Health & Welfare

IMPORTANT INFORMATION

What You See in the News and What it Means to You:

The Affordable Care Act (Health Care Reform)
and Your Over Age 19 Dependent Child

Much has been written about this Act’s provision on covering dependent children to age 26 on their parents’ medical plans. Today and in the immediate future, the maximum age rules are unchanged: up to age 23 if a full-time student, up to age 19 if not. The portion of the federal law that requires dependent coverage through the end of the year they reach age 26 doesn't go into effect until the first ‘plan year’ starting "on or after" Sept. 23, 2010. The law contains a provision with delayed effective dates for collectively bargained plans.

We expect Congress to fine-tune the details and requirements of the Affordable Care Act (Health Care Reform) in the coming months as it relates to your 19-26 year old child who is not currently eligible for H&W coverage or who may lose eligibility in the coming months.   This Act is very extensive --   A good website to watch is www.healthreform.gov.

With the assistance of legal counsel, the Fund Administrator and Board of Trustees will stay in tune with how the health reform act impacts Local 399’s plan and how and when to implement the requirements of this new complex law.

COBRA Continuation Coverage Subsidy

Those H&W participants who have been laid off from their job may have been eligible for a federal subsidy of their COBRA premium.

At this time, Congress has not extended that subsidy for those who are laid off (involuntarily terminated) after May 31st.

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INTRODUCING A NEW RADIOLOGY NETWORK – Local 399’s H&W Fund has contracted with a diagnostic imaging network called DBM (Diagnostic Benefit Management) effective January 1, 2010. Their toll-free number is (800) 331-5720.

Providers in this network meet high credentialing standards for quality. The imaging providers are mainly free-standing facilities rather than hospital outpatient departments. There are over 150 DBM network facilities in the area and almost 4,000 network facilities nationwide.

The advantage to you is that the cost of the imaging test will be lower overall resulting in less out of pocket for you. The contracted amounts charged for tests done through this network are less than a hospital, and there is no additional charge for interpreting the test from a radiologist. Tests performed in these DBM facilities result in one global fee depending upon the exact test. Benefits will be paid to DBM at the in-network benefit level of 90%, subject to deductible.

DBM does the scheduling in a facility convenient for you, helps you with questions, gets pre-authorization when applicable, notifies your physician when you are scheduled and provides the physician with the results. Call DBM's toll-free number (800) 331-5720 to start the process.

These imaging tests, numbering about 2,000 per year, currently represent almost 10% of H&W Plan costs. We anticipate this network to be a positive change to decrease costs and increase service to the plan participants.

IMPORTANT NEWS: Plan Improvements Effective January 1, 2010

MEDICAL – Your lifetime plan maximum for medical claims has been increased from $1 million to $1.5 million.

PRESCRIPTION DRUGS – Your calendar year maximum for prescription drugs will be increased from $15,000 to $20,000.

DENTAL – Your benefit for removal of fully impacted teeth will no longer be applied to the dental calendar year maximum. The claims will continue to be administered by Delta Dental and subject to all other plan provisions.

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COLLEGE STUDENT IN THE FAMILY?

If your son or daughter is between 19 and 23 and is a full-time student in an accredited educational institution - remember to send the Fund Office proof of their Fall, 2010 full-time enrollment in the first month of the semester. Don't wait until your child needs a prescription or medical care to find out their coverage was suspended. You may be able to use a national website to obtain ths document by going to: www.studentclearinghouse.org.