(The following is a reprint of an article of great interest from the International's website)
UTU WINS REDUCTIONS IN CO-PAY AMOUNTS
Members covered by the NRC/UTU Health and Welfare Plan and the Railroad Employees National Health and Welfare Plan will soon have a significant health-insurance benefit improvement.
Effective Nov. 1, office visit co-pays required under the Managed Medical Care Program (MMCP) for in-network nurse practitioners, physician’s assistants, physical therapists and chiropractors will be lowered from $35 to $20.
In addition, a new supplemental discount program will soon be applied to charges for out-of-network services and for charges under the comprehensive benefit that should result in considerable savings to participants.
Co-pays under the July 1, 2008, national rail agreement were set at $35 for specialists as one of several inseparable plan design changes that facilitated the unprecedented expansion of MMCP to almost all geographical areas of the country.
As a result of the MMCP expansion, virtually all members covered by the national health and welfare agreements can now enjoy the lower out-of-pocket costs and unlimited lifetime cap of managed care as opposed to the 85/15 co-insurance arrangement of the comprehensive benefit with its $1-million lifetime cap and annual deductibles.
Notwithstanding the tremendous advantages of the MMCP expansion, the placement of co-pays for nurse practitioners, physician’s assistants, physical therapists and chiropractors in the higher "specialist" provider category had substantial impact on some members and was a benefit change the UTU fought hard to avoid.
At that time, the UTU was unable to achieve the lower $20 co-pays it sought, and the agreement sent to members for ratification in 2008 reflected the $35 co-pays.
However, by steadfastly pursuing the issue with the carriers through its status as a joint policyholder, the UTU was able to achieve a reduction in co-pays through jointly agreed upon action during the moratorium period between contracts.
Likewise, the implementation of the new supplemental discount program was also the result of action by the plan’s governing committee.
Benefits improvements between contracts are extremely rare, and UTU is pleased to have achieved these important plan improvements on behalf of its members.
