Teamsters Local 995 - Las Vegas, Nevada

Aflac's accident and cancer insurance policies are available to Teamsters Local 995 members. For more information, contact David M. Coughlin, Aflac District Sales Coordinator at (702) 884-7650 or enroll online by following the Aflac for Teamsters 995 referral link.

For Participants and Covered Dependents

Effective November 2002

Good dental care is an important part of staying healthy. The Trust Fund provides this comprehensive dental benefit to all employees, retirees and dependents enrolled in the Trust Fund.

• Annual Maximum
  PPO: $2,000 per individual
  
  Non-PPO: $2,000 per individual
• Calendar Year Deductible
  PPO: No deductible
  
  Non-PPO: No deductible
  
  
• Coinsurance Rate
  PPO: Plan pays 80% of UCR for diagnostic, preventive services, restorative services, prosthodontic services, oral surgery, periodontic and endodontic services.
  
  Non-PPO: Plan pays 80% of UCR for diagnostic, preventive services, restorative services, prosthodontic services, oral surgery, periodontic and endodontic services.
• Dentists Accepting Insurance as Payment in Full*

  *See bottom of this page for rules regarding this benefit.
  
  Brown Dental Office PC, dba
  Comfort Care Dental Group**
  803 S. 7th Street
  Las Vegas, NV 89101
  (702) 384-4721

  Lee R. Turner, DDS
  Boca Park Dental**
  1000 S. Rampart Blvd., #13
  Las Vegas, NV 89145
  (702) 285-6380

  Lee R. Turner, DDS
  Elan Dental Cosmetics**
  2931 N. Tenaya Way, #206
  Las Vegas, NV 89128
  (702) 228-7575

  Lee R. Turner, DDS
  Galleria Dental**
  1399 Galleria Drive, #200
  Henderson, NV 89014
  (702) 433-0007

  
  
  **All-union dental offices listed above

   

  Mark J. Escoto, DDS
  A Beautiful Smile
  2471 Professional Court
  Las Vegas, Nevada 89128
  (702) 256-5353

  Dr. Ben Yaghmai
  A Great Smile Dental 
  8420 W. Lake Mead, #100 
  Las Vegas, Nevada 89128
  (702) 804-5154
  
  Michael Alterman, DDS
  Absolute Dental
  8380 W. Cheyenne, #103
  Las Vegas, Nevada  89129
  (702) 388-8989

  Absolute Dental
  6110 W. Lake Mead, #150
  Las Vegas, Nevada  89108
  (702) 565-4040

  Absolute Dental
  8430 W. Farm Rd., #120
  Las Vegas, Nevada  89131
  (702) 732-1010

  Absolute Dental
  5892 N. Losee Road, #135
  Las Vegas, Nevada
  (702) 399-8700

  Absolute Dental
  Absolute Kids
  9400 S. Eastern, #101
  Las Vegas, Nevada  89123
  (702) 456-0009

  Absolute Dental
  3945 S. Maryland Pkwy., #A
  Las Vegas, Nevada
  (702) 732-1010

  Absolute Dental
  860 South Rancho Dr., #3
  Las Vegas, Nevada  89106
  (702) 878-0808

  Absolute Dental
  4035 S. Durango Dr., #103
  Las Vegas, Nevada  89147
  (702) 804-8888

  Absolute Dental
  3830 E. Flamingo Rd., #E-2
  Las Vegas, Nevada  89121
  (702) 435-3888

  Absolute Dental
  2425 E. Tropicana Ave.
  Las Vegas, Nevada
  (702) 240-9200

  Absolute Dental
  556 N. Eastern Ave., #1
  Las Vegas, Nevada  89101
  (702) 365-6800

  Absolute Dental
  169 N. Nellis Blvd.
  Las Vegas, Nevada  89110
  (702) 384-1010

  Absolute Dental
  Absolute Kids
  2301 E. Lake Mead Blvd.
  N. Las Vegas, NV  89030
  (702) 641-5888

  Absolute Kids
  3040 W. Ann Rd., #101
  N. Las Vegas, Nevada  89031
  (702) 839-2244

  Absolute Dental
  150 S. Highway 160
  Pahrump, Nevada
  (775) 727-8818
  
  Ben Nhan Truong, DDS
  AC Dental
  1520 N. Eastern Ave., #105
  Las Vegas, Nevada 89101
  (702) 633-6339

  Ben Nhan Truong, DDS
  AC Dental
  6775 E. Lake Mead, #9
  Las Vegas, Nevada 89156
  (702) 452-7200
  
  Ben Truong, DDS
  Acclaim Dental
  7260 W Lake Mead Blvd., #5
  Las Vegas, Nevada 89128
  (702) 562-8852 
  
  
  Advent Dental
  2764 Lake Sahara Drive, #107
  Las Vegas, Nevada 89117
  (702) 804-0153

  Affordable Dental
  3880 W. Lake Mead Blvd., #100
  N. Las Vegas, Nevada  89032
  (702) 399-8888
   

  Aliante Dental
  6885 Aliante Pkwy., #111
  N. Las Vegas, Nevada  89084
  (702) 515-1888
   

  Dr. Afshin Arian
  6600 W. Charleston, #103 
  Las Vegas, Nevada 89146
  (702) 880-4474

  Dr. Sayed K. Raiyn
  All Teeth R Us Family Dentistry 
  5868 S. Pecos Road, #100-F
  Las Vegas, Nevada 89120
  (702) 796-0009

  Dr. Sayed K. Raiyn
  Aloha Dental Care
  3955 S. Durango, Suite B-3
  Las Vegas, Nevada 89147
  (702) 242-6777

  Dan C. Paik, DDS
  Apple Dental
  1321 W. Sunset Road, #100
  Henderson, Nevada  89014

  (702) 558-4488

  Michael Alterman, DDS
  Art Dental, Inc.
  4035 S. Durango, #103
  Las Vegas, Nevada 89147
  (702) 804-8888
  
