) provides free, confidential assistance for you and your family members when confronting stress, depression, alcoholism, drug abuse, and job or family problems.
How to Contact the CAP
Call 1-800-344-1515 extension 1160 to speak confidentially with a counselor or to make an appointment.
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CAP, in association with the Employee Assistance Program (EAP) service of the Mount Auburn Hospital, provides assistance through a network of facilities throughout the area. Professionals determine an appropriate treatment plan for you and/or your covered dependents. To contact Mount Auburn (EAP), call 617-661-0090 or 1-800-888-5105.You and your family are eligible for the following benefits:
• Assessment for drug, alcohol, marital, emotional or legal difficulties and/or career problems;
• Referral to the appropriate facility for the treatment of drug or alcohol dependency (see Mental Health and Substance Abuse on page 35);
• Diagnostic evaluation and referral to inpatient and/or residential treatment facilities; • Full coverage for short-term counseling provided by the EAP services of Mount
Auburn Hospital for up to eight one-hour visits per incident; • Case management and follow-up services for one year; and • Educational seminars, outreach activities and consultation.
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If you are admitted to a hospital or other facility for emergency care for a mental disorder or for substance abuse treatment, you, a member of your family, your doctor, or the hospital must call Hines & Associates at 1-800-944-9401 within 24 hours of your admission.!! Note: Court-ordered or random drug testing is not covered under the Carpenters Assistance Program.
• The Carpenters Assistance Program is available to participants and eligible dependents in Plan I, Plan II and the Retiree Plan.
• When you call, a CAP counselor will assess your situation and set up an appointment for short-term counseling or refer you to the appropriate provider for treatment.
• Treatment you receive through the Carpenters Assistance Program is strictly confidential.
• If you receive a referral for inpatient treatment of mental health or substance abuse, you must contact Hines & Associates, the Fund’s Health Management provider, at 1-800-944-9401 for pre-admission certification within 24 hours of your admission.
The prescription drug benefit offers you and your family a convenient and cost-effective way to receive your prescription medication. You may have your prescriptions filled by mail or at a pharmacy. If you use generic drugs, you will save money for yourself and for the Health Benefits Fund.
• Present your Ullicare Rx/Medco card at a participating pharmacy and make the applicable copayment to receive your prescription drugs.
• You can save time and money by using the mail order program. You can order a 90-day supply of generic prescription drugs for just $20.
• For retirees, a $15,000 per individual per calendar year maximum applies.
The chart below shows your copayments for prescription drugs based on whether you receive your prescription medication from a retail pharmacy or through the mail.
FAST FACTS:
Prescription Drugs*
Generic Brand Preferred Brand Non-Preferred
Retail (34-day supply) $10.00 $20.00 $30.00 Mail (90-day supply) $20.00 $40.00 $60.00
Generic Drugs
The Health Benefits Fund encourages the use of generic drugs. Generic drugs are a less expensive alternative to brand name drugs. The generic version of any drug contains identical active chemical ingredients and must meet the same manufacturing standards and federal requirements for safety and effectiveness as a brand name drug. Your
copayments for generic drugs are lower whether you use a retail pharmacy or order your prescription drugs by mail.
Brand Preferred
This category of medications consists of brand name and generic medications that are the most commonly used, the most cost efficient and the most therapeutically beneficial in the treatment of common health conditions.
Brand Non-Preferred
All brand name and generic medications not falling into the above categories.
How to Get Your Prescription Drugs
When you fill a prescription at a pharmacy, you simply present your Ullicare Rx/Medco card when you request your medication and pay the applicable copayment.
Mail Order Program
The mail order program is a convenient way for you to receive any medication— especially “maintenance drugs” that you need to take on a regular basis. Because you
know in advance that you will need this medication, it’s easy to establish a routine of filling such prescriptions by mail. Through the mail order program, you are eligible to receive medication for up to a 90-day supply. Contact the Fund Office for a mail order form.
What’s Covered
Coverage for prescription drugs is provided for the following non-hospital items: • Legend drugs;
• Injectable insulin and supplies, including hypodermic needles, syringes and test material;
• Compounded medication of which at least one ingredient is a prescription legend drug; or any other drug which, under state law, may only be dispensed upon the written prescription of a physician;
• Oral contraceptives;
• Viagra (6 tablets every 30 days).
What’s Not Covered
No benefits are payable for:
• The difference in charges between a generic drug and brand name drug unless “Dispensed as Written” appears on the prescription;
• Drugs or medicines lawfully obtainable without a prescription order of a physician or dentist except insulin;
• Birth control devices (other than oral contraceptives); • Levonorgestrel (Norplant);
• Therapeutic devices or appliances and support garments; • Immunization agents, biological sera, blood or blood plasma;
• Drugs labeled “Caution—limited by federal law to investigational use” or with similar language or experiment drugs even though a charge is made to the person; • Any charge for the administration of prescription legend drugs or insulin;
• Any medication, legend or not, which is consumed or administered at the place where it is dispensed;
• Medication which is to be taken by or administered to the person in whole or in part while he or she is a patient in a licensed hospital, rest home, sanitarium, extended care facility, convalescent hospital, nursing home or similar institution which operates on its premises, a facility for dispensing pharmaceuticals;
• Refilling of a prescription in excess of the number specified by the physician or dentist or any other refill dispensed after one year from the order of a physician or dentist;
• Prescription drugs that may be properly received without charge under local, state or federal programs, including Workers’ Compensation or similar law;
How to Fill a
Mail Order Prescription
Obtain a written prescrip- tion from your doctor for a 90-day supply of medica- tion. The prescription must include:
• The patient’s full name • The doctor’s name, phone
number and address • Exact strength, quantity
and dosage; and • Diagnosis, if required for
that drug.
• Call the Fund Office to request a mail order form.
What are
Maintenance Drugs?
Maintenance drugs are those that you require on an ongoing basis such as medication for high blood pressure, heart conditions or diabetes.
• The following drugs:
– Aero Chamber (covered under the Medical Plan with a letter of medical necessity);
– Hepatitis A or B (covered under the Medical Plan with a letter of medical necessity);
– Rogaine (Minoxidil or Loniten) when prescribed for hair restoration;
– Retin-A (Tretinoin Cream, Gel, Liquid) except when prescribed by a physician for acne or a skin disorder for an eligible dependent child before age 24 (covered under the medical plan for adults with letter of medical necessity);
– Smoking deterrent medications;
– Fertility drugs* such as, but not limited to: – Pergonal (menotropins);
– Profasi HP (HCG-Human Chorionic Gonadotropin); – Pro-Ception;
– Serophene (Clomiphene Citrate); – Clomid (Dienestrol);
– Lupron;
– Ephinephrine – primatine mist;
– Ephedrine sulfate – absolute decongestant; – Ferrous sulfate – iron supplement;
– Elixir terpin hydrate – expectorant;
– Over the counter vitamins with or without fluoride; and – Growth hormones.