The Board of Trustees have agreements with certain networks for health care services for our members. A network arranges with health care providers for their services at fees which are usually less than their regular fees.
Participants are required to use network providers for routine vision care benefits and prescription drugs.
Participants are required to use JCAHO approved providers for inpatient mental and nervous conditions and substance abuse, as well as partial hospitalization or intensive outpatient treatment.
Participants are not required to use network service providers for medical, surgical, or dental needs.
For hospital confinement, surgical treatment, or home health care services, you must first secure authorization from the Fund's utilization review program (TMRP).
For inpatient, partial hospitilization, or intensive outpatient mental health or substance abuse, you must first secure authorization from HMC Healthworks.
If you choose to use a network provider, you may receive the benefit of the negotiated fees since the coinsurance amounts on each bill will be less if the negotiated fee is less. The Plan's reimbursement percentages are the same regardless of whether a provider is in or out of a network.
The Fund and its Trustees assume no responsibility for the qualifications of, or for the quality of services provided by, any health care provider.