Southern Illinois Health & Welfare Insurance Trust

Click the links below for Plan A Complete Schedule of Benefits, Enrollment Forms, and Wellness Plan information.

SCHEDULE OF BENEFITS FOR HEALTH SCREENING PARTICIPANTS

DEDUCTIBLE/OUT-OF-POCKET/PENALTIES

SUMMARY OF SERVICES

NETWORK PROVIDERS

NON-NETWORK PROVIDERS

Mandatory Hospital Pre-Admission and Outpatient Services Review Refer To The Section Entitled “Utilization Review Program”

Non-Compliance Penalty

Inpatient Services (Medical, Surgical, Behavioral)

25% up to $1,000

Surgical Procedures (Ambulatory)

25% up to $1,000

Ancillary Services

25% up to $1,000

Durable Medical Equipment

25% up to $1,000

Diagnostic Imaging (Ambulatory)

25% up to $1,000

Annual Maximum Benefit

Unlimited

Lifetime Maximum Benefit

Unlimited

Per Confinement Co-payment

None

$300

Calendar Year Deductible

Individual

$750

$3,000

Family

$2,250

$9,000

Note: The Family Deductible Maximum includes covered expenses which are used to satisfy Deductibles for all family members combined.

Network Providers, and Non-Network Providers expenses will be applied equally toward the satisfaction of the Network Providers, and Non-Network Providers Deductible amounts.

Out-of-Pocket Maximum (including Deductible and Medical Co-insurance)

Individual

$1,500

$6,000

Family

$4,500

$18,000

Note: The Family Out-of-Pocket Maximum includes Out-of-Pocket expenses for all family members combined.

Network Providers and Non-Network Providers expenses will be applied equally toward the satisfaction of the Network Providers, and Non-Network Providers Out-of-Pocket Maximums.

Click to Download Complete Schedule of Benefits

SIHWIT Health Screening SOB 16 – 17

Wellness Plan

Wellness programs are an important factor to help control the rising medical costs.  Our Trustees have always thought it was an important piece of the insurance puzzle.  Every year we like to refresh everyone on the guidelines to be considered a Wellness Plan Participant.

In order to be considered a wellness plan participant you must do the following (spouses are eligible to participate but not required):

1)      The first year you are enrolled under our plan you must participate in the Health Risk Assessment and Biometric Screening by IHS– screenings are scheduled in our Districts in the spring.  You can also contact IHS in order to do a ‘Test on Demand.’

2)      Every year after you must meet Interactive Health Index score goal as deemed by IHS and as compared to the results of last year’s screening and/or defined as:

  1. Healthy– score between -20 (negative 0) and 0 (zero)
  2. Improvement– meet or exceed the goal established last year by IHS
  3. Unable to qualify due to medical conditions– participants should contact IHS (1-847-754-2732).  They will work with you on a case-by-case basis.  A form will need to be completed by your doctor showing that you are working on your goals with them.

3)      Active participation

#2 and #3 above will be determined by Interactive Health Solutions (IHS), our wellness partner, and not by the Trust.  Screening dates will be set each year in the spring, usually at least 30 days prior to the screening.  The Trust provides posters and email reminders about screening dates.

Q & A FOR WELLNESS 2016-2017

SIHWIT Non-Compliant SOB 16-17