  Charles W. Ashman, DDS
  General & Family Dentistry
  208 South Rainbow Blvd.
  Las Vegas, Nevada 89145
  (702) 363-4136

  Ghassan Khalaf, DDS 
  Aura Dental 
  3774 E. Desert Inn Road 
  Las Vegas, Nevada 89121
  (702) 257-2872

  Vashira Tan, DMD
  Axis Dental 
  10010 W. Cheyenne Ave., #140
  Las Vegas, Nevada 89129
  (702) 227-4392

  David Ting, DMD
  Boston Dental
  9484 W. Lake Mead Blvd., #2
  Las Vegas, Nevada  89134
  (702) 304-8338

  Brighton Dental
  5075 E. Bonanza Road
  Las Vegas, Nevada  89110
  (702) 871-8888
   

  Julia Le, DDS
  Creative Dental
  2585 S. Nellis Boulevard, #6
  Las Vegas, Nevada 89121
  (702) 641-0481

  Philip M. Paleracio, DDS
  The Dental Center of Nevada 
  601 S. Rancho, #B-15
  Las Vegas, Nevada 89106
  (702) 385-1166

  Vilas Balakrishna, DDS
  Dental Wellness Centers
  8929 West Sahara Avenue
  Las Vegas, Nevada 89117
  (702) 242-5251

  Discount Dental
  60 N. 25th Street, #110
  Las Vegas, Nevada  89101
  (702) 386-8811
   

  Fenway Dental
  4180 S. Sandhill Road, B1
  Las Vegas, Nevada  89121
  (702) 898-9200

  Friendly Dental
  914 E. Sahara Avenue
  Las Vegas, Nevada  89104
  (702) 794-0304

  Stephen Hahn, DDS
  Galleria Family Dental
  715 Mall Ring Circle, #200
  Henderson, Nevada  89014
  (702) 433-9200
   

  Happy Dental
  6707 W. Charleston Blvd., #1A
  Las Vegas, Nevada  89146
  (702) 438-0888
   

  John H. Hasings, DDS
  Dr. John Hastings, DDS
  4660 S. Eastern Ave., #209
  Las Vegas, Nevada 89119
  (702) 671-0001

  John H. Hasings, DDS
  Dr. John Hastings, DDS
  3965 E. Owens Ave., #190
  Las Vegas, Nevada 89110
  (702) 366-0007

  Hola Dental
  2175 E. Cheyene Ave., #100
  N. Las Vegas, Nevada  89030
  (702) 363-8889
   

  Adrian Ruiz, DDS
  Horizon Dental
  4510 S. Eastern Ave., #2
  Las Vegas, Nevada 89119
  (702) 734-7839

  Adrian Ruiz, DDS
  Horizon Park Dental
  2633 W. Horizon Ridge, #130
  Henderson, Nevada 89052
  (702) 897-7001

  Anthony Q. Ngo, DMD
  Kelly S. Jin, DMD
  Image Dental, Inc.
  1780 N. Buffalo Dr., #109
  Las Vegas, Nevada 89128
  (702) 796-0808
  
  Anthony Q. Ngo, DMD
  Kelly S. Jin, DMD
  Image Dental, Inc.
  4300 E. Sunset Road, #B-2
  Henderson, Nevada 89014
  (702) 968-0707
  
  Ellen Piyevsky, DDS
  Lake Mead Dental
  7481 W. Lake Mead Blvd.
  Las Vegas, Nevada 89128
  (702) 304-1234

  Las Vegas Oral Surgery
  7670 W. Lake Mead Blvd., #130 
  Las Vegas, Nevada 89128
  (702) 312-2273

  Katy Barin, DDS
  Nea Dentistry
  2085 Village Center Circle, #140 
  Las Vegas, Nevada 89134
  (702) 256-6001
  
  Nevada Dental Associates
  2047 W. Charleston, #110-220
  Las Vegas, Nevada 89102
  702-94-SMILE
  (702) 382-0380
  
  Nevada Dental Associates
  2660 Windmill Parkway
  Henderson, Nevada 89074
  702-94-SMILE
  (702) 990-2960
  
  Nevada Dental Associates
  8445 W. Flamingo Rd.
  Las Vegas, Nevada 89147
  702-94-SMILE
  (702) 948-7939
  
  Nevada Dental Associates
  3163 N. Rainbow Blvd.
  Las Vegas, Nevada 89108
  702-94-SMILE
  (702) 656-2301

  Dr. Carol-Ann Rowe
  New Image Dental 
  3885 S. Decatur Blvd., #1100 
  Las Vegas, Nevada 89103
  (702) 838-3311
  
  Raymond Kim, DDS
  North Pointe Dental
  4690 Ann Road, Suite 4
  N. Las Vegas, Nevada 89131
  (702) 515-7737
  
  Paradise Village Dental Ctr.
  518 E. St. Louis Ave.
  Las Vegas, Nevada 89104
  (702) 735-1096

  Simon Shih, DMD
  Peccole Family Dental
  9580 W. Sahara Ave., #190
  Las Vegas, Nevada 89117
  (702) 242-4680

  Dr. Inri T. Hsu
  Pecos Dental
  62 N. Pecos Road, Suite A
  Henderson, Nevada  89074
  (702) 990-6926

  Pointe North Dental
  7312 W. Cheyenne, #3
  Las Vegas, Nevada 89129
  (702) 396-9924
  
  Christopher Trinh, DDS
  Precious Dental
  4210 W. Craig Rd., #104
  N. Las Vegas, NV 89032
  (702) 436-5222

  Mont Ringer, DDS, MS
  Oral Surgeon
  2625 S. Rainbow, #106-B
  Las Vegas, NV  89146
  (702) 876-2988
  
  W.M. Robinson, DDS, PC
  1111 N. Decatur Blvd.
  Las Vegas, Nevada 89108
  (702) 646-2030

