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EMPLOYEE Medical Benefits provided by the Hospital Association, properly known as "Union Pacific Employee Health Systems" (UPREHS). However, the dental and vision benefits are not provided by UPREHS, nor are your dependents covered under this plan (exception: an enrolled Medicare spouse). Dues are currently $100 per month and are deducted from the first half payroll each month (i.e., the check you receive on or about the 30th of the month). The latest regulations were amended on October 1, 2002. The most updated list of providers is available on the Internet or by calling directly to the Salt Lake City office. A pharmacy drug formulary was issued in January 2001. Members have a co-pay of $15 for each office visit and plus co-pay for pharmacy in multiples of $5 per 30 day’s prescription (i.e., $5 generic, $10 name brand). If an out-of-network healthcare provider is used, even on a referral basis, UPREHS will only pay 80% of the reasonable and customary charge after the co-pay; benefits are greatly reduced if members to seek healthcare outside the network (see chart on next two pages). The address is 795 North 400 West, Salt Lake City UT 84103-1452. The toll-free number is 800-547-0421 The fax number is 801-595-4399 The Internet address is http://www.uphealth.com/ The pharmacy address is PO Box 3228, Ogden, UT 84409 The pharmacy number is 800-331-6353 The pre-approval number is 800-572-5508. This number must be called at least 3 days prior to any and all inpatient hospital admissions and certain outpatient procedures or benefits are reduced by 40 percent. Emergency services performed without pre-approval must be reported within 24 hours to avoid the 40 percent reduction. UPREHS also offers an optional plan of secondary insurance, referred to as CHC Supplemental, for an additional $60 per month (deducted from same check as your normal dues). This plan provides coverage for your dependents over and above what the National Health & Welfare Plan provides, i.e., the remaining 15 percent plus the deductible. It does not provide coverage for anything that has been denied by the primary insurance carrier. BENEFITS SUMMARY FOR CHALLENGER HEALTH PLAN (IN AND OUT-OF-NETWORK SERVICES) FOR DETAILS REFER TO YOUR PLAN DOCUMENT EFFECTIVE July 1, 2002 IMPORTANT: All services must be medically necessary and be covered benefits. Payments for out-of-network services are a percentage of the Plan Allowable Amount, NOT the billed charges.
1Annual Limit $150.00; 75% thereafter 2 Waived if Admitted to Hospital 3 Notify UPREHS Within 24 Hours 4 Co-Pay Required – Mail Order Pharmacy Automated Refills 800-547-0421 5 Hospital Admission Pre-Approval Required (800-572-5508) 6 Call for Pre-Approval – UPREHS Care Coordinator (800-547-0421) 7 Behavioral Health Requires Pre-Approval (888-484-3568) Medical Benefits Coverage for dependents of UTU Members is provided by the "National Railway Carriers and United Transportation Union (NRC/UTU) Health and Welfare Plan." For dependents of those employees eligible for coverage under it, the "NRC/UTU Plan" replaces coverage provided under the traditional "Railroad Employees National Health and Welfare Plan" (Original Plan). The NRC/UTU Plan gives eligible members their choice of two different healthcare plan administrators to provide their benefits. The plan administrator for coverage under the original plan is only United HealthCare (which was originally The Travelers, then MetraHealth). The NRC/UTU Plan offers, in addition to that provided by United HealthCare, coverage provided by Highmark Blue Cross Blue Shield of Pittsburg, PA effective January 1, 2005, replacing the Regence BCBS plan that has been in effect for several years. Healthcare plans available under the NRC/UTU Plan include a Comprehensive Health Care Benefit (CHCB); a Mental Health and Substance Abuse Care Benefit (MHSA); a Managed Pharmacy Services Benefit (MPSB); and a Managed Medical Care Program (MMCP), i.e., HMO. A new benefit, Basic Healthcare Benefit (BHCB), is also offered for those whose healthcare needs are minimal. These Benefits are not insured; they are payable directly by the NRC/UTU Plan. Both United