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2012 Benefits at a Glance
• As noted above your share of the premiums will increase for Self Only and increase for Self and Family.
• Also as noted the Retiree’s premiums will increase for Self Only and Self and Family.
• Pay $20.00 for office or outpatient visits or consultations rendered by a PPO provider.
• We now cover licensed Acupuncturists. Previously, we only covered acupuncture when performed by a doctor of medicine or osteopathy. We cover 15 visits per person per calendar year.
• We now require prior authorization for Radiology/Imaging services to include CT/CAT, MRI, MRA, NC, and PET scans.
• We added coverage for vaccination with Tetanus-diphtheria, pertussis (Tdap), for adults’ age 65 and older.
• We now cover Haemophilus influenza type b (Hib) vaccine for adults’ age 19 and older with medical indications as recommended by the Centers for Disease Control (CDC).
• We now cover osteoporosis screening as recommended by the U.S. Preventive Services Task Force (USPSTF). Previously, we covered osteoporosis screening for women age 60 and older.
• The plan covers 100% of lab services when the member of the plan goes to a Quest Diagnostics or Labcorp locations.
• Inpatient Hospital Care with PPO provider, $200 Co-Payment per Admission. Non-PPO 30% after $350 per admission co-pay. The member will pay nothing for Inpatient Care for Maternity related medical and nothing for Group B streptococcus infection screening, sonograms, and fetal monitoring as part of your maternity care when rendered by a PPO provider.
• Preventive Care: You pay nothing when rendered by a PPO provider for Routine Annual Physical Exam, Well Child Care through age 2, and Routine Immunizations up to age 21. You now pay 30% (after Calendar year deductible) for preventive care for children when rendered by a non-PPO provider; we cover meningococcal vaccine for children as recommended by the American Academy of Pediatrics. Adult Routine Immunization & Tests.
• Outpatient Hospital Care: You pay 15% after $300 deductible for services rendered by PPO provider and 35% after $300 deductible for Non-PPO service rendered.
• Chiropractic Care: $20 copayment for initial office visit for services rendered by PPO provider, 30% of bill after $300 deductible for services rendered by Non-PPO provider. One initial set of spinal x-rays to include Spinal Manipulations 20 Per Calendar Year, you pay 15% after $300 deductible for these services.
• Prescription Drug Program:
Mail Order:
• 60-day supply: $8 generic/$43 brand name
• 90-day supply: $5 NALCSelect generic
• 90-day supply: $7.99 NALCPreferred generic
• 90-day supply: $12 generic/$65 brand name
Mail Order Medicare
• 60-day supply: $7 generic/$37 brand name
• 90-day supply: $4 NALCSelect generic
• 90-day supply: $4 NALCPreferred generic
• 90-day supply: $10 generic/$55 brand name
Caremark Specialty Pharmacy Mail Order:
• 30-day supply: $150
• 60-day supply: $250
• 90-day supply: $350
Health Risk Assessment (HRA)
A free Health Risk Assessment is available under the ‘Personal Health Record’ tab at www.nalc.org/depart/hbp. The HRA is an online program that analyzes your health related responses and gives you a personalized plan to achieve specific health goals. Your HRA profile provides information to put you on a path to good physical and mental health. Once you complete the HRA, the plan will waive one $20 copayment (when the plan is the primary payor) for a medical office visit or consultation. The plan will waive Two (2) $20 copayments for Self and Family when at least two family members complete an HRA.
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