  Man V. Chau, DDS
  Skyline Dental
  6430 W. Lake Mead Blvd., #140
  Las Vegas, Nevada 89108
  (702) 647-3377
  
  Liem Vu, DDS
  Smile Brite Dental
  4975 S Fort Apache, #107
  Las Vegas, Nevada 89148
  (702) 248-2748

  Cheng Zhu, DMD 
  Smile Solutions Dental 
  500 N. Rainbow Blvd., #315
  Las Vegas, Nevada 89107
  (702) 877-1055

  Hai Xa, DDS
  Star-Brite Dental
  560 Marks St., #B
  Henderson, Nevada 89014
  (702) 456-5100
  
  Trung Xa, DDS
  Diana Xa, DDS
  Star Brite Dental
  6720 N. Durango, #260
  Las Vegas, Nevada 89149
  (702) 893-2288
  
  Hai Xa, DDS
  Star-Brite Dental 
  893 S. Rainbow Blvd. 
  Las Vegas, Nevada 89145
  (702) 456-0034

  Danny Truong, DDS 
  Sunbrite Dental 
  560 N. Nellis Blvd.,#E-8
  Las Vegas, Nevada 89110
  (702) 459-0303

  Tender Dental 
  5230 Boulder Highway, #130 
  Las Vegas, Nevada 89122
  (702) 851-6724

  Tender Dental 
  5001 E. Bonanza Road, #160 
  Las Vegas, Nevada 89110
  (702) 307-2273

  Today's Dental 
  1471 N. Jones Blvd.
  Las Vegas, Nevada 89108
  (702) 851-6722

  Phung Nguyen, DDS
  Vista Dental 
  3315 W. Craig Road, #108 
  N. Las Vegas, Nevada 89032
  (702) 464-3000

  Ellen Piyevsky, DDS
  Wigwam Dental Care
  2649 Wigwam Parkway
  Henderson, Nevada 89074
  (702) 617-3333
  
  Accepting Insurance as Payment In Full
  
  Teamsters Local 995 has made arrangements with several dental care providers who have agreed to accept Teamsters insurance as payment in full for services rendered. (Cancellation fees for missed appointments are not covered by this agreement.) Local 995 members eligible for Teamsters Local 995 dental coverage will not have to pay co-pays or deductibles for plan-covered services through these providers. Before using any of these providers you should take the following steps:
  
  1. Identify yourself to the provider as a Teamster Local 995 member covered by the Teamsters Security Fund for Southern Nevada dental plan.
  
  2. Before any work begins, ask if the provider is still waiving the co-pays and deductibles for covered services rendered under the Teamsters Security Fund for Southern Nevada. If they are not, you may wish to contact another provider on the list for service and contact our offices with this information as soon as possible.
  
  This list is in no way intended to indicate this office's endorsement for any of the following providers, nor is it intended to imply anything other than the fact that these providers have all agreed to waive the deductibles and co-pays on covered services. Should you or any member of your family encounter any difficulties with any of these providers, please advise our office at your earliest convenience.

• Diversified Dental Services, Inc.
  Diversified Dental Services, Inc., is an independent Preferred Provider Organization (PPO) serving Nevada since 1995. Diversified Dental Services, Inc. contracts with dentists to provide their services at a discount from their normal fees. Clients receive dental services at discounted rates when they seek dental care from a PPO dentist.
  
  Visit this website for a complete list of providers and services.
• How the Dental Benefit Plan Works
  The dental benefit plan is a network plan. You may see any dentist you prefer, whether of on Diversified Dental Services providers list or not. This means the trust will pay only 80% of the rates contracted with Diversified Dental Services, Inc., any cost a dentist outside the Diversified Dental Services providers list may charge above these contracted rates you will be responsible for. When you see the dentist, you pay the dentist for the service (or make arrangements with the dentist for payment), and once you have paid the dentist, submit the receipt to the Fund Administrative Office with a claim form for reimbursement.
  
• Orthodontia Lifetime Maximum Benefit
  PPO: $1,200 lifetime maximum benefit for children under 19 (this benefit is available for each participant under age 19 after 9 full months of coverage under this Plan)
  
  Non-PPO: $1,200 lifetime maximum benefit for children under 19 (this benefit is available for each participant under age 19 after 9 full months of coverage under this Plan)
  
  The Calendar Year and Lifetime Maximum Orthodontic Benefit that will be paid for a covered dependent child under age 19 for orthodontic treatment is shown in the Schedule of Benefits. (A covered dependent must have accumulated 9 full months of coverage prior to the commencement of orthodontic work.) The amount of benefits for Orthodontic Charges will be paid as follows:
  
  

  
  
  1. $300 – banding
  
  
  2. $300 – first six months of adjustments
  
  
  3. $300 – second six months adjustments
  
  
  4. $300 – third six months of adjustments
  
  

This benefit is available to Teamsters Security Fund - Local 995 participants.

Please contact Zenith Administrators at (702) 734-8601 for specific information and required form.

