Your Health Care Plan

Family benefit protection, negotiated and provided by your union.

The Ohio AFSCME Care Plan offers local unions and employers a cost effective way to negotiate expanded ancillary benefits as part of their collective bargaining agreement.

These ancillary services include dental, hearing, prescription, vision, and life insurance coverage, along with legal plans and employee assistance programs.  These plans are fully employer paid.  These are negotiated benefits, not available for purchase.

Care Plan staff have the expertise to evaluate current benefits and advise on money saving and value-added strategies to provide more options for union members and their families.

For more information, contact your Council 8 regional office.

“We don’t run the plan to make a profit for health care providers or investors. We make every decision based on what’s best for the AFSCME members and families we serve.”

-Michael D. Bauer, Plan Administrator

Useful Links:

AFSCME Advantage
Health Care Plans
Care Plan History
Offices
Care Plan Trustees
Frequently Asked Questions

Health Care Plans

Life Insurance Benefit Level I

Coverage in amounts between $14,000 and $30,000
Accidental Death and Dismemberment Benefit
Dependent Coverage- $2,000
Spouse coverage – $2,000
Child coverage – $2,000 to age 19 (up to 23 years if full-time student)
Disability Life Insurance Extension
Accelerated Death Benefit
Seat Belt Benefit

Life Insurance Benefit Level II

Amount of Life Insurance – Member $50,000
Amount of Accidental Death & Dismemberment $26,000
Dependent Coverage – $2,000
Spouse coverage – $2,000
Child coverage – $2,000 to age 19 (23 years if a full-time student)
Disability Life Insurance Extension
Accelerated Death Benefit
Seat Belt Benefit

Prescription Drug Health Reimbursement Account Plan

Covers Employee, Spouse and Dependent Children.
90% reimbursement on each prescription.
$500.00 maximum each year per family member.

Prescription Card Plan

Covers Employee, Spouse and Dependent Children.

Plan covers 90 percent of the cost of the perscription.

Co-pay of 10% of cost at the pharmacy.
$3,000.00 maximum each year per family member.
An Employer can agree to make contributions to the Care Plan to provide coverage for the cost of prescription drugs in excess of the $3,000.00 maximum each year on an individual basis.

Vision Care Benefit Level I

Covers Employee, Spouse and Dependent Children. Adults once every 24 consecutive months and children under the age of 19 once every 12 consecutive months.
Covers Exam (including Glaucoma testing), standard frames, basic single vision, bifocal or trifocal lenses at no cost when provider network used.
Provides an allowance for contact lenses.

Vision Care Benefit Level II

Covers Employee, Spouse and Dependent Children once every 12 consecutive months.
Covers Exam (including Glaucoma testing), standard frames, basic single vision, bifocal or trifocal lenses at no cost when provider network used.
Provides an allowance for contact lenses.

Vision Care Benefit Level III

Covers Employee, Spouse and Dependent Children once every 12 consecutive months.
Covers Exam (including Glaucoma testing), standard frames, basic single vision, bifocal or trifocal lenses at no cost when provider network used.
Provides an allowance for contact lenses.
Additional covered services include:
Polycarbonate lenses
No-line Bifocals (Basic)
Ultra light lenses
Scratch coating
Tints (Basic)

Hearing Aid Benefit

Covers Employee, Spouse and Dependent Children (Benefits are payable once every 4 years)
$1000.00 toward the purchase of a Hearing Aid, Ear Mold and the services of an Audiologist for each ear.

