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Click Here for the Retiree Summary Plan Description dtd. 1/1/19

The BlueCross BlueShield (BCBS) Comprehensive Medicare Supplement covers most (but not all) of the Medicare-eligible expenses that Medicare does not pay. A chart showing the coverage provided appears below.

It is very important to understand that benefits under the Plan will be modified to take Medicare into account, whether or not an individual enrolls in Medicare.

It is very important for a Participant and/or Eligible Dependent to enroll in Medicare Part A and Part B as soon as they are eligible.

However, you should NOT enroll in Medicare Part D prescription benefit coverage.

When you and/or your Eligible Dependent become Medicare Eligible, a copy of the Medicare Card must be furnished to the Fund Office.

Medicare periodically publishes a handbook called “Medicare & You” each year. This handbook details the Medicare benefits available to Medicare recipients and can be obtained directly from Medicare. You should contact Medicare to 

  • obtain a copy of the handbook
  • If you have questions about the benefits provided by Medicare
  • If you have questions about your eligibility for Medicare
  • If you have questions about enrolling in Medicare

You can contact Medicare at 1-800-MEDICARE (1-800-633-4227) or on the internet at

for Medicare Eligible Participants and/or their Medicare Eligible Dependents



Contracted Network Provider: BlueCross BlueShield of Illinois (BCBSIL)

         Out of Pocket Maximum per Calender year   $2,000 individual/$4,000/family

·      Medicare Part A Supplement (Hospital Benefit)

o   First 60 days

Plan Pays Medicare Part A Deductible

o   61st through 90th days

Plan Pays Medicare Part A Co-Payment

o   91st day and after

o   While Using 60 Lifetime Reserve Days

Plan Pays Medicare Part A Co-Payment

o   Additional 365 Days

Plan Pays 100% of Medicare-Eligible Expenses

·      Medicare Part B Supplement

o   Medicare Part B Deductible

Not Covered by Plan

o   Medical Expenses

20% of Medicare-Eligible Expenses at the Medicare

Approved Amount, after the Medicare Part B Deductible

·      Blood

o   First Three Pints

Plan Pays for Three Pints

·     Skilled Nursing Facility Care − Covered Individual must meet Medicare’s requirements, including having been in a Hospital for at least 3 days and enter a Medicare approved facility within 30 days of leaving the hospital

o   First 20 days

Medicare Pays All Approved Amounts

o   21st through 100th day

Plan Pays Medicare Part A Co-payment

·      At-Home Recovery Services Not Covered by Medicare – Home care certified by a Covered Individual’s doctor, for care during recovery from an injury or sickness for which Medicare-approved a home treatment plan.

o   Benefit for Each Visit




Plan pays actual charges of up to $40 per visit, up to the number of Medicare-approved visits, not to exceed 7 visits each week.

o   Calendar Year Maximum


·      Foreign Travel Not Covered by Medicare


o   Calendar Year Deductible

$250 per Individual

o   Plan Pays

80%; The Plan does not pay for expenses in excess of the Reasonable and Customary Allowance for non-PPO out-of-network providers. Amounts over the Reasonable and Customary allowance are the Covered Individual’s responsibility


o   Lifetime Maximum Benefit



BCBS Plan # 50498 - Secondary “Hospital Only” Coverage
This Plan is only available when the carpenter retired on or before June 1, 2006. The Plan pays covered expenses, secondary to Medicare. For a complete listing of covered expenses, please refer to the Summary Plan Description (SPD).
Medicare Part A Supplement
(Hospital/Facility Fees per Benefit Period)

*A benefit period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

Medicare Pays
Plan Covers
You Pay
  • Hospital Confinement (Semi-private room and board, general nursing, and miscellaneous services and supplies:

o      First 60 days

All but Part A Deductible

Part A Deductible


o      61st through 90th day

All but Part A Copayment

Part A Copayment


o   91st day and after while using 60 Lifetime Reserve Days

All but Part A Copayment

Part A Co-Payment


o Once Lifetime Reserve days are used:

    Additional 365 days

100% of Medicare Part A eligible expenses


o   Beyond the additional 365 days


All costs

Hearing Benefits
Retirees and their family members are eligible for a discount on hearing aids through EPIC Hearing Services (EPIC).



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