"Serving Members Since 1952"

• Additional Products
  
  
  • Direct Deposit
  
  
  • Payroll Deposit
  
  
  • ATM/Point of Sale Cards
  
  
  • Check Guarantee/Point of Sale Cards
  
  
  • Credit Life Insurance on Loans
  
  
  • Credit Disability Insurance on Loans
  
  
  • MemberCONNECT Supplemental Insurance
  
  
  • Health Insurance
  
  
  • Life Insurance
  
  
  • Accidental Death and Dismemberment
  
  
• Additional Services
  
  
  • Plus Phone Audio System
  
  
  • Notary Service
  
  
  • Wire Transfer (Incoming and Outgoing)
  
  
  • Quick File Tax Return Service
  
  
  • Travelers Checks
  
  
  • Corporate Checks
  
  
  • Money Orders
  
  
  • Blue Books
  
  
  • Federal Tax Deposits (TT&L)
  
  
• Credit Union Advantages
  
  
  • Member Owned
  
  
  • Low Minimum Deposit Required
  
  
  • High Competitive Savings Yields
  
  
  • Low Competitive Loan Rates
  
  
  • Worldwide ATM Access
  
  
  • Free Personalized Service
  
  
  • Each Account Insured up to $500,000
  
  
  • Full Service Financial Savings and Loan Programs
  
  
• Locations & Hours
  Jones Branch
  1900 South Jones Blvd.
  Las Vegas, NV 89146
  
  Bonanza Branch
  4315 East Bonanza Rd.
  Las Vegas, NV 89110
  
  Sunset Branch
  1090 West Sunset Rd.
  Henderson, NV 89014
  
  Member Service Center
  (702) 871-4746
  
  Outside Las Vegas
  Toll-Free: (877) 871-4746
  
  Fax: (702) 871-3974
  Plus Phone: (702) 438-6831
  
  Lobby Mon - Fri: 9:00 am - 5:00 pm
  Drive Thru/Call Center Mon - Fri: 8:00 am - 6:00 pm
  Lobby Saturday: 9:00 am - 1:00 pm
  Drive Thru/Call Center Saturday: 8:00 am - 2:00 pm
  
  Closed Sundays and for posted Holidays.
  
  VISIT YOUR CREDIT UNION AT THEIR WEBSITE

Zenith Administrators, Inc. is the Program Administrator for Teamsters Local 995 members & retirees enrolled in the Teamsters Security Fund for Southern Nevada - Local 995 Plan.

Zenith Administrators Inc.

2250 S. Rancho, Suite 295

Las Vegas Nevada 89102

(702) 734-8601

(702) 734-8619 (fax)

You can now view your eligibility, work history and claims information on-line, as well as update information.

Visit the Zenith Administrators website.

Click on "Participant Login."

At the first login, the entry required is:

User Name: (Member's Last Name)

Password: (Member's Social Security Number)

The Trust Fund provides life and accidental death and dismemberment insurance to all active employees, and retirees who are not yet eligible for Medicare. Dependents of active employees (but not retirees) are covered by the life insurance policy. This benefit is underwritten and fully insured by a commercial insurance carrier.

• Benefits for Active Employees & Retirees Not Eligible for Medicare
  
  
  • Death Benefit: $9,000
  
  
  • Accidental Death & Dismemberment Benefits: $9,000
  
  
  • Accidental loss of two limbs, two eyes, or one limb and one eye: $9,000
  
  
  • Accidental loss of one limb, or one eye: $4,500
  
  
• Dependent Benefits - for Active Employees Only
  
  
  • Death Benefit for Spouse: $1,000
  
  
  • Death Benefit for Children Age 6 Months But Less Than
      19 Years (Or Until 26th Birthday If A Full Time Student): $1,000
  
  
  • Death Benefit for Children Age 14 Days to Six Months: $250
  
  
• Submitting Claims for Benefits
  If you or your beneficiary(ies) have a claim from the plan, contact the Fund Administrative Office and they can provide you with the claim forms and help you complete the forms and answer any questions.
  
  If your claim for a plan benefit is denied, you have the right to appeal the decision. The rules for appealing denied claims are described under Claims Appeal Procedure on page 61 of the Trust’s Summary Plan Description.

Teamsters Security Fund for Southern Nevada (Local 995 Plan)

Harmony Healthcare can help you and your family with a broad range of personal and work related problems. All services are confidential.

Harmony Healthcare

1701 W. Charleston Blvd., Suite 300

Las Vegas, Nevada 89102

(702) 251-8000

• Alcohol and Substance Abuse Program
  For information regarding the Intensive Outpatient Treatment program please call (702) 251-8000.
• Emergency Admission
  Harmony Healthcare must be notified of an emergency admission within 24 hours or the out-of-network benefit will apply.
• How Does the Managed Care Program Work?
  The Managed Mental Health and Substance Abuse Program has two basic components:
  
  

  
  
  1. A Managed Mental Health Program that is designed to assist you in identifying and effectively dealing with mental health related problems in their early stages and to facilitate your receipt of mental health treatment or assistance. Some of these problems are stress, depression, marital, family, child, workplace issues and anger management.
  
  
  
  2. A comprehensive Managed and Substance Abuse Benefits Program that provides you with a full continuum of clinically appropriate, medically necessary treatment or assistance by a clinical specialist or substance abuse treatment facility.
• How to Obtain Managed Mental Health or Substance Abuse Services
  To arrange for outpatient or inpatient clinical services with an Harmony Healthcare contracted provider, you are required to call Harmony Healthcare directly at 702-251-8000. All eligible participants have two (2) Member Assistance Program (MAP) assessment visits per incident per calendar year at no cost to the participant. If additional services are necessary, Harmony Healthcare will pre-authorize treatment, and you will only be responsible for paying the plan deductible and co-payment (please refer to your Summary Plan Description for fee schedule).
  
  When you call Harmony Healthcare to use your Network benefit, a counselor will discuss the nature of your problem with you and outline a plan of action for you to consider. This plan may include a referral to a clinical specialist for mental health issues or facility in your area for a substance abuse assessment. Whenever a referral is necessary, the counselor stays personally involved and monitors the individual's progress and care.
  
  YOU MUST CALL HARMONY HEALTHCARE TO ACCESS YOUR MAP VISIT AND/OR NETWORK BENEFITS. Harmony Healthcare's professional staff will coordinate everything for you to make sure you receive clinically appropriate care that meets you specific medical needs.
  
• On-line Services
  Get help with just the click of a mouse. Our "always available" service provides assistance with many of today's challenges at one convenient, private website.
  
  

  
  
  • Go to Teamsters Local 995's Harmony Healthcare website.
  