Dental Care Benefit Level I

This plan is no longer available for new policies

Covers Employee, Spouse and Dependent Children
Open Panel (choose your own dentist)
Payment according to fee schedule
No deductible

Dental Care Benefit Level II

Covers Employee, Spouse and Dependent Children
Open Panel (choose your own dentist)
Payment according to fee schedule
$1,500.00 Orthodontic Benefit for Dependent Children under the age of 19
Annual Maximum Benefit – $4,000.00 per each family member. No deductible

Dental Care Benefit Level II-A

Covers Employee, Spouse and Dependent Children
Open Panel (choose your own dentist)
Payment according to enhanced fee schedule
$1,500.00 Orthodontic Benefit for Dependent Children under the age of 19
Annual Maximum Benefit – $4,000.00 per each family member. No deductible

Dental Care Benefit Level III

Covers Employee, Spouse and Dependent Children
Open Panel (choose your own dentist)
Payment will be made based on applying the following schedule of benefit percentages to the lesser of the UCR or the actual amount charged.
Diagnostic/Preventive 100% UCR
Minor Restorative 80% UCR
Major Restorative 50% UCR
$2,000.00 Orthodontic Benefit for Dependent Children under the age of 19
Annual Maximum Benefit – $4,000.00 per each family member. No deductible

Dental Care Benefit Level IV

Covers Employee, Spouse and Dependent Children
Open Panel (choose your own dentist)
Payment will be made based on applying the following schedule of benefit percentages to the lesser of the UCR or the actual amount charged.
Diagnostic/Preventive 100% UCR
Minor Restorative 80% UCR
Major Restorative 60% UCR
$2,000.00 Orthodontic Benefit for Dependent Children under the age of 19
Annual Maximum Benefit – $4,000.00 per each family member No deductible
Certificate booklets which contain a complete description of the covered benefits and any exclusions, are available from any Ohio AFSCME Care Plan office.

Employee Assistance Program Level I

Covers Employee, Spouse and Dependent Children

Provides confidential counseling and referral assistance 24/7

Phone counseling by masters and doctoral-level clinicians – up to 3 calls per problem per year

Password protected online access to Employee Assistance related services

Employee Assistance Program Level II

Covers Employee, Spouse and Dependent Children
Provides confidential counseling and referral assistance 24/7
Phone counseling by masters and doctoral-level clinicians – up to three calls or in-person visits per problem per year
Password-protected online access to EAP related services

Employee Assistance Program Level III

Covers Employee, Spouse and Dependent Children
Provides confidential counseling and referral assistance 24/7
Phone counseling by masters and doctoral-level clinicians – up to five calls or in-person visits per problem per year
Password-protected online access to EAP related services

Legal Benefits

Covers Employee, Spouse and Dependent Children
Provides various legal services, including wills, living wills, codicils, real estate matters and simple divorce or separation agreements
Dependent child coverage to age 19, or age 23, if full-time student

Dependent child eligibility to age 28 for all benefits excluding Life Insurance I and II and Legal Benefits

 

Care Plan History:

The Ohio AFSCME Care Plan was established in 1973 with the Cuyahoga County Hospitals covering some 2,400 employees. The Care Plan was founded under a joint Trust Agreement in strict accordance with the laws of the State of Ohio and Federal Government. A 14-member Board of Trustees, which is composed equally of representatives from AFSCME and organizations that employ members, now administers the Care Plan.

The Ohio AFSCME Care Plan is also covered by the Federal Employee Retirement Income Security Act (ERISA), which requires certain reporting procedures to the Federal Government and to all employee participants covered by the Care Plan.
The first benefit provided was a $2,000 life insurance policy; a year later, prescription drug coverage was added; dental, vision, and hearing soon followed; and plan benefits have only continued to improve.

The Board of Trustees approved a major amendment for the Trust Agreement effective July 1, 1999. This amendment ensures that benefits of the Care Plan are available to non-AFSCME bargaining units where employers are making contributions to the Care Plan on behalf of an AFSCME bargaining unit.

The life insurance plan is underwritten by Consumer Life Insurance Company. The Ohio AFSCME Care Plan is self-funded for all other benefits, which include dental, hearing, prescription and vision care.

Since the Plan was established in 1973, there have been only minor increases in the contribution rate even though health-care costs have increased tremendously during the same period of time. Participating employers are protected from rate increases for the life of their collective bargaining agreement even though the rates may be increased or benefits improved during the term of the agreement. Other insurance companies’ rates usually are increased annually even though benefits may not be improved.

Since 1973, the growth of the Care Plan has been phenomenal. The Care Plan now has three offices located here in Ohio, with service centers in Cleveland, Cincinnati and Toledo.

