LETTER 7
Group Insurance
Plans
Mr. James M.
Parent
Assistant
Directing Business
Representative
District Lodge
No. 26
I.A.M.A.W.,
AFL-CIO
365 New Britain
Road
Kensington,
Connecticut 06037
Dear Mr. Parent:
This is to confirm the
understanding and agreement between the Company and the Union concerning
amendments to the group health insurance, life insurance, disability
insurance and the group dental plan referred to in Article 22. The
following represents a summary of benefits and amendments to contractual
provisions.
Reimbursement
Accounts -- Effective December 6, 2004:
|
Health Care
Reimbursement Account |
$120 to $3,000 per year, pre-tax for eligible medical and dental
expenses.
$120 to
$4,000 per year, pre-tax, effective April 1, 2005 |
|
Dependent Day
Care Reimbursement Account |
$120 to
$5,000 per year, pre-tax for eligible child and/or adult/elder day
care expenses. |
Life/Accidental
Death & Dismemberment/Weekly Disability and
Total and
Permanent Disability Table -- Effective January 1, 2005:
|
Base Rate
Wage Class |
Life & AD&D |
Weekly
Disability |
TPD |
|
$18.00 and
Under |
$55,500 |
$370 |
$1,005.66 |
|
$18.01 -
$18.50 |
$57,000 |
$380 |
$1,032.84 |
|
$18.51 -
$19.00 |
$58,500 |
$390 |
$1,060.02 |
|
$19.01 -
$19.50 |
$60,000 |
$400 |
$1,087.20 |
|
$19.51 -
$20.00 |
$61,500 |
$410 |
$1,114.38 |
|
$20.01 -
$20.50 |
$63,000 |
$420 |
$1,141.56 |
|
$20.51 -
$21.00 |
$64,500 |
$430 |
$1,168.74 |
|
$21.01 -
$21.50 |
$66,000 |
$440 |
$1,195.92 |
|
$21.51 -
$22.00 |
$67,500 |
$450 |
$1,223.10 |
|
$22.01 -
$22.50 |
$69,000 |
$460 |
$1,250.28 |
|
$22.51 -
$23.00 |
$70,500 |
$470 |
$1,277.46 |
|
$23.01 -
$23.50 |
$72,000 |
$480 |
$1,304.64 |
|
$23.51 -
$24.00 |
$73,500 |
$490 |
$1,331.82 |
|
$24.01 -
$25.00 |
$75,000 |
$500 |
$1,359.00 |
|
$25.01 -
$26.00 |
$78,000 |
$520 |
$1,413.36 |
|
$26.01 -
$27.00 |
$81,000 |
$540 |
$1,467.72 |
|
$27.01 -
$28.00 |
$84,000 |
$560 |
$1,522.08 |
|
$28.01 and
Above |
$87,000 |
$580 |
$1,576.44 |
Survivor Income
-- Effective January 1, 2005:
|
Part I and Part II |
$250 per
month |
Medical
Contributions -- Effective December 6, 2004:
|
Employee Only |
$5.50 per week
|
|
Employee plus One |
$11.00 per
week |
|
Employee plus Family |
$16.50 per week
|
Medical
Contributions -- Effective April 1, 2005:
|
|
Effective
4-1-05 |
Effective
1-1-06 |
Effective
1-1-07 |
|
Employee Only |
$8.25 |
$9.49 |
$10.91 |
|
Employee plus
Spouse |
$19.50 |
$22.43 |
$25.79 |
|
Employee plus
Family |
$26.50 |
$30.48 |
$35.05 |
|
Employee plus
Child(ren) |
$15.25 |
$17.54 |
$20.17 |
Special Open Enrollment; Effective
April 1, 2005
During the first quarter of 2005 a
special open enrollment will be scheduled during which employees may
choose either the Company’s Managed Care Plan (if in the health plan
area), an indemnity out-of-area plan (if out of the health plan area), or
a qualified alternative plan. Election will be effective April 1, 2005.
During this special open enrollment employees will be able to change their
medical flexible spending account election.
