THE NEW HEALTH & WELFARE      For Active Employees      Covered by GA 23000                By           Steve Young     De...
HEALTH & WELFARE               Member Contribution• Member contribution  reduced to $200. per month  January 1, 2012• Rema...
HEALTH & WELFARE                 Annual Deductible• $200. annual deductible for in  network, non co-pay services  for a me...
HEALTH & WELFARE            Annual Deductible BLET• $200. annual deductible  – Begins July 1, 2012 at 50% $100.  – January...
HEALTH & WELFARE                 Co-Insurance• Applies only to Non Co-Pay  procedures only• Plan pays 95% of a Non Co-  pa...
HEALTH & WELFARE                Co-Insurance BLET• July 1, 2012 50%   – $500. member   – $1,000. family• January 1, 2013 7...
HEALTH & WELFARE                   Example• Member goes to the doctor  with arm pain. Doctor  prescribes medication and  r...
HEALTH & WELFARE                      Example• Member goes to the doctor with  arm pain. Doctor prescribes  medication and...
HEALTH & WELFARE                    Example• Member meets annual  deductible of $200. and co-  insurance of $1000• Member’...
HEALTH & WELFARE                         Co-Pays• Emergency Room Co-pay will  be $75. UNLESS the visit  results in an admi...
HEALTH & WELFARE                    Example• Member goes to ER with skin  rash and is treated and  released for poison ivy...
HEALTH & WELFARE       Co-Pays for Prescription Drugs• $5. Co-pay for in network  GENERIC drugs• $25. Co-pay for in networ...
HEALTH & WELFARE        Co-Pays for Mail Order Drugs• $5. Co-pay for in network  GENERIC drugs• $50. Co-pay for in network...
HEALTH & WELFARE        Generic v. Brand Name Drugs• Generic prescription plan to  encourage transfer from  brand name to ...
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Blet the new health welfare 12 9-11

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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

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