United Food and Commercial Workers
Tri-State Health and Welfare Fund
Mental Health and Substance Abuse Care
Benefit eligibility varies and is determined based upon the terms and conditions in the collective bargaining agreement (contract) between your Local Union and your Employer.
All claims for Inpatient and Outpatient Mental Health and Substance Abuse treatment will be processed through the Fund office only. All care is monitored for quality and necessity through current utilization review and individual case management.
All non-emergency Mental Health and Substance Abuse treatment, either Inpatient or Outpatient Care, must be pre-approved through the Fund Office.
Emergency Treatment - The Fund office should be notified within 48 hours following Emergency Mental Health and/or Substance Abuse treatment. Pre-approval does not delay emergency care.
FOR PRE-APPROVAL CALL 1-800-228-7484, PROMPT #5.
All assistance is CONFIDENTIAL. This means that no information can be released without your written permission. There are certain exceptions to confidentiality including life-threatening situations such as homicide, suicide, child abuse and other situations which present a serious danger to yourself or others. Receipt of a proper subpoena from a court of law is also an exception.
Qualified professionals are available to assist you in choosing a program that is clinically necessary. In many cases, Participants are able to complete a treatment plan with little interruption to a work schedule or normal activity. Case Managers are available to assist throughout a course of treatment.
IMPORTANT: Participants and eligible dependents who receive services through the Mental Health and Substance Abuse Plan and/or the Employee Member Assistance Program (EMAP) are expected to comply with the treatment plan as prescribed by the attending healthcare Provider. If the Participant or eligible Dependent chooses not to comply with the recommended treatment, or fails to complete a prescribed course of treatment, the Fund has the right to reject the claim, and the Participant could be liable for the cost pertaining to continuing care or repetitive treatment.
Any Participant whose claim is denied for not complying with or completing recommended treatment may appeal the denial of benefits to the Trustees for reconsideration and review of his or her claim. Such Appeal must be made in writing and filed with the Trustees, in care of the Fund Administrator within 180 days from the date such denial notice was received.