Seasonal Medical Benefits

The benefits described on this page are offered to participants who achieved three-year seniority status on or before July 1, 2003.

Choosing Your Medical Plan

You have two medical plan options:

Advantage PPO.
Prudent Buyer PPO.

When choosing the best plan for you, be sure to consider:

The plan’s network of doctors, hospitals, and other health care providers.
How you and the plan share costs when you need care.
Your monthly co-contribution for the plan you choose.

Plan Network Providers

Each plan has a network of doctors and hospitals associated with it. You must use the plan’s network providers, or the plan will not pay for services.

Plan Option	About the Network
Advantage PPO	This plan network option includes most doctors, hospitals and other providers/facilities contracted with Anthem Blue Cross. Sutter providers/facilities are excluded from the Advantage PPO network. You must use a network provider. Except in a medical emergency, this Advantage PPO network option will not pay benefits if you use a doctor or facility outside of the Advantage network. For example, this plan option will not pay benefits if you use a Sutter doctor or facility. Call the JBT Doctor/Facility Helpline at 833-346-3365 to confirm your provider is in the network.
Prudent Buyer PPO	This plan network option includes doctors, hospitals and other providers contracted with Anthem Blue Cross. Sutter providers/facilities are included. You must use a network provider. Except in a medical emergency, this Prudent Buyer PPO network option will not pay benefits if you use a doctor or facility outside of the network. Call the JBT Doctor/Facility Helpline at 833-346-3365 to confirm your provider is in the network.

Plan Option

About the Network

Advantage PPO

This plan network option includes most doctors, hospitals and other providers/facilities contracted with Anthem Blue Cross. Sutter providers/facilities are excluded from the Advantage PPO network.

You must use a network provider. Except in a medical emergency, this Advantage PPO network option will not pay benefits if you use a doctor or facility outside of the Advantage network. For example, this plan option will not pay benefits if you use a Sutter doctor or facility. Call the JBT Doctor/Facility Helpline at 833-346-3365 to confirm your provider is in the network.

Prudent Buyer PPO

This plan network option includes doctors, hospitals and other providers contracted with Anthem Blue Cross. Sutter providers/facilities are included.

You must use a network provider. Except in a medical emergency, this Prudent Buyer PPO network option will not pay benefits if you use a doctor or facility outside of the network. Call the JBT Doctor/Facility Helpline at 833-346-3365 to confirm your provider is in the network.

Note, the definition of a medical emergency is the sudden onset of a medical condition that, in the absence of medical attention would place your health in serious jeopardy or seriously impair body functions, organs, or parts.

Know before you go

To be sure the doctor or facility you choose is part of the medical plan network you selected, call the JBT Doctor/Facility Helpline at 833-346-3365.

Cost Sharing and Benefits When You Need Care

What you pay for care and services (for example, copays and coinsurance) is the same under the Advantage PPO and Prudent Buyer PPO plans. However, the co-contribution is different.

Refer to each plan’s description below for details.

Participant Co-Contributions

You and your employer share in the monthly premium cost for the plan you choose. Your share is called your co-contribution. The co-contribution varies by plan:

Plan Option	Participant Co-Contributions
Advantage PPO	This plan option has the lowest monthly co-contribution cost. Most JBT participants pay $10 per month.
Prudent Buyer PPO	This plan option has a higher monthly co-contribution cost. Most JBT participants pay $125 per month.

If you do not select a medical plan, you will be defaulted into the Advantage PPO plan and subject to a $10 co-contribution per month.

Medical Plans

Advantage PPO

With the Advantage PPO, participants and the plan share the cost of health care through copays and coinsurance.

