1. THE NEW HEALTH & WELFARE
For Active Employees
Covered by GA 23000
By
Steve Young
Designated Legal Counsel

2. HEALTH & WELFARE
Member Contribution
• 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.

3. HEALTH & WELFARE
Annual Deductible
• $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.

4. HEALTH & WELFARE
Annual Deductible BLET
• $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.

5. HEALTH & WELFARE
Co-Insurance
• 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

6. HEALTH & WELFARE
Co-Insurance BLET
• 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

7. HEALTH & WELFARE
Example
• 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

8. HEALTH & WELFARE
Example
• 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.

9. HEALTH & WELFARE
Example
• 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

10. HEALTH & WELFARE
Co-Pays
• 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

11. HEALTH & WELFARE
Example
• 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

12. HEALTH & WELFARE
Co-Pays for Prescription Drugs
• $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

13. HEALTH & WELFARE
Co-Pays for Mail Order Drugs
• $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

14. HEALTH & WELFARE
Generic v. Brand Name Drugs
• 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