July 2, 2002

 

PMA PROPOSED TAKEAWAYS  &  “IMPROVEMENTS”

(PMA Calls Them “A Significantly Improved Health Benefits Plan”)

 

  1.  

1.      Raise the Out of Pocket Maximum to $2,000 per Individual , $3,000 per Family, Eliminate the $100 and $300 Deductible, and Eliminate the Basic Benefit.

           

Cost to the Membership Over 3 Years: $6,114,000 (out of take home pay) (Per Joint Plan Consultant June 14, 2002)

           

Most of our members are enrolled in our Coastwise Indemnity Plan. In the Indemnity Plan beneficiaries, except for those in Non-Choice Ports, are eligible for both PPO and 80/20 services.  There is no separate PPO plan or 80/20 plan. It is one plan. Most Indemnity Plan beneficiaries will have to receive both PPO and 80/20 services.  Services received from a PPO provider are paid at 100% but there is no guarantee that the provider or services you need will be available through the PPO or even in the future if a PPO will be a major part of the health care system. Services received from a Non-PPO provider are paid at 80/20.  For Non-Choice Port members if your Port is found to have a qualified PPO you will then be in the Indemnity Plan.  Current HMO members who, in the future, may want to leave the HMO will be in the Indemnity Plan. Everyone is either directly affected by changes in the Indemnity Plan or can be in the future. The Indemnity Plan is a critical part of our freedom of choice and full access to quality health care.  It has been built up over many years through the efforts of dedicated rank and filers and officers of our Union.

 

2.      After July 1, 2002, new registrants in ports with HMO coverage will only be eligible for HMO

      coverage.  This would take away the rights of almost all of our future members to choose our Indemnity Plan.  When we asked for what period of time, the reply was forever.

 

3.  PMA’s no co-pay for generic drugs is accompanied by a $10 co-pay for brand name drugs for which there is a generic equivalent even if your doctor prescribes the brand name and orders do not substitute.

 

4.      Adding a “broader and more comprehensive PPO network”.

 

For over a year prior to negotiations the Union has been urging in depth analysis of our current PPO Networks to increase the percentage of claims paid at PPO rates and determine the adequacy of our existing PPO.  The employers have shown very little interest in supporting this effort.  Throughout that time the Joint Plan Consultant’s  and the Union’s position has been that we should work to improve our existing networks.

 

It has not been established that a new PPO(s) would be better than our existing networks.  In fact the PPO which PMA had proposed did not respond to our previous request for proposal.  We understand they did not want to release proprietary information to our claims department which they view as a competitor.

 

Changing networks would not change or “increase” benefits. The benefits are the benefits regardless of which PPO network(s) we contract with. Despite this we had agreed to put out Requests For Proposals governed by previously agreed to language to see if we can improve our PPO program.  That’s not good enough for PMA. They want to change the agreed to language even though we have clarified that the Plan Consultant would make the final choice.

 

5.      What’s Involved in Eliminating the Basic Benefit - Under Maintenance of Benefits the Trustees monitor the Indemnity Plan to determine whether or not out of pocket costs to beneficiaries have increased.  If so, Basic Benefit allowances are increased.  Examples of the potential impact of elimination of the Basic Benefit follow:

 

The Basic Benefit is paid before any calculation of what percentage the member may have to pay.  Example: on a $100 doctor office visit the Basic Benefit pays $35.19.  For a non-PPO doctor the member would pay 20% of the balance or $12.96.  Without the Basic Benefit the member would pay $20 (20% of $100).

 

The Hospice Basic Benefit pays 100% of usual, customary and reasonable charges for 90 days which can be extended by your physician.  Hospice care can range from $90 to $200 a day.  Without the Basic Benefit the member could pay 20% of the cost.

 

Outpatient Diagnostic X-ray and Laboratory Basic Benefit pays $578.85 per condition each six months for each member or dependent. Major Medical pays the balance at 80/20.  Without the Basic Benefit the member could pay $115.77 (20% of $578.85) in addition to 20% of any balance.  If your spouse or dependents also need x-ray or lab work you could wind up paying the $115.77 for them too.  X-ray and Laboratory facilities are always PPO providers.

 

Lifetime Major Medical Maximum - Payments made under Basic Benefits do not count against the members’ lifetime Major Medical Maximum (currently $2 million).  In effect the Basic Benefit increases the members Lifetime maximum. PMA’s proposed increase to $2.5 million is not supported by any analysis of what would be sufficient to make up for the loss of our basic benefit.  Even with the Basic Benefit the Union demand was to increase the Lifetime Maximum to $3 million.

 

6.        What’s involved in increasing the Out of Pocket Maximum and Eliminating the Deductible?  Currently once an individual or family has paid $1,000 for covered Major Medical expenses, additional covered Major Medical Expenses are paid at 100% of usual, customary and reasonable charges for the remainder of the contract year. Add the $100 individual or $300 family deductible and the most you have to pay in a year is $1,100 or $1,300. Also there is no deductible for PPO services. PMA’s proposal is to raise that to $2,000 per Individual and $3,000 per Family

 

 

"An Injury to One is an Injury to All"

 

 

 

 

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