Plan Provisions – Effective April 1, 2005:
R&C=Reasonable and
Customary
PCP=Primary Care
Physician
|
|
CIGNA Point of Service (POS) |
CIGNA Preferred Provider Organization
(PPO) |
CIGNA Medical (Out-of Area) |
|
Service |
In-Network |
Out-of-Network |
In-Network
|
Out-of-Network |
All Providers |
|
Ambulance Service
to nearest hospital, if medically necessary |
80% of negotiated
rates after deductible |
80% of billed
charges after deductible if true emergency; otherwise 60% of R&C after
deductible |
80% of negotiated
rates after deductible |
80% of billed
charges after deductible if true emergency; otherwise 60% of R&C after
deductible |
80% of R&C after
deductible |
|
Deductible* |
$200/$400/$500 |
$1,000/$2,000/$3,000 |
$200/$400/$500 |
$1,000/$2,000/$3,000 |
$200/$400/$500 |
|
Dependents,
Adding of |
Within 30 days |
Within 30 days |
Within 30 days |
Within 30 days |
Within 30 days |
|
Emergency
Hospital Notification |
Within 48 hours
or the next business day. |
Within 48 hours
or the next business day. |
Within 48 hours
or the next business day. |
Within 48 hours
or the next business day. |
Within 48 hours
or the next business day. |
|
Emergency Room |
100% after $75
copay
(waived if
admitted) |
$75 copay then
100% of billed charges if true emergency (no deductible); otherwise
60% of R&C after deductible |
80% of negotiated
rates after deductible |
80% of billed
charges after deductible if true emergency; otherwise 60% of R&C after
deductible |
80% of R&C after
deductible |
|
Hearing Aids,
Initial purchase, fitting, maintenance and repairs. Expenses must be
over $200 and pre-authorized by CIGNA |
80% of negotiated
rates after deductible when authorized by PCP |
60% of R&C after deductible, when authorized
by physician |
80% of negotiated
rates after deductible when authorized by physician |
|
80% of R&C after
deductible, when authorized by physician |
|
Home Health Care |
100% of
negotiated rates (no deductible), when medically necessary.
Unlimited visits |
60% of R&C after
deductible (80 visits per calendar year combined with in-network) |
80% of negotiated
rates after deductible, when medically necessary. Unlimited visits. |
60% of R&C after
deductible (80 visits per calendar year combined with in-network) |
80% of R&C after
deductible (80 visits per calendar year) |
|
Hospice |
100% of
negotiated rates with prior approval (no deductible) |
100% with prior
approval (no deductible); otherwise 80% of R&C after deductible |
100% of
negotiated rates with prior approval (no deductible) |
100% with prior
approval (no deductible); otherwise 80% of R&C after deductible |
100% with prior
approval (no deductible); otherwise 80% of R&C |
* Deductible and
Out-Of-Pocket limits stay at “employee only”, “employee plus one
dependent” and “employee plus family”.
|
|
CIGNA Point of Service (POS) |
CIGNA Preferred Provider Organization
(PPO) |
CIGNA Medical (Out-of Area) |
|
Service |
In-Network |
Out-of-Network |
In-Network
|
Out-of-Network |
All Providers |
|
Hospitalization |
80% of negotiated
rates after deductible |
60% of R&C after
deductible. Pre-certifica-tion required. Must be medically necessary. |
80% of negotiated
rates after deductible. Pre-certification required. Must be
medically necessary. |
60% of R&C after
deductible. Pre-certifica-tion required. Must be medically necessary |
80% of R&C.