  
  
• Out-of-Network Benefits
  Pre-authorization by the Member Assistancce Program is required for you to receive treatment with any Out-of-Network provider. Please refer to your Summary Plan Description for your Out-of-Network plan deductibles and co-payments, as your costs are significantly higher than In-Network benefits.
• Principal Benefits and Coverages
  Everyone needs help once in a while. Problems are just a part of everyday life. The Teamsters Security Fund for Southern Nevada (Local 995 Plan) has contracted with Harmony Healthcare to provide a Managed Mental Health and Substance Abuse Program, with both In-Network and Out-of-Network benefits. Harmony Healthcare's staff will refer you to qualified professional counselors or treatment facilities to help you and your eligible family members resolve personal problems affecting your health, family life, abilities and desire to excel at work. The right time to seek help for a problem is as early as possible, before the problem becomes critical.
  
  For a Member Assistance Program assessment visit, at no cost to eligible participants, or to receive your maximum benefits, call Harmony Healthcare at 1-702-251-8000.
• Principal Exclusions and Limitations
  You and your eligible family members are entitled to receive a specified number of treatment/counseling sessions each year. However, there are some limiations and exclusions. Your Mental Health and Substance Abuse benefit services do not provide:
  
  

  
  
  • Treatment for any medically treated illness
    
  • Prescription drugs
    
  • Treatment or services for mental retardation
    
  • Treatment that does not meet medical necessity, as described in the DSM IV-R
    
  • Out-of-Network Outpatient counseling services beyond the annual limit of 12 sessions per family per year
    
  • Inpatient Mental Health services beyond annual limit of 30 days at the acute level of care
    
  • Psychological testing that has not been pre-authorized by HMC
    
  • Counseling required by law or a court, or paid for by Workers' Compensation
    
  • Formal psychological evaluations and fitness-for-duty opinions
• When does coverage begin?
  You and your dependents must be both eligible and enrolled in order to receive Mental Health and Substance Abuse Benefits. Consult your SPD for details on employee and dependent eligibility rules.
• Who is Eligible for Services?
  Indemnity Plan Participants and their Eligible Dependents
  As an Indemnity Plan Participant, you will be eligible for benefits on the first day of the month after your employer has made the required contribution on your behalf for three consecutive months. You must also complete an enrollment card for your benefits to go into effect. Once you become eligible, your benefits will continue for as long as your employer makes the required contribution (please see your SPD for specific requirements).
  
  Eligible Dependents are your lawful spouse, dependent children under age 19 or to age 26 for a dependent child who is a full time student at an accredited institution. Stepchildren must meet specific criteria to qualify as dependents.
  Retirees and Eligible Dependents as defined in the SPD.
• Your Deductible
  Any deductibles that apply are in combination with your medical coverage. Your Fund Office, not Harmony Healthcare, will determine when you have satisfied your annual deductible.

Teamsters 14-995 Security Fund

• Ambulance Services
  Ground Ambulance
  
  PPO: $50 per trip co-payment
  
  Non-PPO: $50 per trip co-payment
  
  Air Ambulance
  
  PPO: $50 per trip co-payment. Limited to a max of $7,500 once every two calendar years
  
  Non-PPO: $50 per trip co-payment. Limited to a max of $7,500 over every two years.
• Beech Street Corporation
  "Celebrating over 50 years in the healthcare industry, Beech Street Corporation is dedicated to providing the latest, most technologically advanced products and services for healthcare consumers. We are focused on meeting the needs of our consumers, payors and providers by providing them with the customer service they deserve, and the quality of care they have come to expect."
  
  Bill Hale
  President & CEO
  Beech Street Corporation
  
  Visit this website for a complete list of options and services.
• Chiropractic Services
  PPO: $15 per visit co-payment, $500 maximum per calendar year
  
  Non-PPO: 50% UCR after deductible, $500 maximum per calendar year
• Deductibles - Medical Plan
  Calendar Year
  
  PPO: $250 per individual, max of $750 per family
  
  Non-PPO: $500 per individual
  
  This deductible is in addition to the per impatient admission deductible (listed below) and any co-payments for network services that may apply. The maximum annual deductible for network services can be satisfied by multiple family members and does not require that three (3) separate individual deductibles be met.
  
  Inpatient Admission
  
  PPO: $100 per admission
  
  Non-PPO: $1,000 per admission
• Dependent Coverage
  Teamsters Security Fund of Southern Nevada Local 14 is pleased to announce the following benefit enhancements effective January 1, 1999:
  
  Members covered by the Trust who wish to have their grandchild(ren) covered may do so if they grandchild(ren) is deemed to be a dependent under the following criteria: The grandchild must be legally adopted or the grandparent appointed by the court as the legal guardian; and the grandchild must be principally dependent on the grandparent for support and live with the grandparent.
• Emergency Services
  Emergency Room
  
  PPO: $25 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Emergency Room Doctor
  
  PPO: $25 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Urgent Care Facility
  
  PPO: $15 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
• Hearing Aids
  PPO: $50 per device co-payment, maximum of $600 per ear in a five-year period
  
  Non-PPO: 50% UCR after deductible, maximum of $600 per ear in a five-year period
• Home Health Care
  Home Visit
  
  PPO: $10 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  IV Therapy
  
  PPO: $10 per visit co-payment. Limited to 40 visits per calendar year.
  
