A Very Important Message Regarding Your Newspaper Guild Health Benefits
Over the past few years, as health care costs have risen at nearly five times the rate of inflation, the Newspaper Guild’s Health & Welfare Trustees (three Guild representatives and three company representatives) have worked diligently to continue to provide the best possible care at the most affordable price.
This, however, has come at a huge cost to the Health & Welfare Fund, which has used a great deal of its reserves to subsidize Guild members’ weekly health care contributions. To give you the scope of these subsidies and an idea of what your health care really costs, the Fund has been contributing approximately $80 per member per week to supplement member contributions – depleting its reserve $2 million per year.
Like most subsidies, this is unsustainable, and with health care reform uncertain at best and unhelpful at worst, the Trustees have voted to make a substantial change in the health care benefit. This was not done lightly, but after hours of meetings with area health insurance companies, our administrators at richard Gabriel and our consultants at Aon Hewitt.
If we do not do something now, the Fund reserves will soon disappear. If we allow that to happen, member weekly contributions for the health plans you have now will have to increase by more than $80 per week (more than $4,000 per year). And that’s just for the first year. After that, you can expect estimated increases of 10 to 15 percent annually. The Trustees believe such a financial hit would be impossible for most Guild members to absorb.
We have therefore made changes. The new health care benefit negotiated by the Trustees will be more expensive for some, but not for everyone. If you stay healthy and manage your medical expenses, some members will even find this new plan cheaper than the previous plan, and with better care options. As we said previously, a lot of time and effort went into this decision and we tried to make it as fair as possible for the greatest number of members.
Here are the key points.
As of June 1, Guild health benefits will be provided by Aetna. 97% of doctors presently used by members in the present Blue Cross plan are in the Aetna plan so this should not be a problem for all but a few people.
The Aetna plan will be a point-of-service plan and not an HMO. For those of you were in the Keystone HMO, you will now have an improved benefit, similar to what Personal Choice users got under the Blue Cross plan – you no longer need referrals.
The cost of the new plan for full-time active members will be $20/week for singles and $50/week for couples, singles with children or families. Part-time employees will be notified by richard Gabriel associates of their new weekly payroll deductions. Everyone will be on the same plan. IMPORTANT: This rate will not change for members for two years. In year two of the plan, the Health & Welfare Fund will subsidize any increased costs.
The Aetna plan will be a Customer-Directed Health Care Plan. Before marketers and re-branders got a hold of these plans they were known as High-deductible Plans.
The deductible will be $1,500 for singles and $3,000 for couples, singles with children or families. For those of you unfamiliar with the concept of the deductible, what it means is that you are responsible to pay for that amount of coverage before the Plan picks up your coverage costs at 100% of in-network service. This is a big change and you should budget accordingly – but there is some good news:
Since the Trustees understand this deductible will present a hardship for many Guild members, we have worked with Aetna to provide a VERY IMPORTANT benefit:
The Health & Welfare Fund and Aetna will fund the first $750 in deductible expenses for singles and the first $1,500 in deductible expenses for couples, singles with children or families (this is a Health Reimbursement Arrangement [or HRA]). What this means is that the single member will be responsible for paying his/her annual health care expenses from $751 to $1,500 and the non-single member will be responsible for paying health care expenses from $1,501 to $3,000. Once you have reached your deductible – if you reach your deductible – the Aetna plan pays 100% of your in-network medical expenses.
One other bit of good news: If you don’t use all the money the Fund is providing toward your deductible in year one of the plan, the leftover money will roll over into year two. Let’s say you are couple who uses $1,000 of the $1,500 the Fund provides for your deductible between June 1, 2011 and May 31, 2012. When year two begins on June 1, 2012, the $500 remaining in your HRA will rollover, giving you $2,000 toward your $3,000 deductible in the second year. Should you retire or be laid off and go into COBRA through the Fund, your rollover money stays. If you voluntarily leave the company, you do not get to take that money with you.
Drug coverage will be provided through Aetna and not by Medco. Co-pays will be similar to the Medco plan and mail order will be recommended as in the Medco plan (for maintenance medications). An important difference, however, is how the plan works in a Health Reimbursement Account program. It is important to understand that the cost you pay for prescriptions comes directly out of your HRA fund and counts toward your deductible. The cost of the drugs are the Aetna discounted rate (as opposed to a flat $10/$15 co-pay plan design) so it will be even more important for you and your doctor to consider if a generic is a more effective way to spend your fund dollars and maximize your benefits (how long the fund lasts). Once you have reached your deductible, the plan will revert from discounted amounts to flat co-pays.