HealthCare and Highmark provide coverage under the CHCB and/or MMCP. Employees living in Colorado can choose to be covered by a MMCP if they desire; otherwise they (and the majority of Local 446 members living in Wyoming and Nebraska) are covered by a CHCB. In either case, the eligible employee may choose whether United HealthCare or Highmark Blue Cross Blue Shield shall be the plan administrator. When the NRC/UTU Plan was negotiated, the benefits offered by both United HealthCare and Regence (now Highmark) were made equal; neither plan administrator can offer greater benefits in an effort to entice business away from the other. The main competition between these plan administrators is found in the service that they provide (e.g., speed of resolving claims, or hassle-free claim handling), and the competitive rate paid by the nation’s rail carriers in order to provide the contractual coverage, which is a major factor in negotiating our national contract. Your benefits under the Mental Health and Substance Abuse Care Benefit (MHSA) are administered by ValueOptions, Inc. Formerly some of you were covered by Magellan, but they are no longer part of the team. The Managed Pharmacy Services Benefit (MPSB) is administered by Merck-Medco Rx Services, regardless of whether United HealthCare or Blue Cross is chosen. You should have a booklet explaining the NRC/UTU Plan; it has a light blue cover and was made effective January 1, 2000. There is an open enrollment period each October to afford employees the opportunity to change plan administrators for the coming year. The opportunity to change between MMCP and CHCB is also given during the enrollment period. Toll-free telephone numbers are provided in the summaries below. Dental Employee and dependents Dental Benefits are provided under the Railroad Employees’ National Dental Plan administered by Aetna Insurance Company. Eligibility is based upon completing one (1) year of service with the same railroad and commences on the first day of the calendar month following that requirement. Employee must also meet the previous-month-seven-day requirement. Vision Employee and dependents Vision Benefits are provided under the Vision Service Plan. Eligibility is based upon completing one (1) year of service with the same railroad and commences on the first day of the calendar month following that requirement. Employee must also meet the previous-month-seven-day requirement.
Benefit Contacts and Plan Overview
Metropolitan Life Insurance Company – Railroad Employees National Health and Welfare Plan (Original Plan) (GP-1023000-G) Life Insurance and Accidental Death and Dismemberment (AD&D) Benefit Dues: None. Plan Overview: This is a paid-up life insurance plan provided by the National Plan. Group Life in the amount of $10,000, reduces to $2,000 paid-up life at retirement. $8,000 is maximum benefit for accidental death and dismemberment. NOT TO BE CONFUSED WITH METLIFE OPTIONAL COVERAGES PLAN DESCRIBED BELOW. Crafts Covered: All crafts including Hospital Association members. (Dependents are not covered). Telephone Contact & Claim Address: Metropolitan Life Insurance Company 800-310-7770 MetSource Life Recordkeeping Center, P.O. Box 6122, Utica, NY 13504-6122
=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= Metropolitan Life Insurance Company – OPTIONAL Contributory Group Life & AD&D Insurance (Formerly Equitable)Dues: Premiums vary with age of employee and the amount of insurance purchased. Plan Overview: Employees can purchase either Optional Group Term Life Insurance and/or Voluntary Accidental Death & Dismemberment Insurance for themselves and dependents. Crafts Covered: All crafts. (Employees must sign up within first year of employment). Telephone Contact & Claim Address: Metropolitan Life Insurance Company 800-357-4482 MetSource Life Recordkeeping Center, P.O. Box 6129, Utica, NY 13504-6129
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The Aetna Life Insurance Company / Aetna U.S. Healthcare - Railroad Employees National Dental Plan (GP-12000) Plan Booklet amended through January 1, 1999. Dues: None – But must meet "Requisite Amount" of service. Plan Overview: Provides benefits to cover dental expenses incurred by a covered employee and eligible dependents. Crafts Covered: All crafts Telephone Contact: 877-277-3368 (877-2RR-DENT) or 616-942-6400 Internet Address: www.aetna.com
