Paraprofessional Health & Welfare Fund
Look How Far We’ve Come!
It’s true — we’ve come a long way.
Over the years we’ve made many improvements to your Health and Welfare Fund benefits, and your package of benefits just keeps getting better. As a member of the Boston Teachers Union Paraprofessional Health and Welfare Fund, you have access to high-quality dental care, vision care and prepaid legal services, plus other services highlighted in the brochure.
Your health and well-being are important to us, and that’s why we designed the Boston Teachers Union Paraprofessional Health and Welfare Fund benefits to supplement your City of Boston medical plan benefits.
The Fund offers covered Paraprofessionals Delta Dental PPO Plus Premier.
The plan will provide coverage for:
The Delta Dental Premier Option
The Delta Dental PPO Plus Premier Option is administered by Delta Dental of Massachusetts. The one plan provides coverage under two national networks: Delta Dental PPO and Delta Dental Premier. There is a $1,310 annual maximum (excluding orthodontia) under this plan. There is also a separate annual maximum of $1,000 per person for covered implant procedures only. To your benefit, implant-related procedures (abutments and crowns) will be applied toward the overall annual maximum amount
The Schedule of Covered Dental Procedures under this plan provides dental coverage for eligible individuals to go to any licensed dentist.
To see if your dentist is part of either of the national networks: Delta Dental PPO or Delta Dental Premier you can go to the Delta Dental web site at www.deltadentalma.com or contact the customer service department at 800-872-0500.
Eye Care Benefits
The eye care benefits provided by your Health and Welfare Fund are available exclusively at our own, private Eye Care Center. The Eye Care Center is located within the Boston Teachers Union Building, off of Day Boulevard in Dorchester. We are located a short walk from the MBTA Red-Line JFK / UMASS station, and we have ample free parking at the BTU building.
For information about your eye care benefits please click on one of the following:
Hospitalization Income Supplement Benefit
If a Covered Paraprofessional is confined to a hospital because of illness or injury for three or more consecutive days, the Covered Paraprofessional can receive the Hospitalization Income Supplement benefit beginning with the third day of hospitalization.
This benefit is payable up to 52 weeks for each hospital stay, as long as the member remains eligible.
The amount of the Income Supplement is as follows:
Consecutive Days Amount
In a Hospital of Benefit
0 – 2 None
3 – 6 $75
7 – 13 $150
14 – 20 $300
21 – 27 etc. $450 etc.
If you are confined to the hospital for three or more consecutive days, obtain a claim form from the Fund Office or print from the attachment on line. You need not wait until you are discharged from the hospital to print or request your claim form, although you should not submit the claim until you are discharged.
Hospitalization Income Supplement Benefit
(For Covered Paraprofessionals Only)
Please complete the Claim Form in its entirety but only complete the block at the top of the Hospital Verification Form.
Return both forms to us. We’ll take care of contacting the hospital involved in each case and we also verify your “Covered Paraprofessional” status.
Obviously, the sooner you mail us back the forms, the sooner we can proceed with our part. Please do not divert from this procedure as it can only delay your benefit.
Also, the Internal Revenue Service has determined that this type of benefit represents taxable income. You should then, report the income on your income tax form for the year in which the benefit is received.
Hearing Aid Benefit
If a Covered Paraprofessional or Eligible dependent requires a hearing aid, the charge for the hearing aid up to a maximum of $5,000 ($2,500 per ear) will be paid for by the Fund directly to the supplier provided the following requirements are met:
- The eligible person has undergone an Audiology Test, which has been authorized by a licensed physician, conducted at an appropriate hospital/facility; and the audiology report(s) and graph(s) are accompanied with the benefit request; and
- The invoice issued for the hearing aid is by the Audiology Department of an appropriate hospital/facility or by a supplier recommended by the Audiology Department; and that the invoice accompanies the benefit request.
Please note that this benefit does not include payment for any portion of the charge made by the hospital or facility for the Audiology Test. The hearing aid benefit will cover the cost of the hearing aid itself – no hearing aid accessories, additional fees, etc.