Pre-certification required. Must be medically necessary. |
|
Laboratory and
Radiology Services – MRI, MRA, CAT, PET |
$150 copay per
procedure; then 100% of negotiated rates with prior approval
|
60% of R&C after
deductible |
80% of negotiated
rates after deductible with prior approval |
60% of R&C after
deductible |
80% of R&C after
deductible with prior approval |
|
Other Laboratory
Tests in independent x-ray and/or Lab Facility (including doctor’s
office) |
100% of
negotiated rates (no deductible) |
60% of R&C after
deductible |
80% of negotiated
rates after deductible |
60% of R&C after
deductible |
80% of R&C after
deductible |
|
Other Laboratory
Tests not in independent facility |
80% of negotiated
fees after deductible |
60% of R&C after
deductible |
80% of negotiated
rates after deductible |
60% of R&C after
deductible |
80% of R&C after
deductible |
|
Maternity fee,
Global (includes charges for pre- and post-natal exams and delivery,
but not initial office visit) |
80% of negotiated
rates after deductible. Covers birth and newborn until Mother’s
discharge. |
60% of R&C after
deductible (CIGNA certification required). Covers birth and newborn
until Mother’s discharge. |
80% of negotiated
rates after deductible. Covers birth and newborn until Mother’s
discharge. |
60% of R&C after
deductible (CIGNA certification required). Covers birth and newborn
until Mother’s discharge. |
80% of R&C after
deductible (CIGNA certification required). Covers birth and newborn
until Mother’s discharge. |
|
Medical
Equipment, Durable |
100% of
negotiated rates (no deductible) with prior authorization |
60% of R&C after
deductible ($10,000 annual maximum combined w/in-network) |
80% of negotiated
rates after deductible |
60% of R&C after
deductible ($10,000 annual maximum combined w/in-network) |
80% of R&C after
deductible ($10,000 annual maximum) |
|
Medical Supplies,
Consumable |
80% of negotiated
rates after deductible with prior authorization |
60% of R&C after
deductible |
80% of negotiated
rates after deductible |
60% of R&C after
deductible |
80% of R&C after
deductible |
|
|
CIGNA Point of Service (POS) |
CIGNA Preferred Provider Organization
(PPO) |
CIGNA Medical
(Out-of Area) |
|
Service |
In-Network |
Out-of-Network |
In-Network |
Out-of-Network |
All Providers |
|
Mental Health and
Substance Abuse:
- Outpatient |
Must call
ValueOptions.
100% after $10
copay for visits 1 - 10 and $25 copay for visits 11 – 50. 50 visits
per plan year for in-network and out-of-network combined. |
Must call
ValueOptions.
50% of
ValueOptions’ program cost. 50 visits per plan year for in-network and
out-of network combined. |
Must call
ValueOptions.
100% after $10
copay for visits 1 - 10 and $25 copay for visits 11 – 50. 50 visits
per plan year for in-network and out-of-network combined. |
Must call
ValueOptions.
50% of
ValueOptions’ program cost. 50 visits per plan year for in-network and
out-of network combined. |
Same as
In-Network or Out-of-Network coverage.
|
|
- Inpatient |
80% of network
fee. Admission limits apply. |
50% of
ValueOptions’ program cost. Admission limits apply. |
80% of network
fee. Admission limits apply. |
50% of
ValueOptions’ program cost. Admission limits apply. |
Same as
In-Network and Out-of-Network coverage. |
|
OB/GYN Services
(not selected as PCP) |
100% of
negotiated rates after $30 copay by network provider |
60% of R&C after
deductible |
100% of
negotiated rates after $30 copay by network provider |
60% of R&C after
deductible |
|
|
Office Visits,
PCP |
100% of
negotiated rates after $20 copay by network provider (no deductible) |
60% of R&C after
deductible |
100% of
negotiated rates after $20 copay by network provider (no deductible) |
60% of R&C after
deductible |
100% of R&C less
$20 (80% of R&C for ancillary services) |
|
Office Visits,
Specialist |
100% after $30
copay with referral |
60% of R&C after
deductible |
100% after $30
copay |
60% of R&C after
deductible |
100% of R&C less
$30 (80% of R&C for ancillary services) |
|
PCP Referrals |
Yes, but not for
OB/GYN Network services. |
No, but services
must be medically necessary. |
No, but services
must be medically necessary. |
No, but services
must be medically necessary. |
No, but services
must be medically necessary. |
|
PCP Selection |
Mandatory |
No |
No |
No |
No |
|
|
Physical Therapy
and Rehabilitative Services |
100% of
negotiated rates, no deductible, after $30 copay per visit (Up to a
max of 30 treatment days per calendar year combined w/out-of-network) |
60% of R&C after
deductible (Up to a max of 30 treatment days per calendar year
combined w/in-network) |
100% of
negotiated rates, no deductible, after $30 copay per visit (Up to a
max of 30 treatment days per calendar year combined w/out-of-network) |
60% of R&C after
deductible (Up to a max of 30 treatment days per calendar year
combined w/in-network) |
100% of R&C after
$30 per visit (Up to a max of 30 treatment days per calendar year).
80% of R&C after deductible for ancillary services. |
|
|
|
CIGNA Point of Service (POS) |
CIGNA Preferred Provider Organization
(PPO) | |