  Non-PPO: 50% UCR after deductible. Limited to 40 visits per calendar year.
• Hospice Care
  Inpatient Care
  
  PPO: $100 deductible per admit, 90% of next $5,000, then 100% thereafter
  
  Non-PPO: $600 deductible per admit, 50% for next $5,000, then 100% of UCR thereafter
  
  Outpatient Care
  
  PPO: $10 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Family Counseling
  
  PPO: $20 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Bereavement Counseling
  
  PPO: $20 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
• Hospital Inpatient Services
  Hospital Admission Room & Board
  
  PPO: $100 deductible per admit, 90% of next $5,000, then 100% thereafter
  
  Non-PPO: $500 calendar year deductible plus $1,000 admit deductible, 50% of UCR with no out-of-pocket annual maximum
  
  Routine Nursery Care
  
  PPO: $100 deductible waived, 90% of first $5,000, then 100% thereafter
  Non-PPO: Deductibles waived, 50% of UCR
  
  Newborn Extended Stay
  
  PPO: $100 deductible per admit, 90% of next $5,000, then 100%
  
  Non-PPO: $250 calendar year deductible plus $600 per admit, 50% of UCR with no out-of-pocket annual maximum
• Inpatient Physician Care
  Primary Care Provider
  
  PPO: $10 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Specialist
  
  PPO: $15 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
• Inpatient/Out Surgical Services
  In Doctor’s Office
  
  PPO: $15 co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Outpatient Facility
  
  PPO: $50 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
• Lifetime Maximum Benefit Per Individual
  PPO: $1,000,000.00
  
  Non-PPO: $1,000,000.00
• Out of Pocket Maximum
  Individual
  
  PPO: $500 plus hospital deductible & applicable co-payments
  
  Non-PPO: No limit on out of pocket maximum for non-ppo providers. Plan pays 50% of UCR after deductible
  
  Family
  
  PPO: $1,500 plus hospital deductible & applicable co-payments
  
  Non-PPO: No limit on out of pocket maximum for non-ppo providers. Plan pays 50% of UCR after deductible
• Physician Office Visit
  Primary Care
  
  PPO: $10 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Specialist
  
  PPO: $15 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
• Pre-Admission Testing
  PPO: No co-payment
  
  Non-PPO: 50% UCR after deductible
• Pre-authorization Required
  Many services require pre-authorization from the Utilization Review Organization. When pre-authorization is not obtained when required, benefits payable by the Fund are reduced by 50%.
• Prepaid Health Plan Option or Indemnity Plan Option
  When you become eligible for coverage for the first time, you must complete enrollment designating the Health Plan Option of your choice:
  

  
  A. Prepaid Health Plan Option, or
  B. Indemnity Plan Option

  
  A. PREPAID HEALTH PLAN OPTION
  If you select the Prepaid Health Plan Option, you and your eligible dependents will be provided hospital-medical care and prescription drug benefits under an agreement with Health Plan Nevada. Under this plan, you are required to use the doctors, medical clinics and hospitals which are a part of the Health Plan Nevada.
  
  

  • Election to be Covered Under the Prepaid Health Plan
    (Health Plan of Nevada)
    If you live within the service area of Health Plan of Nevada, and you are otherwise eligible for coverage under the active Eligible Member Plan, you may elect to be covered under Health Plan of Nevada in lieu of being eligible for the Medical Expense Benefits described in this booklet. Even if you elect the prepaid health plan option, you will still be eligible for the Life, Accidental Death and Dismemberment, Dental, and Vision benefits, your dependents will still be eligible for Life, Dental and Vision benefits.
  
  
  
  • Rules for Electing and Revoking Election of Prepaid Health Plan Coverage
    If you live within the service area of Health Plan of Nevada, you will have an opportunity annually to elect or revoke the prepaid health plan coverage.

  
  B. INDEMNITY PLAN OPTION
  The Indemnity Plan provides you with the greatest flexibility of provider selection. When you obtain covered medical services from a PPO Provider, you will receive greater benefits with lower out-of-pocket costs. In addition, you can obtain covered medical services from a Non-PPO Provider of your choice, but you will have higher out-of-pocket costs, and will be responsible for any changes in excess of what the Plan considers Usual, Customary and Reasonable (UCR).
  
  PPO PROVIDER
  PPO or contract providers are paid at a contracted rate schedule (CRS), which is the negotiated rate for Contract Providers. You will not be responsible for charges in excess of the discounted negotiated rate for medical services provided by a PPO Provider.
  
  NON-PPO PROVIDER
  Non-PPO or NON-Contract Providers are paid at USUAL, CUSTOMARY AND REASONABLE (UCR) rates, which are based on the fees most frequently made to the majority of patients for the same service or procedure. The charge must be within the range of charges most frequently made in the same or similar medical service area for the service or procedure as billed by other physicians.  You will be responsible for charges in excess of what the Plan considers in excess of UCR.
• Prosthetic & Orthopedic Device & Durable Medical Equipment
  Prosthetic & Orthopedic
  
  PPO: $50 per device co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Durable Medical Equipment
  
  PPO: $50 per device co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Medical Supplies
  
  PPO: No co-payment
  
  Non-PPO: 50% UCR after deductible
  
• Routine Mammogram
  PPO: $15 per procedure, limited to once per calendar year
  
  Non-PPO: 50% UCR after deductible
• Short Term Rehab Services
  Outpatient
  
  PPO: $15 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Inpatient
  
  PPO: $100 admit deductible, 90% of next $5,000, then 100%
  
  Non-PPO: 50% UCR after deductible, $600 admit deductible, 50% of next $5,000, then 100%
  
  Skilled Nursing Facility
  
  PPO: 100% admit deductible, 90% of next $5,000, then 100%
  
  Non-PPO: $600 admit deductible, 50% of next $5,000, then 100%
• Sterilization
  Tubal Ligation
  
  PPO: $200 co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Vasectomy
  
  PPO: $100 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
• Surgical Services
  Surgeon
  
  PPO: $50 co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Assistant Surgeon
  
  PPO: No co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Anesthesia Services
  
  PPO: $100 co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Obstetrical Care Physician
  
  PPO: $100 co-payment
  
  Non-PPO: 50% UCR after deductible
• Temporomandibular Joint Treatment (TMJ)
  PPO: 50% of contracted rate up to a $4,000 lifetime maximum
  
  Non-PPO: 50% UCR after deductible, not to exceed $4,000 lifetime
• Well Baby Care
  Primary Care: 0-12 months
  
  PPO: $10 per visit co-payment
  
  Non-PPO: 50% UCR after deductible
  
  Specialists: 0-12 months
  
  PPO: $15 per visit co-payment
  
  Non-PPO: 50% UCR after deductible

For Participants and Covered Dependents

Effective April 1, 2003

• About Benefits
  The prescription drug benefit is provided to help you pay for take home prescription drugs you purchase from a pharmacy or through mail order. To combat the escalating cost of prescription drugs, the Trustees have selected the RxAmerica network for prescription drug coverage. The prescription drug benefit will cover any drug that:
  

  
  
  • Is prescribed by a licensed physician;
  
  
  • Must be obtained by prescription;
  
  
  • Has been approved by the Food and Drug Administration for general marketing by RxAmerica; and
  
  
  • Is dispensed bya licensed pharmacist.
  