A HEARING AID BENEFIT WILL NOT BE PAID FOR HEARING AIDS NOT
FOLLOWING THE ABOVE MENTIONED TERMS, NOR FOR A HEARING AID OF
THE SAME PRESCRIPTION AS ONE PREVIOUSLY PAID FOR BY THE FUND FOR
THE SAME PATIENT AND THE SAME EAR WITHIN A FIVE YEAR PERIOD
This benefit does not pay for repairs nor does it pay for replacement of a lost or damaged hearing aid, so recipients may want to insure their hearing aid against loss or damage.
Funeral Expense Benefit
If you have paid the funeral expenses of a Covered Paraprofessional who has recently passed away, you may be eligible to make application for the benefit.
In the event that funeral expenses are incurred as a result of the death of a person who is a Covered Paraprofessional at the time of his/her death, the Fund will pay a funeral expense benefit equal to the amount of such expense, but not exceeding four thousand five hundred dollars ($4,500).
The Fund will make payment of this funeral expense benefit to the estate of the Covered Paraprofessional or to a person equitably entitled thereto, in the opinion of the Trustees, upon satisfactory proof of payment of such expense.
If you wish to apply for the benefit, please complete the application and return it with a copy of the death certificate and receipt of bills. Please feel free to call if you have any questions.
Click View & Print the Application for Funeral Expense Benefit.
The Plan will pay for one MedicAlert ID if you or a family member has a medical condition that needs to be identified in an emergency situation.
Please review the attached forms, complete the appropriate form carefully and clearly and return it to:
B.T.U. Paraprofessional Health and Welfare Fund
180 Mount Vernon Street
Boston, MA 02125-3198
Do not send the form to MedicAlert.
However, before you complete and return your form to us for processing, you should be aware that although the Boston Teachers Union Paraprofessional Health and Welfare Fund will pay to the MedicAlert Foundation International, their charge for your MedicAlert membership, and will forward your MedicAlert Enrollment Form, or otherwise, to the MedicAlert Foundation, your compliance with the conditions and instructions on the MedicAlert Enrollment Form and the service provided by the Foundation are not responsibilities of the Fund.
Please review your completed form for accuracy before sending it to us.
Your benefit includes the basic MedicAlert ID. If you select a product other than the basic stainless steel type, you must enclose a check payable to the B.T.U. Paraprofessional Health and Welfare Fund for the difference in cost.
Please sign and date the displayed letter and return it with your completed form.
Paraprofessional Prepaid Legal Services Benefit
The Board of Trustees of the Prepaid Legal Services Fund has selected a panel of attorneys so that you and your eligible dependents may receive legal help with a variety of services such as buying or selling your principal residence or preparing a will. Also, participating mediators can assist you in separation and divorce disputes.
Attorneys and mediators who participate in the Prepaid Legal Services Plan (participating providers) can help you with a variety of legal services, such as:
- Preparing a will and certain related services
- Buying or selling a home that is your primary residence
- Mediation services for separation and divorce
- Assisting with your claims against your landlord
- Certain probate matters
- Changing your name
- Debt management
To take advantage of the Prepaid Legal Services that the Plan offers, contact the Fund Office. The Fund Office will explain what you need to do to receive quality legal services.
Deceased Member Benefits
Sources of Possible Benefits to Deceased BTU Members/City Employees
Your eye care benefit includes a comprehensive eye examination and one pair of prescription eyeglasses every year. When appropriate, additional non- emergency ophthalmologic medical / surgical evaluations can be scheduled at the Eye Care Center. This benefit is provided by your Health & Welfare Fund at no cost to yourself. Your spouse and dependant children are eligible to receive this benefit as well, at no cost.
The eye examination is a comprehensive examination covering all aspects of the visual system and the health of the eyes. The examination will include checks for cataracts, glaucoma, macula degeneration, retinal problems, external eye diseases, injuries and infections as well as tests of color vision, depth perception and peripheral vision. This testing protocol averages 30 minutes per patient, so you should arrive on time for your appointment and allot enough time at the Eye Care Center for your examination and subsequent selection of eyeglasses, should they be necessary. We are unable to provide any ‘baby-sitting’ services at the Eye Care Center, so you should make your own arrangements for the care of your children, at home, for the time you are at the Eye Care Center.
