District No. 9 Welfare Trust would like to welcome the employees and their families of Silgan Closures. To ease in the transition to our plan, we have created this page which contains network directories, forms, summaries and plan documents. If you have any questions, please don’t hesitate to contact us. Our goal to is assist our membership in any way we can.
Credit for any Deductible or Out-of-Pocket Met
Remember to send us a copy of your most recent Explanation of Benefits (EOB) from Anthem showing any amount you met towards your deductible and/or out-of-pocket. We will apply these amounts to reduce your deductible and/or out-of-pocket under our plan.
Network Providers Medical
Using a network contracted provider will give you the best benefit with the least amount of money out of your pocket. The Evansville Indiana and surrounding areas has a large selection of Healthlink providers. To find a contracted provider online refer to the below instructions.
Healthlink Providers -Plan reimburses at 85% (HMO – Tier 1) or 75% (PPO – Tier 2) of eligible charges after deductible is met. If you choose to use an Out-of-Network provider this plan reimburses 55% of the allowed amount.
Healthlink Network Evansville Indiana
Pharmacy Benefits
LDI Pharmacy Network Evansville Indiana
Additional Forms
Adult Child Form – Each adult child must complete this form upon attaining age 19 or when first enrolled in the plan and each calendar year thereafter.
Change of Address Form – Use this to notify the Fund’s of your new address.
Disability Claim Form – Members can use this form to file for weekly income benefits if you become disabled.
Enrollment Form with Required Documents List– Every eligible member must complete an Enrollment Form in order to activate their eligibility for benefits. A new form must be completed to add dependents to a plan.
HIPAA Authorization Form– One of the most significant effects of the privacy laws is that the Welfare Fund may no longer discuss your health information (including eligibility information) with your family members without your specific written authorization. Please have each family member that is 18 years old and over complete an authorization.
