The Fund has implemented a Nation PPO through Private Health Care Systems, Inc. (PHCS), which covers most areas of the Fund.  The Trustees have selected the PHCS Preferred Provider Organizations (PPO's) in certain area as a way to help hold the line on medical costs.  A PPO is a network of physicians and Hospitals who have an agreement with the Fund to charge Employees and Dependents a "preferred" or negotiated rate.  The PPO network is continually expanding its service area, therefore if you have questions about the PPO or want to determine if there is a PPO provider in your area, PHCS may be contacted at the following toll-free number:

Private Health Care Systems, Inc. (PHCS)
1100 Winter Street
Waltham, Massachusetts 02154
1-800-474-4831

Current provider of information is also accessible through the PHCS website on the Internet at http://www.phcs.com.

In order to receive full medical coverage under your Schedule of Benefits, you must use a Participating PPO Provider.  If you do not use a Participating PPO Provider, your benefits will be paid at 50% of your normal schedule, unless one of the following applies:

1. In a Medical Emergency where selection of a provider is not an option.
2. If you reside more than 25 miles from a PHCS PPO Market Area; or
3. When you or your dependent require medical service while traveling outside a PPO Market area.

In the event exception No. 1 or No. 3 above applies to you, you are responsible for contacting the Fund Office in advance of the claim submission or the penalty will be applied.  The Fund Office will identify those living outside a PPO Market area by zip code.

How To Use a PPO

If a PPO has been implemented in your area, you automatically participate.  You do not have to sign any papers or fill out an enrollment card to take advantage of a PPO. Your doctor may already belong to the PPO in your area.  If you have a question whether or not a doctor or Hospital is part of the PPO, call the PHCS PPO Network at 1-800-474-4831.  Also the number is printed on your medical Fund Identification Card.  it is wise to check because new doctors and Hospitals are added to PPOs periodically.  Again, if you are unsure if a provider is participating with the PPO Network, call the PPO member services at 1-800-474-4831 and they will assist you in locating a PPO Provider.