FMCP Member Premium Chart – Everbrite LLC
Semi-Monthly Deductions (20% Union Member Share)
Two equal payments per month
| Coverage Tier |
2025 Monthly Rate |
2025 Per Paycheck |
2026 Monthly Rate |
2026 Per Paycheck |
| Employee Only |
$149.91 |
$74.96 |
$153.36 |
$76.68 |
| Employee + Child |
$263.52 |
$131.76 |
$269.58 |
$134.79 |
| Employee + Spouse |
$281.67 |
$140.84 |
$288.15 |
$144.08 |
| Employee + Family |
$390.06 |
$195.03 |
$399.03 |
$199.52 |
IBEW + NECA FMCP Plan 18-Everbrite
Member Resource Packet – 2025
Effective January 1, 2025
Questions? Call the Benefit Office at 1-877-937-9602 or visit www.nifmcp.com
Section 1: Medical & Prescription Benefits Cheat Sheet
Medical Benefits (Anthem Blue Cross Blue Shield – Blue Card PPO)
| Service |
In-Network (PPO) |
Out-of-Network (Non-PPO) |
| Deductible (Annual) |
$1,000/person; $3,000/family |
Combined with PPO |
| Out-of-Pocket Max |
$4,000/person; $8,000/family |
No limit |
| Plan Pays |
70% after deductible |
60% after deductible |
| Preventive Care |
100% covered |
Not guaranteed |
| Office Visit |
30% co-insurance |
40% co-insurance |
| Emergency Room |
30% co-insurance |
30% co-insurance |
| Hospital (Inpatient/Outpt.) |
30% co-insurance |
40% co-insurance |
| Mental Health/Substance Use |
30% co-insurance |
40% co-insurance |
| Chiropractic (15 visits/year) |
30% co-insurance |
40% co-insurance |
Pre-certification required for many services: Call 1-855-343-4851
Prescription Drugs (Sav-Rx)
| Tier |
Retail (30-day) |
Mail Order (90-day) |
| Generic (Tier 1) |
$0 |
$0 |
| Preferred Brand (Tier 2) |
20% |
20% |
| Non-Preferred Brand (Tier 3) |
30% (min $40) |
30% (min $80) |
Walmart & Sam’s Club are NOT in-network
Annual Rx Out-of-Pocket Max: $1,000/person; $2,000/family
Virtual & Specialty Services
Other Key Benefits
- ABA Therapy (Autism): Covered with pre-certification
- Hearing Aids: Up to $4,000 every 3 years
- TMJ Treatment: Covered
- Mental Health & Substance Use: Inpatient & outpatient covered
- Special Fund Account: Use for co-pays, deductibles, and self-payments
- Weekly Disability (if applicable): $600/week (non-occupational); $300/week (occupational)
- Life Insurance (if applicable): $10,000 for active employees
Section 2: Preventive Care Cheat Sheet
Covered at 100% (no deductible or co-pay) when using PPO or Non-PPO providers
You may be balance billed by Non-PPO providers for charges above the allowable amount
Adult Preventive Services
- Abdominal Aortic Aneurysm Screening
- Alcohol & Drug Use: Screening & Brief Counseling
- Anxiety, Depression, Suicide Risk: Screening
- Aspirin (generic only) for CVD/CRC prevention
- Chlamydia, Gonorrhea, Syphilis, HIV, Hepatitis B & C: Screening
- Colorectal Cancer Screening (starting at age 45)
- Diabetes & Pre-diabetes: Screening
- Healthy Diet & Physical Activity Counseling
- Hypertension & Tuberculosis: Screening
- Intimate Partner Violence & Elder Abuse: Screening
- Lung Cancer Screening (Low-Dose CT)*
- STI Behavioral Counseling
- Skin Cancer Prevention Counseling
- Statin Therapy (subject to Step Therapy)
- Tobacco Cessation: 2 quit attempts/year, 4 counseling sessions/year, 90 days of meds
- Obesity (BMI ≥ 30): 26 behavioral therapy sessions/year, 1 dietary assessment
- Annual Preventive Health Exam
Women’s Preventive Services
- UTI & Bacteriuria: Screening
- BRCA Risk Assessment, Counseling & Testing*
- Breast Cancer: Chemoprevention Counseling, Mammograms (ages 40–74)
- Breastfeeding Support & Supplies
- Cervical Cancer Screening
- Contraceptives (FDA-approved generics or medically necessary brands)
- Folic Acid (for pregnancy)
- Gestational Diabetes Screening
- Healthy Weight Counseling During Pregnancy
- Osteoporosis Screening (age 65+ or postmenopausal)
- Preeclampsia: Aspirin Therapy
- Routine Prenatal Visits (labs/ultrasounds covered under major medical)
- Rh Incompatibility Testing
- Annual Women’s Preventive Health Exam
Children’s Preventive Services
- Anxiety, Depression, Suicide Risk: Screening
- HIV & STI Screening
- Obesity Screening
- Tobacco Use Counseling
- Skin Cancer Prevention Counseling
- Vision Screening (ages 3–5)
- Dental Health & Oral Fluoride (under age 5)
- Newborn Screenings: Hearing, PKU, Hypothyroidism, Hemoglobinopathies, Ocular Prophylaxis
- Iron Supplements (ages 6–12 months)
- Annual Preventive Health Exam
Immunizations (All Ages)
Covered per CDC/ACIP guidelines, including:
- Hepatitis A & B
- Rotavirus
- DTaP
- Hib
- Polio (IPV)
- Pneumococcal (PCV/PPSV)
- Influenza (Seasonal)
- MMR
- Varicella
- Meningococcal (MCV)
- HPV
- Zoster (Shingles)
Section 3: Using Your Medical ID Card & Finding a Provider
What’s on Your FMCP Medical ID Card
Front of Card Includes:
- Member ID – Use this when visiting a provider or pharmacy
- Group Number: GB0200M002
- Plan Code: 102
- Office Visit Co-Pay: $20
- Rx Info (Sav-Rx):
- Rx BIN: 006558
- Rx Group: NIFMCP
- Rx Member ID: (Matches your FMCP ID)
Back of Card Lists Key Contacts:
- Member Services: 1-877-937-9602
- Pre-Certification: 1-855-343-4851
- Sav-Rx Pharmacy: 1-866-233-4239 | www.savrx.com
- LiveHealth Online: www.livehealthonline.com
- Travel Coverage Info: 1-800-810-2583
Possession of the card does not guarantee eligibility. Always confirm coverage before receiving services.
How to Find an In-Network Provider
- Visit www.anthem.com
- Click “Find Care” in the upper right corner
- Select “Use Member ID for Basic Search”
- Enter your Member ID from your card
- Browse doctors, hospitals, and specialists in your network
You can also search as a guest by selecting your plan and location.
Download:
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