Lake County, Illinois, Plasterers and Cement Masons Welfare Fund

Downloadable Forms
Disability Form - Page 1
Disability Form - Page 2

Subrogation Acknowledgement - Page 1
Subrogation Acknowledgement - Page 2

Accident Information Form

Caremark Mail Service Order Form - Page 1
Caremark Mail Service Order Form - Page 2

Appointment of Personal Representative Form

These forms will display correctly using the Adobe Acrobat Reader. The latest version can be found here.

Related Sites
Blue Cross/Blue Shield
Caremark
EyeMed

Basic Benefit Information for the Lake County, Illinois, Plasterers and Cement Masons Welfare Fund Active Plan:

Eligibility Requirements:
A participant will be eligible the first day of the month following the month in which he/she is credited with at least 800 hours for a participating employer during a 12-month period. To maintain their eligibility, the participant must have at least:
 -300 hours for the Contributing Quarter immediately preceding the Benefit Quarter;
 -or 1200 hours during the last 12-month period ending on the date the current contribution ends.

Medical Care:
The Fund uses the Blue Cross Blue Shield (BCBS) PPO network for medical claims. Claims are paid as follows:
-In network providers are paid at 80% with a $2000.00 out of pocket;
-Out of network providers are paid at 60% with a $8000.00 out of pocket.

There is a $300.00 a year deductible per person enrolled with the Fund. There is a 1,000,000.00 lifetime maximum limit. BCBS  providers can be located either by calling  (800)571-1043 or via their website at www.bcbsil.com.

Preventative Care:
There is a $200.00 yearly benefit payable for well-child care for children up to the age of two.

MRI and Cat Scans:
Out patient, non-emergency MRI's and Cat Scans must be scheduled thru MedLink to be paid. To contact MedLink to schedule a MRI or Cat Scan, they can be reached at (888) 558-0680. Claims for MRI's and Cat Scans are paid as follows:
-80% if scheduled thru MedLink;
-60% if not scheduled thru MedLink;

Dental Care:
Dental claims are paid as follows:
-Preventative and diagnostic services are payable at 100% (cleanings, exams, and bitewings); -Cleanings and exams are allowed once every 6 months;
-Bitewing x-rays are allowed once every 12 months;
-Fluoride Treatments are only allowed for dependents up to age 19 and limited to once every 12 months;
-Full mouth x-rays are allowed once every 36 consecutive months;
-Basic and major services are payable at 80% (fillings, extractions, crowns, etc...);

 The maximum benefit allowed per person per calendar year is $1,500.

Prescription Coverage:
This funds prescription drug coverage is provided through Caremark and is payable as follows:

Caremark customer service can be contacted at 1-800-824-6349 or via their website at www.caremark.com.

Vision Care (if applicable to your local):
Vision benefits are available once in a calendar year. EyeMed is the vision network. If you choose to go out of the EyeMed vision network, claims should be mailed to the fund office and are payable as follows:

EyeMed providers can be located by calling 800-334-7591 or on their website at www.eyemedvisioncare.com.