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Gerard Gallagher, our Director of Health Benefits attended the Health Benefit Plan seminar—October 18-21 at the Flamingo Las Vegas. More NALC HBP Director Tim O'Malley announced plans for the open season. Participants learned about the enhanced benefits being added to the NALC Health Plan for the 2010 benefit year.
Our branch president, Jim McCullough continues to send our members to appropriate training. With that training, our branch continues to be one of the most educated in the country. For any questions on the NALC Health Plan, contact Gerry at the union office! (610) 461-8333
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Health Benefits
by Gerry Gallagher
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How the Plan Changes in 2010
Changes to this Plan
- We now cover removal of impacted teeth that are not completely erupted.
- We now cover repair of existing orthotics, with a maximum Plan payment of $100 every 3 years.
- We now cover the initial office visit associated with a routine colonoscopy and sigmoidoscopy screening
- We now cover 1 hemoglobin A1C and 1 2-hour blood sugar test every 3 years for adults with medical indications as recommended by the U.S. Preventive Services Task Force (USPSTF).
- We now cover 1 human papillomavirus (HPV) screening every 3 years for adult women ages 30 through 70.
- We now cover hepatitus A and B vaccine for adults age 19 and older with medical indications as recommended by the CDC.
- We now cover an annual routine urinalysis for children age 5 through 21 and an annual routine hemoglobin/hematocrit test for females, ages 11 through 21.
- We now cover a routine screening test for congenital hypothyroidism, phenylkentonuria(PKU) and sickle cell done in the office for newborns.
- We now pay the Plan allowance for non-PPO air ambulance at the PPO benefit level. Previously, you paid 30%.
- We now pay 55% for prescriptions purchased at the non-network pharmacy. Previously, we paid 50%.
- You will now pay nothing for covered lab services performed by LabCorp, Previously you paid 10%.
You now pay $5.00 for a 90-day supply of NALC Select generic medications purchased through mail order. You pay $4.00 for these NALC Select generic medications when Medicare Part B is your primary carrier. Previously, for prescriptions on the NALC Select generic list, you paid $12.00. You previously paid $10.00 if Medicare Part B was your primary carrier.
- You now pay nothing for a routine pap or a chlamydial test for female dependent children when the test was rendered by a PPO provider. If you use a non-PPO provider, you will pay the difference, if any, between our allownace and the billed amount.
- You now pay nothing for immobilization by splinting or strapping of a sprain, strain or fracture when you receive care within 72 hours of an accidental injury. Previously, when you used a PPO provider, you paid 10% of Plan allowance for the surgury and 15% of the Plan allowance for the outpatient facility. If you used a non-PPO provider, you previously paid 25%.
- You now pay 20% of the cost of generic drugs and 30% of the cost of brand name drugs for up to a 30-day supply of a covered prescription purchased at an NALC CareSelect network pharmacy and Medicare Part B is the primary carrier. Previously, you paid 15%.
- You now pay a $300 per person ($600 per family) calendar year deductible. Previously, you paid a $250 per person ($500 per family) PPO calendar year deductible. If you used non-PPO providers, your calendar year deductible was #300 per person ($600 per family).
- You now pay a $300 per person ($600 per family)mental health and substance abuse calendar year deductible. Previously, you paid a $250 per person ($500 per family) in-network mental health and substance abuse calendar year deductible.If you used out-of-network mental health and substance abuse providers, your calendar year deductible was $300 per person ($600 per family).
- Your catastrophic protection out-of-pocket maximum is $5,000 per person or family for PPO providers and $7,000 per person or family for PPO and non-PPO providers combined. Previously, it was $4,000 and $6,000.
- You now pay 15% for covered services rendered by PPO physicians and other health care profesionals. Previously, you paid 10%.
- You now pay 30% for covered services rendered by non-PPO physicians and other health care professionals. Previously, you paid 25%.
- You now pay 10% for transplant services obtained through the CIGNA LIFESOURCE Transplant Network. Previously, you paid nothing.
- You now pay a $200 copayment per admision for non-maternity inpatient room and board and other hospital services and supplies in a PPO hospital. If you use a non-PPO hospital, you will pay a $300 copayment plus 30% of the Plan allowancde. Previously, you paid a $100 copayment per admision for non-maternity inpatient room and board and other hospital services and supplies in a PPO hospital. If you used a non-PPO hospital you previously paid a $100 copayment plus 30% of the Plan allowance.
- You now pay $43.00 for up to 60-day supply and $65.00 for a 90-day supply of brand name drugs purchased through our mail order program. Previously, you paid $24.00 for a 60-day supply and $35.00 for a 90-day supply.
- You now pay $37.00 fro up to 60-day supply and $55.00 for a 90-day supply of brand name drugs purchased through our mail mail order program when Medicare Part B is the primary carrier. Previously, you paid $20.00 for a 60-day supply and $30.00 for a 90-day supply.
- You now pay $150.00 for a 30-day supply of a specialty drug purchased at a Preferred network or NALC CareSelect network pharmacy, and $350.00 for up to a 90-day supply of a specialty drug purchased through our mail order program. Previously, you paid the applicable cost share for brand name drugs.
- We added fraudulent claims to our list of general exclusions.
- We added custodial care to our list of general exclusions.
- We added "Never Events" to our list of general exclusions.
More to be entered everyday this week! Sorry.
Clarifications
- We clarified the catastrophic protection of out-of-pocket maximum for prescriptions is $4,000 per person or family.
- We clarified the 45% coinsurance for prescriptions purchased at a non-network pharmacy or additional fills at a network pharmacy.
- We clarified you pay a $15 copayment for a second surgical opinion rendered by a PPO provider.
- We clarified bone density study for osteoporosis.
- We alphabetized the screening tests in Preventive care, adult section.
- We clarified benefits with a lifetime maximum.
- We clarified we cover routine prenatal and postnatal visits and anesthesia related to delivery or amniocentesis.
- We clarified we do not cover routine lab tests except as listed in Preventive care children.
- We clarified we do not cover prolotherapy.
- We clarified we cover physical therapy rendered by a chiropractor in a medically underserved area when the services are performed within the scope of his/her license.
- We clarified we cover hearing aids for neurosensory hearing loss.
- We clarified additional vision care discounts are available through our Healthy Rewards program.
- We clarified we may cover alternative treatment providers in medically underserved areas.
- We clarified we offer a weight management program.
- We clarified to which benefits our calendar year deductible applies.
- We clarified implantable devices, surgical hardware, etc. are subject to our Plan allowance.
- We clarified we cover medically necessary local ambulance service to an outpatient hospital under our Accidental injury benefit.
- We clarified our dispensing limitations and how to file a claim for prescription drugs.
- We clarified we cover vitamins and minerals requiring a physician's prescription under federal law.
- We added our website under the Healthy Rewards Program.
- We updated the filing procedure for overseas claims.
**** For further details contact Gerry Gallagher at the union office
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It's so nice to have an outside job mailman!