  

  
  When you enroll in the indemnity medical plan, you are automatically covered by this prescription drug benefit. If you are enrolled in the HMO, you will be covered under the HMO prescription drug benefit.
  
  Generic - $8
  
  Brand with no generic available - Formulary - $20
  
  Brand with no generic available - Non-Formulary - $30
  
  If brand name drug is dispensed when a generic exists, participant pays $8 generic payment, plus the difference in cost between brand name and generic.
  
  Maintenance Drugs can be purchased through mail-order provider. A three month supply can be ordered for cost of one month of applicable payment, i.e. three months of a formulatory prescription would cost $20, etc.
• Co-payment Schedule: Mail Order Pharmacy, 90-day limit
  (Do remember these costs are for a 90-day mail order supply of medications.)
  

  
  
  • Network Pharmacy - Generic Drug: No co-payment
  
  
  • Network Pharmacy - Brand Drug No Generic Available (formulary):  $30
  
  
  • Network Pharmacy - Brand Drug Generic Available (non-formulary): $60
  
  
  • Non-Network Pharmacy:  Not Covered
  
  

  
  
• Co-payment Schedule: Walk In Pharmacy, 30-day limit
  
  
  • Network Pharmacy - Generic Drug: No co-payment
  
  
  • Network Pharmacy - Brand Drug No Generic Available (formulary):  20% (minimum of $20) of the retail cost
  
  
  • Network Pharmacy - Brand Drug Generic Available (non-formulary): 45% (minimum $45) of the retail cost
  
  
  • Non Network Pharmacy:  Not Covered
  
  
• Drug Formulary
  A drug formulary is a list of preferred medications published by the prescription drug network service provider, RxAmerica, which offers the best value without sacrificing quality of care. A formulary is developed and maintained by a panel of practicing pharmacists and physicians. This panel, called a Pharmacy & Therapeutics Committee, meets quarterly to review new drugs, and maintain the integrity of the formulary.
  
  Studies show that the choice of the most appropriate drug through the use of a formulary results in fewer treatment failures, reduced hospitalizations, a fewer side effect. Efficient and effective use of a drug formulary helps to keep overall medical costs down.
• Mail Order
  The prescription drug benefit has a convenient mail-order program through American Diversified Pharmacies (mail order provider through RxAmerica). You can receive a 90-day supply (rather than a 30-day supply) for one co-payment, i.e. three months of a formulatory prescription would cost $20, etc. This is particularly convenient when taking drugs on a regular, long-term basis, such as drugs for high blood pressure, arthritis or diabetes.
  
  To order prescriptions by mail order, follow these steps:
  

  
  
  • Ask your doctor to prescribe necessary medications for up to 90-days, plus refills.
  
  
  • Complete the initial order form, which includes a patient information questionnaire with your first order only.  This allows the mail order pharmacist to make sure you are not taking medications that could conflict with other medications or conditions you have. Be sure to answer all of the questions for yourself and your covered dependents.  To obtain an initial order form and patient information questionnaire, call the Fund Administrative Office. Refills may be called into the mail-order pharmacy at 800-568-2155.
  
  
  • Send the completed Patient Information Questionnaire and your original prescription(s) to American Diversified Pharmacies using the preaddressed order envelope. Enclose the appropriate co-payment.
  
  
  • Refills may be called into the mail-order pharmacy at 800-568-2155, American Diversified Pharmacies (mail order provider through RxAmerica). RxAmerica Help Desk: 800-700-8014.
  
  
• On-Line Services
  Refills may be ordered on-line.
  
  Go to American Diversified Pharmacies website.
• RxAmerica
  "As an industry leader, RxAmerica is dedicated to provide quality pharmacy benefits management services, improve the health of patients, and reduce costs for our clients.
  
  RxAmerica has proven experience in successfully controlling the medical loss ratio associated with pharmaceutical care while delivering operational excellence, exceptional provider support and complete consumer satisfaction. ”
  
  John Gardynik, President RxAmerica L.L.C.
  
  Visit this website for more information on our services.
• Walk In Network Pharmacy
  Present your ID card to the participating pharmacy. Provided your name is included in the list of eligible participants in the prescription drug plan, you pay the applicable
  co-payment. (If your name is not on the list, contact the Fund Administrative Office.)
  
  The plan pays for prescriptions only when purchased at a network pharmacy.  Here is a partial list of network pharmacies in Nevada:
  

  
  
  • Albertson’s
  
  
  • Costco
  
  
  • Longs
  
  
  • Medicine Shoppe
  
  
  • Safeway
  
  
  • Sav-on
  
  
  • Shopko
  
  
  • Smith’s Food and Drug
  
  
  • Vons
  
  
  • Walgreen’s
  
  
  • Rite Aid
  
  

  
  Call the Fund Administrative Office at 702-734-8601 for a complete list of network pharmacies.

