Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Blet the new health welfare 12 9-11

4,026 views

Published on

Published in: Business, Economy & Finance
  • Be the first to comment

  • Be the first to like this

Blet the new health welfare 12 9-11

  1. 1. THE NEW HEALTH & WELFARE For Active Employees Covered by GA 23000 By Steve Young Designated Legal Counsel
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

×