Announcements

Save the Date!

Annual Health Fair at the Union Hall on Saturday, September 25th

COPAYMENT CHANGES for Kaiser, HealthNet, and PacifiCare

The office visit copay for most professional services will increase from $10 per visit to $15 per visit.
The inpatient and outpatient Hospital copay will increase from $0 to $100 per admission for inpatient hospital and per procedure for outpatient procedures.
The Emergency Room copay will increase from $50 to $100. The copay will be waived if you are admitted to the hospital as an inpatient.

COINSURANCE CHANGE – USE OF OUT-OF-PPO NETWORK PROVIDERS

The Trust’s Self-Funded Medical Plan operates by using a deductible and coinsurance system. A deductible is the amount of money you pay before the Plan begins paying a portion of your benefits. Coinsurance is the ratio percentage that you share with the Plan in covering medical expenses after reaching the deductible. Out-of-Pocket Maximum is the total dollar amount that you must spend on health care expenses, excluding the deductible, before the Plan will pay 100% of any future charges.

Effective January 1, 2009, if you utilize an out-of-network provider for services, the coinsurance percentage that the Plan pays will be reduced from 80% to 60%. Also, your out-of-pocket maximum when using an out-of-network provider for services will now be capped at $5,000 per person, $10,000 per family. Formerly, there was no cap and you paid 20% out-of-pocket for ALL expenses.

PRESCRIPTION DRUG PROGRAM CHANGES

The prescription drug benefit administered by RESTAT has added two new programs that apply to prescriptions on or after January 1, 2009:

Step Therapy Program
This program requires the use of less expensive generic drugs or brand equivalent drugs before allowing the use of a more expensive non-preferred drug within selected drug classes. Drug classes and medical conditions in this program include: GI/Ulcer Proton Pump Inhibitors, Antihistamines, Antidepressants, Hypertension, Cholesterol and Asthma. This program ensures that you receive the clinically appropriate, most cost-effective medication based upon your prescription history.

Specialty Pharmacy Program
This program provides clinical management and distribution services for specialty medications for individuals living with chronic illness.
Participants and providers must order specialty medications exclusively through the Specialty Pharmacy Program administered by RESTAT.

What are specialty medications?

Specialty medications are primarily available as injectable drugs, infusions and inhalants. They usually require special handling, such as temperature-controlled packaging, individual dosing or express delivery. These drugs are also typically administered in a physician’s office, through home infusion therapy, or in-home health agency and infusion suites.

All Self-Funded Medical Plan participants will soon receive a separate mailing from RESTAT, the Trust’s pharmacy benefit manager, providing detailed information on these two new prescription drug benefit programs.