Here’s how it works:


Providers and doctors	You must use providers within the Anthem Advantage PPO Network. There is no out-of-network coverage except for emergency room treatment for a medical emergency.
Cost sharing between you and the plan	Annual deductible (what you pay before the plan starts sharing costs): $300 individual/$750 family. Any amount applied towards your deductible during the last three months of the calendar year will also carryover and be applied against your deductible requirement for the following year. This is called the “carryover deductible.” Calendar-year out-of-pocket maximum (the most you’ll pay in any year for eligible services): $3,000 individual/$6,000 family. Preventive care (your annual checkup) and prescription drugs that qualify as preventive care under the Affordable Care Act: You pay $0.
What you pay for frequently used services	Doctor/specialist office visits: You pay 20% coinsurance after you meet your annual deductible. Urgent care center: You pay 20% coinsurance services after you meet your annual deductible. Emergency room: You pay 20% coinsurance after you meet your annual deductible. Inpatient hospital stay: You pay 20% coinsurance after you meet your annual deductible. You must receive preauthorization for inpatient hospital stays, or you will pay a 50% penalty. Outpatient surgery: You pay 20% coinsurance after you meet your annual deductible. Surgeon/anesthesiologist: You pay 20% coinsurance after you meet your annual deductible. X-rays, lab services, and medical supplies: You pay 20% coinsurance after you meet your annual deductible. Mental health: You pay 20% coinsurance after you meet your deductible. You must receive preauthorization for inpatient mental health services, or you will pay a 50% penalty.

Prudent Buyer PPO

When comparing the Advantage PPO and Prudent Buyer PPO plans, you will see that cost-sharing (copays and coinsurance) for care is the same. But, the Prudent Buyer PPO network is larger and the co-contribution is higher.

Here’s how the plan works:


Providers and doctors	You must use providers within the Anthem Blue Cross PPO (Prudent Buyer)—Large Group network. There is no out-of-network coverage except for emergency room treatment for a medical emergency.
Cost sharing between you and the plan	Annual deductible (what you pay before the plan starts sharing costs): $300 individual/$750 family. Any amount applied towards your deductible during the last three months of the calendar year will also carryover and be applied against your deductible requirement for the following year. This is called the “carryover” deductible. Calendar-year out-of-pocket maximum (the most you’ll pay in any year for eligible services): $3,000 individual/$6,000 family. Preventive care (your annual checkup) and prescription drugs that qualify as preventive care: You pay $0.
What you pay for frequently used services	Doctor/specialist office visits: You pay 20% coinsurance after you meet your annual deductible. Urgent care center: You pay 20% coinsurance after you meet your annual deductible. Emergency room: You pay 20% coinsurance after you meet your annual deductible. (If you are admitted directly to the hospital from the emergency room, this visit will be paid the same as inpatient care.) Inpatient hospital stay: You pay 20% coinsurance after you meet your annual deductible. You must receive preauthorization for inpatient hospital stays, or you will pay a 50% penalty. Outpatient surgery: You pay 20% coinsurance after you meet your annual deductible. Surgeon/anesthesiologist: You pay 20% coinsurance after you meet your annual deductible. X-rays, lab services, and medical supplies: You pay 20% coinsurance after you meet your annual deductible. Mental health: You pay 20% coinsurance after you meet your deductible. You must receive preauthorization for inpatient mental health services, or you will pay a 50% penalty.

Find a Provider

Your medical plan pays only for care you receive from network doctors at network facilities. That’s why it’s important for you to choose network providers.

To learn if your doctor is part of the Advantage PPO network or Prudent Buyer network—or to find a provider who is:

Call the JBT Doctor/Facility Helpline at 833-346-3365.
Visit the Anthem Blue Cross website.

To find an Advantage PPO network provider:

Scroll to Find a Doctor.
Choose Guests.
Under What state do you want to search in, select California.
Under What type of plan do you want to search with, select Medical (Employer-Sponsored).
Under Select a plan/network, select Advantage PPO.
Then, choose your category (doctor, hospital, etc.) and specialty (family practice, dermatology etc.).
Finally, choose your location and how far you’re willing to travel.
You’ll see a list of providers.

To find a Prudent Buyer PPO network provider:

Scroll to Find a Doctor.
Choose Guests.
Under What state do you want to search in, select California.
Under What type of plan do you want to search with, select Medical (Employer-Sponsored).
Under Select a plan/network, select Blue Cross PPO (Prudent Buyer)— Large Group.
Then, choose your category (doctor, hospital, etc.) and specialty (family practice, dermatology etc.).
Finally, choose your location and how far you’re willing to travel.
You’ll see a list of providers.