Offices:

CLEVELAND
1603 East 27th Street
Cleveland, Ohio 44114
216-781-6420
1-800-526-7201

CINCINNATI
1213 Tennessee Avenue
Cincinnati, Ohio 45229
513-641-4111
1-800-562-1822

TOLEDO
420 South Reynolds Road
Toledo, Ohio 43615
419-536-0880
1-800-237-2631

Care Plan Trustees

Deborah Allison
Risk Manager, City of Cincinnati

Daniel K. Lewis
Chief Administrative Officer (CAO) MetroHealth System

Joni Harbaugh
Benefits Manager, Cuyahoga County

Richard Jackson
Assistant Service Director, City of Elyria

Emily Moore
Cincinnati Regional Vice President and President of AFSCME Local 232 Cincinnati Board of Education

Debbie Warman
Vice President Human Resources, MetroHealth System

John A. Lyall
President. AFSCME Ohio Council 8, AFL-CIO

Harold Mitchell
First Vice President, AFSCME Ohio Council 8, AFL-CIO

Mark E. Owens
Clerk of Dayton Municipal Courts

Robert L. Thompson Sr.
Regional Director, Akron AFSCME Ohio Council 8, AFL-CIO

Pamela D. Brown
Cleveland Regional Vice President and President of AFSCME Local 1746 Cuyahoga County DJFS

R. Sean Grayson, Esq.
General Counsel, AFSCME Ohio Council 8, AFL-CIO

Alvin Freeman
Commissioner, Dayton Metro Housing Authority

Thomas J. Ritchie, Sr.
Director of Field Services, AFSCME Ohio Council 8, AFL-CIO

Michael D. Bauer
Plan Administrator

Trustees of Ohio AFSCME Legal Care Plan
Employer Trustee

Mark E. Owens
Clerk of Dayton Municipal Courts

Union Trustees

John A. Lyall
President, AFSCME Ohio Council 8, AFL-CIO

Harold Mitchell
First Vice President, AFSCME Ohio Council 8, AFL-CIO

Frequently Asked Questions

What kind of benefits does the AFSCME Care Plan offer?

The AFSCME Care Plan offers a complete line of benefits. In addition to life insurance, the Care Plan includes health care benefits like dental, vision, prescription drug, and employee assistance programs, as well as hearing aid coverage.

Are the Care Plan’s rates competitive with the rest of the health insurance industry?

Because the Care Plan was established to provide the highest-quality health care benefits for AFSCME members and their families, instead of earning profits for investors like traditional health care plans, our rates are more than competitive.

Are there any specific requirements for Care Plan benefits?

There are several requirements that must be met in order to participate in the AFSCME Care Plans. These requirements are as follows:

  • There must be a Collective Bargaining Agreement between the employer and AFSCME.
  • AFSCME must be recognized as the sole and exclusive representative of all employees in the AFSCME bargaining unit.
  • The employer must be obligated to make contributions to the Care Plan for an AFSCME bargaining unit.
Is there an employee co-pay for AFSCME Care Plan benefits?

No. The employer must pay the entire monthly contribution for each employee in the bargaining unit. In addition, all employees in the bargaining unit, whether AFSCME members or non-members, must be covered, and there must be specific language in the agreement requiring the employer to participate and pay the monthly contribution rate.

Can non-AFSCME workers be covered by the AFSCME Care Plan?

Yes, with certain restrictions. In order for a non-AFSCME bargaining unit to participate in the AFSCME Care Plan, there must also be a Collective Bargaining Agreement between the employer and the non-AFSCME bargaining unit.

If I have a problem making a claim or finding a provider, is it easy to get help?

The Care Plan staff is only a telephone call away. You can be sure of first-class, professional service as well as the highest-quality health care when you work with our team.

If you’d like to speak with us in person, the AFSCME Care Plan has three offices conveniently located in Cleveland, Cincinnati, and Toledo.

6800 North High Street, Worthington, Ohio, 43085-2512
Phone: 614-841-1918
Fax: 614-841-1299