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Union Pacific Employee Health Systems (UPREHS) - Challenger Health Plan Plan Booklet amended through October 2000. Dues: $100 per month, deducted from first pay period in month (the check you receive on the 30th). Plan Overview: Provides medical, surgical, hospital, prescription drugs, mental health and substance abuse for the employee. Provides optional CHC Supplemental Family Plan for dependents to pick up the deductible and the remaining 15% that is not paid by the healthcare plan for dependents (Note: will not pay on what is not covered by such dependents’ plan). Cost: $60 per month additional. Crafts Covered: All crafts. Telephone Contact: 800-547-0421 Fax: 801-595-4399 Mental Health / Substance Abuse 888-484-3568 The pre-approval number is 800-572-5508. This number must be called at least 3 days prior to any and all inpatient hospital admissions and certain outpatient procedures or benefits are reduced by 40 percent. Emergency services performed without pre-approval must be reported within 24 hours to avoid the 40 percent reduction. The address is 795 North 400 West, Salt Lake City, UT 84103-1452. The Internet address is http://www.uphealth.com/
=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= National Railway Carriers and United Transportation Union Health and Welfare Plan – (NRC/UTU Plan) Group # 690100 for dependents of employees; one has choice of administrators (two separate packages) from year to year via open enrollment each October. Plan Booklet amended through January 1, 2000. Dues: None – But must meet "Requisite Amount" of service. Plan Overview: Provides medical, surgical, hospital (under CHCB, BHCB or MMCP where available), prescription drugs (MPSB), mental health and substance abuse for the dependents (MHSA). Crafts Covered: All Crafts. Telephone Contact & Claim Addresses for the Choices of Healthcare Package Options Available: 1) United HealthCare: CHCB, MMCP or BHCB plans, 800-691-0013 or 888-445-4379 Send claims to P. O. Box 30985, Salt Lake City, UT 84130-0985 For mandatory prior approval for certain tests and procedures 800-842-4555 To Report Suspicious Billing and Fraud 800-414-2013
ValueOptions: MHSA (800-934-7245) Merck-Medco: MPSB (800-842-0070) OR 2) Highmark BlueCross BlueShield: CHCB, MMCP or BHCB
For mandatory prior approval for certain tests and procedures 800-452-8507 Internet Address: http.//www.highmark.com 3) ValueOptions: MHSA 800-934-7245 4) Merck-Medco: MPSB 800-842-0070
MMCP = Managed Medical Care Program (not available in Wyoming) BHCB = Basic Healthcare Benefit
MPSB = Managed Pharmacy Service Benefit
=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= Railroad Employees National Early Retirement Major Medical Benefit Plan Group GA-46000: United HealthCare. Dues: None for basic GA-46000; if Plan E supplemental coverage is attached, dues are currently $130 per month per person. Plan Overview: Provides major medical benefits and a managed pharmacy benefit to dependents of eligible retired and disabled railroad employees; however will cover these employees only if not covered by UPREHS. Eligibility for Medicare ceases coverage under this plan. Crafts Covered: All crafts Telephone Contact & Claim Address: GA-46000 (incl Plan E): 800-842-5252 or 800-842-9905
For mandatory prior approval for certain tests and procedures: 800-842-4555 To Report Suspicious Billing and Fraud 800-414-2013 Internet Address: http://www.myuhc.com/ =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= Group GA-23111: United HealthCare Dues: Plan C - $370 (employee or dependents) / $50 (student child) / $175 (incapacitated child); Plan D - $325 Medicare Supplement; Plan F - $140, Medicare Supplement; all per month per person. The various plans provide different levels of coverage as options. Plan Overview: Provides major medical benefits for furloughed, dismissed and retired railroad employees and their dependents when coverage under GA-23000, GA-46000 or GA-690100 ends. Plan D is available as a supplement to Medicare. Crafts Covered: All crafts Telephone Contact & Claim Address: Plan C: 800-842-5252 or 800-842-9905