Prescription Drugs

With both the Advantage and Prudent Buyer PPO plan options, you fill your prescriptions at retail pharmacies in the CVS Caremark network or through CVS Caremark’s mail-order service. Without your doctor obtaining authorization from CVS Caremark, there is no coverage for brand name drugs when a generic is available. Also, if you use an out-of-network pharmacy, your plan will not cover the cost of your prescription.

What you’ll pay for most prescriptions


In-network retail pharmacy (30-day supply)	$10 for generic drugs. $20 for brand-name drugs (when a generic is unavailable). No coverage for drugs that are not on the CVS Caremark covered drug list.
Mail order (90-day supply)	$20 for generic drugs. $40 for brand-name drugs (when a generic is unavailable). No coverage for drugs that are not on the CVS Caremark covered drug list.
Specialty drugs	$40 copay for specialty drugs for 30-day supply (preauthorization and mail order delivery may be required).
Prescription drug annual out-of-pocket maximum	$3,600 individual/$7,200 family.

Is your local pharmacy in network?

Call 888-685-7752 or go to the CVS Caremark website.

Dental

Your JBT benefits include comprehensive dental coverage for you and your eligible children.

The plan pays a set amount for each covered dental procedure. This is called the scheduled allowance.

You need to meet an annual deductible before the plan pays benefits, and there is an annual maximum benefit.

How the Plan Works


Dental providers	JBT contracts with Arrin dental network providers, who agree to accept JBT’s scheduled allowance for procedures as payment in full. If you use an out-of-network dentist, you are responsible for paying the difference between the scheduled allowance for a procedure and the cost billed by the dentist. Your dentist can use this dental claim form or any other dental claim form to file a claim or submit a request for preauthorization.
Cost sharing between you and the plan	Annual deductible (what you pay before the plan starts sharing costs): $50 individual/$100 family. There is no carryover. Calendar-year maximum benefit: $800 per individual. Network provider: After you meet your annual deductible, the plan pays 50% of the scheduled allowance for your procedure, up to the annual maximum. You are responsible for amounts over the annual maximum. Out-of-network provider: In addition to the coinsurance described below, you are responsible for paying any amount over the scheduled allowance for a procedure. You are also responsible for amounts over the annual maximum.
Scheduled allowance for frequently used services	The plan pays up to 50% of the amounts below after you meet the deductible; you are responsible for the balance due. Dental checkups (two per calendar year): $60. X-ray: $108 complete set. Filling (single surface): $81 (amalgam); $92 (resin). Inlay restoration (one surface): $324 (metallic); $265 (porcelain/ceramic). Replacement inlay: $59. Crown: $281 (resin). Replacement crown: $59. Root canal: $373 (front); $448 (bicuspid); $562 (molar). Review the full table of scheduled allowances for covered dental procedures.

Will your dental treatment cost more than $500? Ask your dentist to request preauthorization on a dental claim form before you receive care.

Need a network dentist?

Find one here

Vision

JBT’s vision benefit provides coverage for standard eye exams and glasses or contact lenses for you. Your children are not covered.

You will pay discounted rates for covered vision services when you see a Vision Service Plan (VSP) Advantage Network provider. Although you can go to any eye doctor you choose, you will pay less when you see an in-network eye doctor or optician (a person who manufactures and dispenses glasses and contact lenses).

How the Plan Works


Vision providers	VSP providers: You may save money when you use a Vision Service Plan (VSP) Advantage Network provider. After you pay a $10 copay, the plan pays 100% of the exam and an allowance for frames and lenses. The plan also offers discounts and savings on other services not covered by the vision plan. Out-of-network provider: If you use an out-of-network eye doctor or optician, you are responsible for paying the difference between the fees billed by the provider and an out-of-network allowance set by VSP. Call VSP at 800-877-7195, or or go to the VSP website for details.
What you pay for frequently used services (with a VSP provider)	WellVision eye exam (1 every 24 months): $10 copay. Eyeglass frames (1 every 24 months): $0 after exam copay, up to $150 allowance, and 20% discount on the amount over the allowance. Eyeglass lenses (1 pair every 24 months): $0 after exam copay for single vision, lined bifocals, and lined trifocals. $55 after exam copay for standard progressive lenses. $95–$105 after exam copay for premium progressive. Contact lenses (1 pair every 24 months instead of eyeglasses): The plan provides a $100 allowance for contact lenses (including contact lens exam); you pay any balance due.

