Your Benefits With the Trust
The Trust is committed to being your partner in health and providing you with the support you need to live a happy and healthier life. Click below to learn more about your comprehensive benefits and coverage with the Trust, and find out about preventive care and prescription benefits.
The Trust has Preferred Provider Organization (PPO) arrangements with Aetna’s Choice POS II network for medical services. This network of hospitals, physicians and other healthcare professionals provides eligible employees and dependents with efficient, cost-effective services and supplies at discounted rates.
Providers not in the network are called non-PPO providers. Non-PPO providers are reimbursed at a lower level of benefits and charges are allowed only up to usual, customary and reasonable (UCR) fees.
Although you may see any provider covered by the plan, you receive higher benefits if you use PPO providers—the choice is yours, each time you use your benefits.
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- Find a Preferred Aetna’s Choice POS II network provider online, or by asking your doctor if they are in the preferred network.
- Preventive care is paid in full with your Trust plan. Learn more here.
- Find the details of your medical coverage in your Summary Plan Description booklet in the sidebar at right. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. It is printed on the far left-hand side under the Trust logo.
Aetna Case Management
The Trust has contracted with Aetna to provide Case Management services in certain health care treatment situations, such as before a scheduled hospitalization, after discharge from the hospital or if you are considering weight-loss surgery. An Aetna case manager will work cooperatively with you and your physician to consider effective alternatives to hospitalizations and other high-cost care to assist you in making the most efficient use of your benefits with the Trust. Aetna Case Management is included in the benefits provided to you by the Trust and is strictly confidential and voluntary. If you qualify, an Aetna case manager will call you to get started. For more information, call the Trust Office at (206) 282-4500 or (800) 225-7620.
The Trust has an agreement with VSP (Vision Service Plan) to provide vision benefits to you and your eligible dependents. Under this agreement, you can use any provider you wish. However, if you use a VSP network doctor, you may receive higher benefits—and they automatically file claims for you.
- Find a VSP network doctor with the VSP Provider Directory. You’ll need a user ID and password to logon to this site. If you don’t have a VSP user ID and password, you can register on the VSP site. Or call VSP directly at (800) 877-7195.
- Find the details of your vision coverage in your Summary Plan Description booklet in the sidebar at right. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. It is printed on the far left-hand side under the Trust logo.
Here’s a summary of covered services:
- Exam: 100% after $10 copay at a VSP provider, up to $50 at a non-VSP provider, once each 12 months from last date of service.
- Lenses: 100% at a VSP provider, from $50 to $125 at a non-VSP provider; once each 12 months from last day of service.
- Frames: up to $150 at a VSP provider, up to $70 at a non-VSP provider; once each 24 months from last date of service.
- Contact Lenses: 100% up to $130 at a VSP provider, up to $105 at a non-VSP provider; once each 12 months in place of eyeglass lenses and frames.
DDWA Preferred Program
This option allows you to see any licensed dental provider. Search for a dentist using the Delta Dental of Washington site. Your reimbursement will depend on the dentist’s contract with DDWA:
- DDWA Preferred (PPO) Providers: Seeing a Preferred Dentist will provide the highest level of benefits and the lowest out of pocket costs.
- DDWA Participating Providers: These dentists provide a discount, but your benefits percentage is lower, resulting in higher out of pocket costs vs. a Preferred Dentist.
- Non-DDWA Dentist: If your dentist is not Preferred or Participating, your benefits will be lower, and you will have higher out of pocket costs. Reimbursement is made based on maximum allowable fees, which may leave you with higher patient responsibility.
Schedule Plan
This option allows you to see any licensed dental provider. Benefits will be paid according to the schedule of allowances. Dental charges in excess of the schedule will be your responsibility.
DeltaCare Program
DeltaCare is a dental HMO plan. This option requires you to choose from a smaller list of approved dentists and clinics. You MUST choose a DeltaCare primary care dentist who coordinates all of your care, including any referrals to specialists. Under this plan you cannot just see any licensed dentist for treatment. A list of DeltaCare providers can be found at www.deltadentalwa.com. Make sure you have a DeltaCare provider in your area and that they are accepting new patients before enrolling in this option.
Get More Information in Your Benefits Booklet
Find the details of your dental coverage in your Summary Plan Description booklet in the sidebar at right. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. It is printed on the far left-hand side under the Trust logo.
The Trust’s four-tier therapeutically based prescription plan is designed to promote the use of proven, cost-effective medications.
The Sound Health & Wellness Trust uses a pharmacy network managed by WellDyneRx to provide discounts on prescription drugs. The Trust Custom Pharmacy Network (PDF) consists of pharmacies owned by employers who participate in the Trust.
