The Plan provides a different Level of Benefits for employees working as house wiring specialists whose employers are contributing to the Plan on their behalf under the residential agreement (the H Plan). Please note that the Plan will not pay benefits if you do not use a UnitedHealthcare provider.
Note: H Plan Employees are not eligible for prescription drug, mental health and substance abuse (although such Employees are eligible for up to eight (8) free Employee Assistance Provider (EAP) visits), vision, hearing benefits, death benefits, weekly accident and sickness benefits or supplemental occupational accident benefits. Medical expenses that are considered “essential health benefits” are subject to an annual limit of $100,000. This annual limit is below the maximum annual limit of $750,000 set forth by the Patient Protection and Affordable Care Act, but the H Plan has received a waiver from the U.S. Department of Health and Human Services. The waiver is valid for the 2011, 2012, and 2013 plan years. For example, for the plan year commencing on January 1, 2011, once the H Plan has provided $100,000 in “essential health benefits” on behalf of an individual for claims incurred in 2011, it will not pay for any additional expenses for that individual with respect to claims incurred in 2011. The H Plan will maintain the $100,000 annual limit on essential health benefits through December 31, 2013. Medical expenses that are not considered “essential health benefits” are subject to a $100,000 maximum lifetime benefit.
Except for these exclusions, the benefits are the same as those in the Summary of Benefits.