The Sound Health & Wellness Retiree Trust offers retirees the medical coverage detailed below. The LiveWell program is also part of your medical benefits. This extensive health and wellness program was designed to help you live a healthier life, prevent illness and make informed decisions about your healthcare. Find out more.

In the “Helpful Documents” box at the bottom of the page, you’ll find a benefit plan booklet called a Summary Plan Description that explains the details of your plan. For a quick list of helpful phone numbers for your benefit and wellness questions, check out the “Numbers to Know” section at the bottom of this page.

• Annual Deductible
  $500/person/calendar year
  $1,500/family/calendar year
  

  Please note: Flu and pneumonia immunizations are covered in full and not subject to the annual deductible.

  Coinsurance
  Preferred covered provider—80%
  Non-preferred covered provider—50% of UCR charges
  Other covered expenses—80% of UCR charges
  All covered providers and expenses—when the out-of-pocket maximum is reached, the plan pays 100% for the rest of the calendar year.

  (UCR means “usual, customary and reasonable charges”.)

  Prescription Drug Maximum
  $5,000/person/calendar year

  Out of Pocket Maximum
  $10,500/person/calendar year
  $31,500/family/calendar year

  (includes the annual deductible as well as 20% and 50% co-payments)

  $0 co-pay flu and pneumonia shots
  Eligible Sound Health & Wellness Retiree Trust plan participants and their covered dependents can receive $0 co-pay flu and pneumonia shots either at a pharmacy or at the doctor’s office, with coverage up to $30 for flu shots and $60 for pneumonia shots

  If you use a Trust Custom Network pharmacy you will pay nothing, up to $30 for a flu shot and $60 for a pneumonia shot. If you use any other Catalyst Rx 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 First Choice doctor, you will pay only your co-insurance if you are charged for an office visit, if your deductible has been satisfied.

  • See a list of Trust Custom Network pharmacies
  • Find a First Choice provider

  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. People aged 65 and older or those with chronic illnesses or compromised immune systems are highly encouraged to also get a pneumonia shot.

• Lifetime Maximum
  $1,000,000/person

  With this plan, covered services are available from any covered provider. However, if you use a Preferred Provider from the First Choice network, your benefits will be greater. All services provided by non-preferred providers are subject to Usual, Customary and Reasonable (UCR) charges.

  Mental Health
  OptumHealth Behavioral Solutions offers full care management of your mental health needs including pre-certification of inpatient admission, referrals for outpatient treatment, care advocacy follow-up and continued management post-discharge from higher levels of care.

  Call OptumHealth at (866) 763-0466. Trained and licensed clinical staff are available 24 hours a day, 7 days a week to provide assessment, crisis counseling and referral to contracted providers, along with help selecting a provider.

  For additional resources, go to LiveWell Behavioral Health Online for OptumHealth’s industry-leading website. The site contains a wealth of information and resources to help you with your daily life and any stressors you may be experiencing.