Active Employee Schedule of Benefits

Retired  Employee Schedule of Benefits 

Summary Plan Description (SPD)

To Participants of the I.B.E.W. Local 701 Health & Welfare Plan

Remember using the PPO (Blue Cross Blue Shield of Illinois), Sav-RX  (Prescription Drug Card& Mail Order Programs), NVA (National Vision Administrators) and AFAS (Podiatry Network) Saves you and the Fund Money.

Tips for Expediting your Claims

1. All BCBS PPO Physicians MUST submit ALL Medical Claims to:
   • BlueCross and BlueShield of Illinois
   • P.O. Box 1364
   • Chicago, IL 60690
   • Group No: P81221 BS Plan Code: 621 BC Plan Code: 121
   • Non-PPO, Dental and Dental Claims  are mailed to the Fund Office.
   • Vision Claims are sent to NVA Office
     PO Box 2187 Clifton, NJ 07010
     Sponsor #1090
     Phone 1-800-672-7723
2. We require one completed BLUE Universal Claim Form (entire front side including signatures) on file per calendar year, per family.
3. Promptly Return Requests for Additional Information.
4. An itemized bill along with an Explanation of Benefits (EOB) is required for all family members covered by other insurance (including Medicare).
5. ALL Accidents and Injuries require a completed White Claim Form with accident details (when, where and how the accident occurred).
6. Original Bills must be submitted; balance due statements are not accepted as a claim.
7. Dental Claims require an Annual Blue Claim Form on file.
8. Vision claims require the original bill which indicates full description of vision services and provider tax id with each Claim along with an Annual Blue Claim Form on file..
9. Full Name(s), Social Security Number(s), Date(s) of Birth, Date of Marriage, and Current Address is required on Health & Welfare Beneficiary Cards.