Teamsters Local 631 Security Fund for Southern
Nevada
Important Notice
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What's New? |
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New Co-payments under the Indemnity and HMO Plans
As the result of rising healthcare costs, the Board of Trustees has investigated and discussed ways to cut Plan costs while keeping as high a level of benefits as possible for Plan participants. At its recent meeting, the Trustees decided to make changes to both the Indemnity Medical and HMO plans. In most cases these changes will result in slightly higher co-payments for medical services and prescription drugs. The Board of Trustees is making these changes to preserve the ability of the Fund to provide health and welfare benefits to its members into the future. Following is a brief description of the changes:
For the Indemnity Medical Plan, all co-payments that are currently less than $20 will be increased to $20. For example, the co-payment for primary physician office visits will be increased from $10 to $20, while the co-payment for lab tests will increase from $5 to $20. Co-payments that are currently $20 or higher will not be changed.
For the Health Plan of Nevada (HPN) HMO Plan, new medical and prescription drug plans are being introduced. The new medical plan replaces the current $10 co-payment for office visits with a $20 co-payment. While several of the co-payments will increase under the new plan, some co-payments, such as for surgical services and outpatient hospital elective procedures will decrease under the new plan.
The retail prescription drug co-payments for members covered by HPN will be increased from a flat $6 co-payment for all “Preferred” drugs (drugs which are on the HPN formulary) to a three tier $7/$15/$40 plan. Under this plan, the member pays $7 for Preferred Generics, $15 for Preferred Brand Name drugs when no generic equivalent is available, and $40 for Non-Preferred Generic or Brand Name drugs. For Preferred Brand Name drugs when a generic equivalent is available, the member pays $7 plus the difference in cost between the Brand Name drug and the generic equivalent. One benefit of the $7/$15/$40 Rx plan over the current benefit is that non-Preferred drugs will be covered at the $40 co-payment. Under the current benefit, members pay the full cost of non-Preferred drugs.
For the PacifiCare HMO Plan, new medical and prescription drug benefits are also being implemented. The co-payments for primary care physician office visits will be increasing from $10 to $20. Prescription drug co-payments will be increased from a flat $6 to a three-tier co-payment level with co-payments of $10 for generic “Preferred” drugs (drugs on the PacifiCare formulary), $20 for Brand Name Preferred drugs, and $30 for Non-Preferred drugs. One benefit of the $10/$20/$30 Rx plan over the current benefit is that non-Preferred drugs will be covered at the $30 co-payment. Under the current benefit, members pay the full cost of non-Preferred drugs.
Please note that co-payment changes for the HMO’s are applicable to Actives and to
Non-Medicare Retirees only. The Medicare Risk Plans for Retirees who are Medicare eligible are not affected.
The open enrollment materials you are receiving with this mailing contain a benefit comparison between the newly revised Indemnity, HPN and PacifiCare plans. If you find that you have specific questions about the new benefit plan designs which are not answered by these summary benefit comparisons, you may request the Fund Office to send you more detailed packets about either or both of the HMO plans. After the open enrollment period, members continuing in one of the HMO plans or newly electing one of the HMO options, will receive a packet of information about the plan prepared by the HMO (PacifiCare or HPN.)
Elimination of Indemnity Option for Retirees
For many years now, the Board of Trustees has observed that premiums paid to the HMOs for retiree medical coverage have been significantly less than the cost of retiree coverage under the Indemnity Plan. This is due in part to the HMOs cost-containment efforts and in part to higher retiree cost sharing in the HMO plans.
In further efforts to control rapidly increasing retiree costs, the Board of Trustees has decided to eliminate the Indemnity Plan option for retirees. Retirees will need to enroll in the PacifiCare or Health Plan of Nevada HMO plan, or, if living outside of the service area for both HMOs, will need to make arrangements for alternative coverage. The Fund will subsidize the cost of health and welfare benefits (medical, prescription drug, dental, vision and life) by $200 per retiree per month. Retirees will be receiving a separate mailing detailing the remaining costs which retirees will need to pay to continue coverage under the HPN or PacifiCare plans. For retirees enrolling in managed care plans outside of the HPN or PacifiCare service areas, the Plan will reimburse the retiree for the cost of coverage up to $200 per month.
Coverage for dental and vision benefits will still be available for an additional self-pay rate. Retirees who opt out of dental coverage at retirement are still not allowed to add the coverage at a later date.
You may also visit our website at www.swadmin.com
Teamsters Local 631 website at www.631trustfunds.com
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