• SPD Table of Contents
  1. Important Contact Information
  2. Introduction
  3. Table of Contents
  4. Plan A Schedule of Benefits
  5. Plan B Schedule of Benefits
  6. Plan C Schedule of Benefits
  7. Plan 11 Schedule of Benefits
  8. Plan 11-C Schedule of Benefits
  9. Eligibility for Active Participants
  10. Eligibility for Retiree Coverage
  11. Insurance Coverage
  12. Weekly Loss of Time Benefit
  13. Medical Benefits
  14. Prescription Drug Program
  15. Medicare Part D Prescription Drug Plan (PDP) for Retirees
  16. Members Assistance Program (MAP)
  17. Dental Benefit
  18. Vision Benefit
  19. Hearing Benefit
  20. Special Fund Program
  21. General Plan Exclusions and Limitations
  22. Other Limitations on Your Benefits
  23. Definitions
  24. Claim and Appeal Procedures
  25. General Plan Provisions
  26. Information About the Plan
  27. Board of Trustees

Important Contact Information

Fund Office – 1-630-393-1701 #3

• IBEW Local 701 Welfare Fund
  28600 Bella Vista Parkway, Suite 1110
  Warrenville, IL 60555

Utilization Review Organization (Med-Care Management) – 1-800-367-1934 (24 hours)

• Pre-certify all inpatient hospitalizations, skilled nursing facility or residential treatment facility services, whether in or out of the PPO network
• Outpatient surgery, whether in or out of the PPO network.
• Other services requiring pre-certification are listed inside this booklet.
• There are penalties ($100) for failing to pre-certify

Prescription Drug Program (Sav-Rx) – 1-866-233-4239

• Sav-Rx
  224 North Park Avenue
  Fremont, NE 68025
  www.savrx.com
  Group / Plan No. IBEW701
  Sav-Rx also handles customer service for the retiree Medicare Part D plan.

Medical Preferred Provider Organization (PPO) – 1-800-810-BLUE

• Blue Cross Blue Shield of Illinois
  www.bcbsil.com, select “Labor accounts,” alpha prefix: IBW to find a participating provider

Special Fund (HRA) Program – 1-877-933-3539

• TASC DirectPay
  www.tasconline.com

Dental PPO (DNoA) – 1-866-522-6758

• Dental Network of America (DNoA) (through Blue Cross Blue Shield of Illinois)
  www.dnoa.com (to find a participating provider), select the “Labor+” plan

Vision Plan (NVA) – 1-800-672-7723

• National Vision Administrators
  P.O. Box 2187
  Clifton, NJ 07015
  Plan No. 10900001
• www.e-nva.com (to find a participating provider)

Members Assistance Program (MAP) – 1-630-393-1701 #6

• 1-630-791-2673
  Available 24/7
  Suite 1120 in the IBEW Local 701 building

Preferred Imaging Provider (Absolute Solutions, LLC) – 1-800-321-5040

• Call number above to schedule an MRI, CT scan or PET scan at a negotiated price

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