Operating Engineers Health & Welfare Fund

Surgery Benefits

 

Surgeon

Anesthesia

Assistant Surgeon

Cosmetic Surgery

 


SURGERY BENEFITS

The physician's fee for inpatient surgery, or surgery done at the doctor's office, or surgery done on an outpatient basis will be paid at 100% of the amount listed on the SURGICAL SCHEDULE, after satisfaction of the Annual Deductible.  Follow-up care is included in the surgery charge if applicable.

EXAMPLE:

Surgeon's Charge $ 500.00
Surgical Schedule Allowed Amount    400.00
Fund's Payment    400.00
Member's Out-of-Pocket Expense    100.00

 

The complete SURGICAL SCHEDULE is too lengthy to publish.  If you require information on a specific surgery, please call or write the Fund Office for the details you require.  You must have the Relative Values Study (RVS) number, the Current Procedural Terminology (CPT) code, or a complete description of the surgery.  The complete SURGICAL SCHEDULE is available from the Fund Office upon request.

 

For a better benefit see AHF.

ANESTHESIA

Fees for anesthesia services will be reimbursed at 100% of the amount listed in the Anesthesia Schedule.  The Fund's allowed amount is based on the procedure performed, complications, and the amount of time involved.

EXAMPLE:

Anesthesiologist's Charge $ 700.00
Allowed Amount from Schedule    600.00
Fund's Payment    600.00
Member's Out-of-Pocket Expense    100.00

 

For a better benefit see AHF.

 

ASSISTANT SURGEON

If the procedure REQUIRES an assistant surgeon, the assistant surgeon will be reimbursed at 20% of the amount allowed for the surgery, after satisfaction of the Annual Deductible, not to exceed the assistant's charge.  If the only assistant is a Registered Nurse First Assistant (RNFA) or Physician's Assistant (PA), reimbursement will be at 10% of the amount allowed for the surgery, after satisfaction of the deductible.

EXAMPLE:

Surgery Allowance $ 500.00
Assistant Surgeon's Charge    125.00
Allowed Amount    100.00
  
(20% of Surgery Allowance)
Member's Out-of-Pocket Expense      25.00

 

For a better benefit see AHF.

 

COSMETIC SURGERY

The term "Cosmetic Surgery" means surgery which is performed merely for the purpose of improving the appearance of an individual.

The Fund does NOT cover Cosmetic Surgery unless the surgery is being done to repair disfigurement resulting from an accident which occurred while the patient was eligible, or for the correction of a congenital defect in a dependent child, or for breast reconstruction following mastectomy.