If you use a Trust Custom Network pharmacy, you will only pay the required co-payment when you pick up your prescription. If you fill your prescription at a WellDyneRx pharmacy that is not part of the Trust Custom Pharmacy Network, you will have to pay the full discounted price up front and submit a claim to the Trust Office for benefit reimbursement.
Maintenance prescription drugs written for a 30-day supply can be filled at a retail pharmacy. However, any maintenance prescriptions written in excess of a 30-day supply can only be purchased from WellDyneRx Mail or a Trust Custom Network pharmacy.
Tier 0—Some highly cost-effective medications: Co-pay per 30-day supply $0. Learn more about this benefit here.
- Cholesterol lowering medications (Simvastatin – all strengths and Rosuvastatin calcium – only 5 mg & 10 mg)
- Proton pump inhibitor (Omeprazole)
- Non-sedating antihistamines (Loratadine and Loratadine D)
- Treatment of diabetes (Metformin and Lancets)
Tier 1—Current generics, some future generics: Co-pay per 30-day supply: $6
Tier 2—Most brand drugs, and more costly or less desirable future generics: Co-pay per 30-day supply: $22
Tier 3—Non-preferred brand drugs and some undesirable future generics: Co-pay per 30-day supply: $35
Download the formulary to find out what Tier your prescriptions are in.
Brand Name Drug with Generic Available
If you fill a prescription for a brand name drug when there is a generic, you will pay the generic co-pay plus the actual difference in cost between the generic and the brand name drug. If you do not identify yourself or dependents as participants in the Sound Health & Wellness Trust to the pharmacist when your prescription is filled, you will be assessed a processing fee in addition to the co-pay. The processing fee for generic drugs is $10; the processing fee for brand name drugs is $20.
Maintenance “Mail” at Retail
Tier 3 Maintenance Drugs:
$60 co-pay for a 90-day supply if purchased at certain “Trust Network” pharmacies.
Mail Order (optional):
Co-pays for a 90 day supply listed below:
- Tier 0 – $0
- Tier 1 – $18
- Tier 2 – $66
- Tier 3 – $70
- Brand Name Drug with Generic Available – Generic co-pay plus the actual difference in cost between the generic and the brand name drug
To start a new prescription through home delivery, please call WellDyneRx Mail Order at (800) 373-1568 to have the mail order forms sent to you.
Download a list of Maintenance Medications here (PDF).
Get More Information in Your Benefits Booklet
Find the details of your prescription drug coverage in your Summary Plan Description in the sidebar at right. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. It is printed on the far left-hand side under the Trust logo.
Eligible Sound Health & Wellness Trust PPO plan participants and their covered dependents can receive $0 co-pay flu shots either at a pharmacy or at the doctor’s office, with coverage subject to plan limitations.
If you use a Trust Custom Network pharmacy you will pay nothing, subject to plan limitations. If you use any other WellDyneRx pharmacy, you will pay a discounted amount for your shots. You can then submit your claim to the Trust Office for 100% reimbursement, up to the covered limits. If you prefer, you can still go to your doctor for your vaccination, as long as your doctor is an approved Aetna Choice POS II network doctor. However, your office visit will not be covered. Flu shots are not subject to your deductible.
Getting a flu shot is the single best way to protect against the flu. Children from 6 months to 19 years of age, pregnant women, people 50 and older, and people with certain chronic medical conditions are especially encouraged to get a flu shot.
Employee Life Insurance—The employee life insurance benefit is $15,000. This amount will be paid to your beneficiary in the event of your death from any cause.
Dependent Life Insurance—The spouse or State Registered Same Sex Domestic Partner’s benefit is $1,000. This amount will be paid to you in the event of your spouse or partner’s death from any cause.
Employee Accidental Death or Dismemberment—This benefit is payable to your beneficiary in the event of your death, or to you in the event of your loss, if your death or loss is caused by an accidental injury while you are covered under the Plan.
Get More Information in Your Benefits Booklet
Find the details of your life insurance coverage in your Summary Plan Description in the sidebar at right. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. It is printed on the far left-hand side under the Trust logo.
If you are totally disabled because of your injury or sickness, you may be eligible for weekly disability benefits. To qualify, you must have worked at least 80 hours during your eligibility month (which was two months before the onset of your disability). Your time-loss payments will range from $135 to $225 per week (less Social Security taxes), depending on the number of hours you worked during your eligibility month.
Get More Information in Your Benefits Booklet
Find the details of your time loss coverage in your Summary Plan Description in the sidebar at right. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. It is printed on the far left-hand side under the Trust logo.
