ARTICLE
XV - BENEFITS PROVIDED UNDER THE RAILROAD
EMPLOYEES NATIONAL
Section
I - Continuation of Plan
Except as provided in this Article, the
benefits and other provisions under the Railroad Employees National Health and
Welfare Plan will be continued. Contributions to the Plan will be offset by the
expeditious use of such amounts as may at any time be in Special Account A or in
one or more special accounts or funds maintained by the insurer in connection
with Group Policy Contract GA-23000, and by the use of funds held in trust that
are not otherwise needed to pay claims, premiums or administrative expenses
which are payable from trust.
Section
2 - Benefit Changes
The following changes in benefits
provided under the Plan and in matters related to such benefits will be made:
(a) Hospital Pre-Admission &
Utilization Review Program -This program shall include a comprehensive guidance
and support structure for employees and other beneficiaries covered by the Plan
and their physicians beginning prior to planned hospitalization and continuing
through recovery period. The program shall include, among other things, review
of the propriety of hospital admission (including the feasibility of ambulatory
center or out-patient treatment), the plan of treatment including the length of
confinement, the appropriateness of a second surgical opinion, discharge
planning and the use of effective alternative facilities during convalescense.
Reduced benefits will be provided if the program is not fully complied with.
This program shall become effective not earlier than January 1, 1986 in order to
provide adequate time to set up and communicate the program.
(b) Extension of Benefits - Vacation
pay received by a furloughed employee shall not qualify such employee for any
benefits under the Plan and will not generate premium payments on his behalf.
This change shall become effective January 1, 1988.
(c) Reinsurance - Reinsurance will be
discontinued not later than December 31, 1985.
Section
3 - Special Committee
(a) A Special Committee selected by the
parties will be established for the purpose of reviewing and making
recommendations concerning ways to contain health care costs consistent with
maintaining the quality of medical care; and reviewing the existing Plan
structure and financing and making recommendations in connection therewith. In
addition, the Committee may review and make recommendations with respect to any
other matter included in the parties' notices with respect to the health care
plan.
(b) The Committee shall retain the services of a recognized expert on health
care systems to serve as a neutral chairman. The fees and expenses of the
chairman shall be paid by the parties.
(c) The Committee shall be convened as
promptly as possible and meet periodically until all of the matters that it
considers are resolved. However, if the Committee has not resolved all issues by
May 1, 1986, the neutral chairman will make recommendations on such unresolved
issues no later than June 1, 1986. Upon voluntary resolution of all issues or
upon issuance of recommendations by the neutral chairman, whichever is later,
the Committee shall be dissolved.
(d) The proposals of the parties
concerning health benefits (specifically, the organization's proposals dated
January 23, 1984, entitled "Revise Contract Policy GA-23000" and the
carriers' proposals dated on or about January 12, 1984, entitled "C.
insured Benefits") shall not be subject to the moratorium provisions of
this Agreement, but, rather, shall be held in abeyance pending efforts to
resolve these issues through the procedure established above. If, after 60 days
from the date the neutral Chairman makes his recommendations, the parties have
not reached agreement on all unresolved issues, the notices may be progressed
under the procedures of the Railway Labor Act, as amended.
(e) Agreement reached by the parties on
these issues will provide for a contract duration consistent with the provisions
of Article XVII of the Agreement, regardless of whether such agreement occurs
during the time that the proposals of the parties are held in abeyance or
subsequent to the time that they may be progressed in accordance with the
procedures of the Railway Labor Act as provided for above.