Should you require further evaluation of a specific problem or a surgical consultation with our ophthalmologist, a return visit for that purpose can be scheduled for you at the Eye Care Center.
Should you require prescription eyeglasses, one pair of prescription eyeglasses per year will be provided to you at the Eye Care Center at no charge. Additional lens enhancements that are currently, and may become available in the future with the advances in technology of lens manufacturing, can be purchased before your eyeglasses are ordered. Currently these items include Transitions photochromatic lenses, Crizal anti-reflection coating, polarized sun lenses and high index, polycarbonate and aspheric extra-thin lenses.
All eyeglasses are warranted for damage or breakage by the Eye Care Center and will either be repaired or replaced, at the discretion of the Eye Care Center staff. This repair/replace warranty will apply, repeatedly if needed, until the patient is eligible for new eyeglasses again.
Lost or stolen eyeglasses and non-prescription sunglasses are not covered by this warranty and cannot be replaced under this benefit. However replacement eyeglasses may be purchased at the Eye Care Center. Currently there is no limit to the number of additional pairs of eyeglasses, spares or replacements, a member or eligible dependant may purchase at the Eye Care Center.
Additional Benefits / Contact Lenses
Your eye care benefit includes a comprehensive eye examination and one pair of prescription eyeglasses every year. Additional office visits, for emergency care and follow-up visits may also be scheduled at the discretion of the Eye Care Center staff in consultation with one of the Eye Care Center doctors.
Your eye care benefit also includes partial coverage for the fitting and provision of medically necessary contact lenses at a doctor of your choosing, outside of the Eye Care Center. Medically necessary contact lenses are used to compensate for defects or deformities of the eyes that prevent the correction of the vision by eyeglasses. This does not include situations where contact lenses are for cosmetic or occupation needs that can be taken care of by eyeglasses. This medical need has to be certified by one of the doctors at the Eye Care Center during the patient’s examination. Once the medical necessity has been certified, this benefit allows for the reimbursement to the patient of up to $100.00 toward their cost for the fitting and supply of contact lenses by the vendor of the patient’s choice. This benefit is renewable on the same cycle as the rest of the eye care benefit.
Contact lenses for non-medical vision correction use are not available through the benefit or for purchase at the Eye Care Center. However, all of the professional services from initial contact lens fitting, to lens handling and care instructions, all follow-up evaluations and the provision of a written prescription for the purchase of contact lenses, can be provided in conjunction with the eye examination benefit. At this time, this benefit is available for members and partners / spouses only, and is not transferable to another family member.
Member Only Benefits
All of the above benefits are available to all members and their covered dependents. There are also, a number of benefits, described below, that at the present time are available only to the members.
Non-prescription sunglasses selected by the Eye Care Center staff may be provided to members in lieu of prescription eyeglasses for those members who do not need or want prescription eyeglasses. Non-prescription sunglasses are NOT covered under the warranty as are prescription eyeglasses. This one pair of non-prescription sunglasses will be the entire eyeglass benefit for a full 12 month cycle.
A one-time-only-benefit exists for the provision of a single pair of replacement eyeglasses for replacement of the most recent set of eyeglasses provided by the Eye Care Center, that have been lost or stolen at school or during a school authorized activity or function. In order to apply for this benefit, a member will need to provide written documentation, on official school letterhead, signed by the Headmaster or immediate supervisor, stating the circumstances and situation in which the eyewear disappeared.
Due to the large number of patients for whom we provided services, 7000 covered members plus their families, who are all eligible for services at the Eye Care Center, we are unable to see patients for services without appointments. This applies for all eyeglass services as well as examination services. Individuals who come to the Eye Care Center for services without appointments may have to be turned away and scheduled an appointment to return for services.
During the periods when school is in session, the Eye Care Center is open sixty (60) hours a week, including evenings and Saturdays. During school vacations, the schedule is modified to a day-time, work-week schedule to accommodate the members’ changed availability.
To schedule an appointment or to seek any further information, please call;
Boston Teachers Union Health and Welfare Fund
Eye Care Center
180 Mount Vernon Street
Boston ( Dorchester), MA 02125