+ All Categories
Home > Business > Blet the new health welfare 12 9-11

Blet the new health welfare 12 9-11

Date post: 29-Nov-2014
Category:
Upload: john-passi
View: 3,506 times
Download: 1 times
Share this document with a friend
Description:
 
14
THE NEW HEALTH & WELFARE For Active Employees Covered by GA 23000 By Steve Young Designated Legal Counsel
Transcript
Page 1: Blet the new health  welfare 12 9-11

THE NEW HEALTH & WELFARE

For Active EmployeesCovered by GA 23000

BySteve Young

Designated Legal Counsel

Page 2: Blet the new health  welfare 12 9-11

• Member contribution reduced to $200. per month January 1, 2012

• Remains $200. through June 30, 2016– Four years frozen– Frozen into first full year of

next negotiations

• July 1, 2016 can be increased to a maximum of $230.

HEALTH & WELFAREMember Contribution

Page 3: Blet the new health  welfare 12 9-11

• $200. annual deductible for in network, non co-pay services for a member

• $400. Annual deductible for in network, non co-pay services for a member’s family

• Applies to NON Co-Pay:– MRI’s– Surgery– X-Rays– Etc.

HEALTH & WELFAREAnnual Deductible

Page 4: Blet the new health  welfare 12 9-11

• $200. annual deductible– Begins July 1, 2012 at 50% $100. – January 1, 2013 75% $150.– January 1, 2014 100% $200.00

• $400. Annual deductible– Begins July 1, 2012 at 50% $200– January 1, 2013 75% $300.– January 1, 2014 100% $400.

HEALTH & WELFAREAnnual Deductible BLET

Page 5: Blet the new health  welfare 12 9-11

• Applies only to Non Co-Pay procedures only

• Plan pays 95% of a Non Co-pay in network procedure with a $1,000. annual cap for the member and a $2,000. annual cap for the member’s family

HEALTH & WELFARECo-Insurance

Page 6: Blet the new health  welfare 12 9-11

• July 1, 2012 50%– $500. member– $1,000. family

• January 1, 2013 75%– $750. member– $1,500. family

• January 1, 2014 100%– $1,000. member– $2,000. family

HEALTH & WELFARECo-Insurance BLET

Page 7: Blet the new health  welfare 12 9-11

• Member goes to the doctor with arm pain. Doctor prescribes medication and rest

• Member pays $20. co-pay and no more

• No deductible or co-insurance payment as this is a co-pay visit

HEALTH & WELFAREExample

Page 8: Blet the new health  welfare 12 9-11

• Member goes to the doctor with arm pain. Doctor prescribes medication and an MRI that costs $1,000

• Member pays co-pay- office visit• Member pays deductible of $200.

– Member’s deductible for the year is met

• Member pays 5% of the remaining $800. which is $40.

HEALTH & WELFAREExample

Page 9: Blet the new health  welfare 12 9-11

• Member meets annual deductible of $200. and co-insurance of $1000

• Member’s family incurs non co-pays bills of $22,000. Member then pays a $200. deductible and an additional $1,000. co-insurance

• Gets credit towards family deductible and co-insurance

• Member only has co-pays for remainder of the year

HEALTH & WELFAREExample

Page 10: Blet the new health  welfare 12 9-11

• Emergency Room Co-pay will be $75. UNLESS the visit results in an admission

• $20. Co-pay for urgent care facilities

• $10. Co-pay for convenient care clinic– health care facility typically located

in a high traffic retail store, supermarket or pharmacy that provides affordable treatment for uncomplicated minor illness and/or preventative care to consumers

HEALTH & WELFARECo-Pays

Page 11: Blet the new health  welfare 12 9-11

• Member goes to ER with skin rash and is treated and released for poison ivy.

• Total charges are $625.• Member pays $75. co-pay• Member pays $200.

deductible• Member pays 5% of

remaining balance of $375. of $17.50

• Convenient Care clinic would only require $10. Co-pay

HEALTH & WELFAREExample

Page 12: Blet the new health  welfare 12 9-11

• $5. Co-pay for in network GENERIC drugs

• $25. Co-pay for in network BRAND name drugs

• $45. Co-pay for in network drug not on the plan’s formulary list of drugs

HEALTH & WELFARECo-Pays for Prescription Drugs

Page 13: Blet the new health  welfare 12 9-11

• $5. Co-pay for in network GENERIC drugs

• $50. Co-pay for in network BRAND name drugs

• $90. Co-pay for in network drug not on the plan’s formulary list of drugs

HEALTH & WELFARECo-Pays for Mail Order Drugs

Page 14: Blet the new health  welfare 12 9-11

• Generic prescription plan to encourage transfer from brand name to generic drug– Voluntary program

• Prior authorization, step therapy, quantity & duration, Generic prescription program will be applicable to GA 46000 (retiree plan) on January 1, 2012

HEALTH & WELFAREGeneric v. Brand Name Drugs


Recommended