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THE NEW HEALTH & WELFARE
For Active EmployeesCovered by GA 23000
BySteve Young
Designated Legal Counsel
• 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
• $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
• $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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• $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
• $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
• 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