Plan D or F: 800-809-0453 P. O. Box 30304, Salt Lake City, UT 84130-0304 For mandatory prior approval for certain tests and procedures: 800-842-4555 To Report Suspicious Billing and Fraud 800-414-2013 Internet Address: http://www.myuhc.com/ =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=
MENTAL HEALTH AND SUBSTANCE ABUSE MHSA Benefit included in both NRC/UTU Plan and Original Plan Dues: None – But must meet "Requisite Amount" of service. Plan Overview: Provides mental health and substance abuse (MHSA) managed care benefits for all dependents and employees not covered by a hospital Association. Crafts Covered: All Telephone Contact & Claim Address: ValueOptions (if United HealthCare or Highmark is administrator) 800-934-7245 Railroad Unit, Attn: Claims, P. O. Box 1002, Merrifield, VA 22116
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EMPLOYEE: UPREHS Pharmacy Drug Formulary amended to September, 2003.Dues: Included with basic UPREHS dues. Plan Overview: Covers prescription drugs that are medically necessary for employee members. Emergency and one-time-only prescriptions may be obtained from a contract network pharmacy. Medications intended to be taken longer than 30 days must be ordered through UPREHS Mail-Order Pharmacy. Co-Pay: $5 per 30-day supply (generic) or $10 per 30-day supply (name brand) through Mail-Order Pharmacy; $6 (generic) or $8 (brand name) per 30-day supply through contract network pharmacies. Tier 3 Non-Formulary drugs are $40 per 30-day supply through Mail-Order Pharmacy. Telephone Contact: 800-331-6353 or 800-547-0421 The pharmacy address is PO Box 3228, Ogden, UT 84409 The Internet address is http://www.uphealth.com/ =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= DEPENDENT: Merck-Medco Prescription Drug Card Program Group #690100 - (NRC/UTU): Group # GA46000: Dues: None – But must meet "Requisite Amount" of service. Plan Overview: Covers prescription drugs that are medically necessary for dependents. Use of an In-Network Pharmacy is easiest, as you will pay only the co-pay ($2 generic or $6 for brand-name). Use of an Out-of-Network Pharmacy will result in your being reimbursed for 75% of the cost for only the first 21 days, none thereafter; you must make a claim. There is a mail-order program available. Crafts: All Telephone Contact & claim Address: Above named Plans: 800-842-0070 www.merckmedco.comPlan D GA-23111 800-842-0304 PAID Prescriptions, LLC, P.O. Box 702, Parsippany, NJ 07054 =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=
Railroad Employees National Vision Plan Administered by Mid-Atlantic Vision Service Plan, Inc. Plan booklet amended to January 1, 1999. Dues: None – But must meet "Requisite Amount" of service. Plan Overview: Provides benefits for employees and dependents for eye examinations and benefits toward vision care expenses including glasses or contact lenses. Eligibility established after one year of service. Telephone Contact & Claim Address (not necessary if using VSP Doctor):
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SUMMARY
OF CONTINUATION OF COVERAGE (OTHER THAN CONTINUATION
UNDER COBRA
Notes:
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OPTIONAL CONTINUATION OF HEALTH COVERAGE (COBRA) UPREHS (COBRA) or United HealthCare (COBRA) Dues: Yes (premiums) Plan Overview: All employees and their dependents not entitled to Medicare whose medical coverage ends as a result of a termination of employment, reduction in hours, dissolved marriage, failure to meet dependent eligibility status, etc., may continue health coverage at their own expense. Telephone contacts: UPREHS 800-877-0618 United HealthCare 800-842-5252 Trustmark – Supplemental Sickness: 800-669-5066 Provident – Supplemental Sickness: 800-542-4231 COBRA refers to a Federal Law, known as the Consolidated Omnibus Budget Reconciliation Act of 1985, which requires that coverage be provided to those no longer eligible, if they desire, at their own expense; written to avoid non-insurability that some persons encounter.
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