News & Changes

Active Employees – PPO*
• In-Network Coinsurance for Basic Services will be 90% (rather than the current rate of 100%). This means the Plan will pay 90% of the allowable charges and you will be responsible for the remaining 10% of the allowable charges for Basic Services.  With this change, there will be a $500 Out-of-Pocket Maximum** per person per year for In-Network services. For example, if you have a $3,000 bill for in-network medical expenses, $300 (10%) will be applied towards the $500 Out-of-Pocket Maximum. If you then incur another $2,000, $200 (10%) will be applied and your $500 Out-of-Pocket Maximum will be satisfied for the year.
• For Supplemental Services, the In-Network Coinsurance will remain at 80% and the Out-of-Network Coinsurance will remain at 70%. There is no Out-of-Pocket Maximum for Supplemental Services.

Pre-65 Non-Medicare Eligible Retirees – PPO/POS*
• In-Network Coinsurance for Basic Services will be 85% (rather than the current rate of 100%). This means the Plan will pay 85% of the allowable charges and you will be responsible for the remaining 15% of the allowable charges for Basic Services.  With this change, there will be a $3,750 Out-of-Pocket Maximum** per person per year for In-Network services.
• There will be a new annual $300 per person/$1,200 per family deductible for Basic Services. These deductibles will need to be satisfied each calendar year.
• For Supplemental Services, the POS In-Network Coinsurance will be 85% and the Out-of-Network Coinsurance will remain at 60%, while the PPO In-Network Coinsurance will remain at 70% and the Out-of-Network Coinsurance remains at 60%. There is no Out-of-Pocket Maximum for Supplemental Services.

*Deductibles and coinsurance do not apply to services where copayments are made.
**The Out-of-Pocket Maximums do not include Plan deductibles.

Prescription Drug Benefit Changes For All Participants

Current Copay Amount	New at Retail(30 day supply)	New at Mail Order(90 day)
Generic  10%	10%; $5.00   minimum	10%; $10.00 minimum
Formulary Brand 10%	10%; $15.00 minimum	10%; $30.00 minimum
Non-Formulary Brand 10%	10%; $30.00 minimum	10%; $60.00 minimum

Note: The maximum copayment per prescription remains unchanged at $75.00 for retail and the maximum copayment per prescription has been increased to $150.00 at mail order.

Specialty Prescription Drug Benefit Changes
Specialty prescriptions dispensed through Diplomat Pharmacy will have a $50.00 minimum and $100.00 maximum copayment per each 30 day supply prescription.

Changes in Monthly Self-Pay Contribution Rates for Pre-65 Retirees
The new monthly self-pay contribution rate for individuals will be $500 as of July 1, 2010 (current rate is $400) – and there will be an additional $400 monthly contribution required for each covered dependent. These new rates apply to all retirees regardless of their retirement date and will be based on the ages of the retiree and his/her dependent(s). For example, if you are a retiree under age 65, but your spouse is age 65 or older, you will be charged the under age 65 individual rate ($500) and your spouse will be charged the age 65 and over individual rate ($300).

Changes in Monthly Self-Pay Contribution Rates for Medicare-Eligible and Post-65 Retirees
The chart below highlights the new rates that will apply to members who retired on or after January 1, 2005. All other retiree rates will increase by $50, regardless of the current monthly self-pay contribution rate. The contribution rate is based on the ages of the retiree and his/her spouse. For example, if you are a retiree age 65 or older and your spouse is under age 65, you will be charged the age 65 and over individual rate and your spouse will be charged the under age 65 individual rate.

Medicare-Eligible and Post-65 Retiree Monthly Self-Pay Contribution Rates

	Current Self-Pay Rate	New Self-Pay Rate
Individual	$250	$300
Family	$450	$0
Per Dependent	$0	$300

Please Click to see the May 12th 2010 Notice