Vision providers

VSP providers: You may save money when you use a Vision Service Plan (VSP) Advantage Network provider. After you pay a $10 copay, the plan pays 100% of the exam and an allowance for frames and lenses. The plan also offers discounts and savings on other services not covered by the vision plan.

Out-of-network provider: If you use an out-of-network eye doctor or optician, you are responsible for paying the difference between the fees billed by the provider and an out-of-network allowance set by VSP. Call VSP at 800-877-7195, or or go to the VSP website for details.

What you pay for frequently used services
(with a VSP provider)

WellVision eye exam (1 every 24 months): $10 copay.

Eyeglass frames (1 every 24 months): $0 after exam copay, up to $150 allowance, and 20% discount on the amount over the allowance.

Eyeglass lenses (1 pair every 24 months):

$0 after exam copay for single vision, lined bifocals, and lined trifocals.
$55 after exam copay for standard progressive lenses.
$95–$105 after exam copay for premium progressive.

Contact lenses (1 pair every 24 months instead of eyeglasses):

The plan provides a $100 allowance for contact lenses (including contact lens exam); you pay any balance due.

Looking for a VSP provider?

Find one here

Substance Abuse

JBT works with the Teamsters Alcohol Rehabilitation Program (TARP) to provide participants and their dependents with drug or alcohol treatment.

You need to call TARP at 800-522-8277 for an initial assessment and referral to the appropriate providers and services. Your treatment must be preauthorized by TARP; otherwise, benefits may be denied, and you’ll pay the full cost for your treatment.

Other Services

Chiropractic

Whether you’re enrolled in the Advantage PPO or Prudent Buyer PPO medical plan option, you and your covered children have chiropractic benefits through Landmark Healthplan. To find a provider in your area, call 800-298-4875 (option 2) or visit the Landmark Healthplan website.

You can also use a chiropractor in your Advantage or Prudent Buyer network, but your benefit will be lower. If you use a chiropractor who is not in your Anthem network or the Landmark Healthplan network, your services will not be covered.

Here’s how the plan works:


Chiropractic providers	Contact Landmark Healthplan for providers in your area. There is no coverage for providers who are not in the Landmark Healthplan, Advantage PPO, or Prudent Buyer PPO network.
Cost sharing between you and the plan	Annual deductible: Accumulates with medical coverage ($300 individual/$750 family). Calendar-year maximum benefit: $680.
What you pay for frequently used services	Office visit and x-rays: The plan allows up to $50 per day. After you meet your deductible, you pay 20% plus any charges above the $50 per day limit. So, the plan will pay $40 on any charge of $50 or more.

Mammography Network

Participants in the Advantage PPO or Prudent Buyer PPO plan can take advantage of JBT’s special mammography network. If you use a Mammography Network Center facility, your mammogram will be covered at no cost to you.

The plan covers a yearly mammogram for female participants and any female covered dependents who are 40 and older.

Use this list to locate a Mammography Network Center facility in your area—but, before you make your appointment, be sure to reconfirm the facility’s participation and that you’re eligible for this benefit.

Note, if you don’t use a Mammography Network Center provider, and instead choose a provider within the Advantage PPO or Prudent Buyer PPO network you selected, the plan pays a maximum benefit of $163; you are responsible for the balance. If you go out-of-network, the plan does not pay benefits.

Contact JBT at 800-528-4357 before scheduling an appointment.

Hip/Knee Replacement Designated Hospitals

Participants in the Advantage PPO or Prudent Buyer plan will pay much less by using a designated hospital for hip or knee replacement surgery.

The plan provides an allowance of up to $35,000 for inpatient hospital charges for routine hip and knee replacements, and designated hospitals agree to keep their charges at or under this cost. The plan pays 80% of the allowance after you meet the deductible.

If you do not use a designated hospital, you will pay the difference between the hospital’s charge and JBT’s $35,000 allowance, in addition to the 20% coinsurance.

When considering and scheduling one of these surgeries, be sure to confirm that your facility is on the designated hospital list. Call JBT at 800-528-4357 before scheduling your doctor’s appointment and surgery.