• Teamsters Security Fund Board of Trustees
  Union Trustees:
  Gary Mauger, Chairman
  Mike Magnani
  
  Employer Trustees:
  Doug Coon, Secretary
  Scott Haverlock
  
  Fund Administrative Office:
  Zenith Administrators
  101 Convention Center Drive, Suite 600
  Las Vegas, NV 89109 
  Phone: 702-734-8601
  Fax: 702-734-8619
  
  Legal Counsel:
  Schreck Brignone Godfrey
  1200 Bank of America Plaza
  300 South Fourth Street
  Las Vegas, NV 89101
  
  Plan Consultant:
  Milliman & Robertson, Inc.
  650 California Street
  San Francisco, California 94108
  
  Certified Public Accountant:
  Layton, Layton & Tobler
  606 South Ninth Street
  Las Vegas, NV 89101
• Zenith Administrators, Inc.
  Zenith Administrators, Inc. is the Program Administrator for Teamsters Local 995 members & retirees enrolled in the Teamsters Security Fund for Southern Nevada - Local 995 Plan.
  
  Zenith Administrators Inc.
  2250 S. Rancho, Suite 295
  Las Vegas Nevada 89102
  
  (702) 734-8601
  (702) 734-8619 (fax)
  
  
  You can now view your eligibility, work history and claims information on-line, as well as update information.
  
  Visit the Zenith Administrators website.
  
  Click on "Participant Login."
  At the first login, the entry required is:
  
  User Name: (Member's Last Name)
  Password: (Member's Social Security Number)
  
  
  

AFL-CIO Community Services

ULAN, a non-profit agency, is a joint venture of the Nevada AFL-CIO and the United Way.

• AFL-CIO & United Way
  ULAN is the only labor sponsored United Way funded community services agency in Nevada with special emphasis on assisting union members and their families.
  
  ULAN provides various programs to assist union members and their families who have been victims of an accident, illness, layoff, disaster or any situation that has caused a hardship. These include information and referral to access existing community services such as counseling, education and training, food, shelter, clothing, financial, medical and legal aid. ULAN also provides emergency assistance, food baskets, clothing and household items and citizenship assistance. To receive assistance from ULAN, union members must be referred by their union.
• Citizenship Assistance
  Through donations and fund-raising, ULAN is able to provide on-site emergency assistance to prevent homelessness, hunger, utility turn-offs, and to aid in obtaining health care needs, clothing, household items and employment fees.
• Contact Us
  United Labor Agency of Nevada (U.L.A.N.)
  1201 N. Decatur Suite 106
  Las Vegas, Nevada 89108
  Phone: (702) 648-3500
  Fax: (702) 648-3509
• Direct Assistance
  Through donations and fund-raising, ULAN is able to provide on-site emergency assistance to prevent homelessness, hunger, utility turn-offs, and to aid in obtaining health care needs, clothing, household items and employment fees.
• Holiday Food Baskets
  During the Thanksgiving and Christmas Holidays, ULAN provides special holiday foods to needy union members so they can prepare a nice holiday dinner for their families.
• How does ULAN work?
  When members of local unions and their families are referred to ULAN, they are interviewed by ULAN staff who will assess their needs. These needs are met by referrals to appropriate off-site agencies or through the direct assistance programs provided on-site by ULAN. All discussions held with the ULAN staff remain confidential. There is no fee for ULAN's assistance.
• ULAN Programs
  ULAN locates available resources, prescreens for eligibility and makes referrals to appropriate human and health services. ULAN works with other non-profit, government and private agencies to facilitate potential solutions.

The Trust Fund provides vision benefits through Vision Service Plan (VSP). Vision Service Plan (VSP) provides eye exams, and, if your vision needs to be corrected, lenses and frames or contact lenses through their network of VSP Doctors who include licensed ophthalmologists, opticians and optometrists. The Trust Fund provides this vision benefit plan to all employees, retirees and dependents who are enrolled under the Trust Fund.

• Contact Lenses
  Medically Necessary Contact Lenses
  One pair every 12 months if necessary instead of frames and lenses
  
  Elective Contact Lenses
  $105 allowance for one pair every 12 months, if necessary instead of frames and lenses
• Cost of Vision Benefits
  When you or your enrolled dependents select a doctor from the VSP list, the vision benefit covers examination, professional services, lenses, and a wide selection of frames at no expense to you, except a $5 deductible. Copayments are to be paid to the VSP Doctor at the time of examination. Any additional care, services and/or materials not covered by the vision benefit may be arranged between you and your doctor.
• Deductible - Vision Plan
  PPO: $5 co-payment
  
  Non-PPO: $5 co-payment
• Frames
  PPO: 1 set every 24 months, if necessary.
  
  Non-PPO: Up to $45
• How the Vision Plan Works
  VSP has a network of vision care providers (ophthalmologists, optician and optometrists) from which you can choose. Follow these steps:
  
  1. Obtain a list of VSP Doctors in the area from the Fund Administrative Office.
  
  2. Select a VSP doctor from the list.
  
  3. When you call to make an appointment inform the VSP Doctor that you are a VSP participant.
  
  4. The VSP Doctor will contact Vision Service Plan for your eligibility status and a benefit form.
  
  5. Pay the $5 copayment to the VSP Doctor when you receive the service.
  
  6. Payment for any additional (non-covered) services can be arranged between you and your doctor.
  
• Lenses
  Single Vision, Bifocals, Trifocals, Lenticular
  
  PPO: 1 pair every 24 months, if necessary.
  
  Non-PPO: Up to $40
• Seeing Non-VSP Providers
  You or your eligible dependents may obtain services from a non member optometrist, ophthalmologist or dispensing optician. You and your enrolled dependents that follow this course must still obtain a benefit form, which you can obtain from the Fund Administrative Office. You should pay the doctor his or her full fee. You will then be reimbursed by VSP according to the reimbursement schedule for non-providers provided in the full Summary Plan Description.
• Vision Exam
  PPO: 1 exam every 12 months by VSP provider
  
  Non-PPO: Up to $40