However, the Guild and Aetna did add a very important provision to this plan that allows members who are taking prescriptions to manage their chronic conditions, to pay only a co-pay which is not subject to the deductible. There is a list of those medications that will be provided at meetings and online for your and your family’s reference.Only drugs that appear on the Aetna Chronic/Preventive drug list (high blood pressure, diabetes, etc.) will be subject to the co-pay and will NOT count toward your. Other drugs will be purchased through Aetna at the Aetna-discounted rate and will count toward your deductible.
With regard to medical coverage, please consider the following: One of the reasons we switched to the Aetna HRA is because of the member payment experience. In this new plan, there are no co-pays when you visit a doctor’s office. You simply provide your new id card to the physician’s office, the physician submits the bill to Aetna for processing and if there is money left in your HRA fund, Aetna will pay the provider directly for you. You will then receive an EOB (Explanation of Benefits) statement from Aetna showing how much came out of your fund, your remaining balance, the impact on lowering your deductible and that you owe no money to the provider. If your HRA funds were partially or fully exhausted at that point in time, you will receive an EOB from Aetna stating the balance you will owe your provider and how that will lower your deducible. Your provider will bill you, you pay them directly and you are that much closer to fulfilling your deductible and having your services covered 100%.
IMPORTANT: Although you will no longer be paying a co-pay, you will only be responsible for paying the Aetna-approved rate for medical services.
IMPORTANT: The plan also allows you routine physicals, immunizations, one annual mammogram and other preventive service options to be paid by the plan at 100 percent with the deductible waived and no cost to you or your family members.
With regard to prescription drug coverage, please consider the following: Again, the Aetna HRA offers ease of payment. If you go to a retail pharmacy with a prescription, please provide your card to the pharmacist as you typically would.
1) If you are taking a drug on the chronic/preventive list, you will pay a flat co-pay ($5 for generic preferred formulary/$20 for brand, preferred formulary and $40 for non-preferred drugs at retail). However, we also suggest you maximize your savings and use Aetna’s Mail Order Drug program through which you will pay 2 co-pays for a 3 month supply-saving you and your family money. As with Medco, the Mandatory Mail Order provision is a component of this plan as well.
2) If you are taking a prescription NOT on Aetna’s chronic/preventive medication list, the pharmacist will run the prescription through the system and if you have money in your HRA fund, the cost of the prescription is pulled automatically from your HRA fund and you leave the pharmacy with no out of pocket costs. If you do NOT have all of the money in your HRA fund to cover the cost of the drug, the pharmacy will pull any/all available funds and then ask you to pay the balance at that time. Those additional dollars will count towards satisfying your deductible.
3) Once you have fully satisfied your deductible, you will simply pay a flat co-pay for drugs. $5 for generic, preferred formulary, $20 for brand, preferred formulary and $40 for non-formulary drugs or 2 times that for mail order.
Having said that, it is important for you to manage your plan well and discuss your prescriptions with your doctor. With the cost of generic medications being much less than that of brand name drugs, it may benefit you and your family to consider the generic alternatives to maximize the value of the HRA Fund the Guild has provided as part of this plan. This will also keep your out of pocket costs low.
One last way to save money: In the fall of 2011, the company will offer open enrollment for Flexible Spending Accounts (FSAs) beginning on January 1, 2012. For those of you who do not already have or are not aware of flexible spending accounts, they allow you to take up to $5,000 out of your paycheck – pre-tax – to be used for approved medical expenses. (Your weekly health care contribution is also pre-tax.). The Trustees urge all members who know they are going to be spending money on health care in calendar year 2012 – either due to drug expenditures or having to pay the unfunded portion of your deductible – to sign up for an FSA. This will save you money because you will not be paying income tax on money you spend for your medical care.
There is a lot to digest here as these are big, but necessary, changes and the Trustees want the transition to go as smoothly as possible. Aetna representatives will be offering Q&A sessions about the plan changes for Guild members on the following dates and times in the large 1st floor conference room at 400 N. Broad Street. on:
Monday, May 2 at 10 am and 6 pm
Wednesday, May 4 at 3 pm
Tuesday, May 10 at 9 am and 6 pm
Thursday, May 12 at Noon and 8 pm
There will also be a session Tuesday, May 3 at 2 pm in Cherry Hill.
We will also answer questions via e-mail at email@example.com.
You should also receive this message via regular mail from richard Gabriel associates within the next week.
Please note, if there are changes to your status, you must contact richard Gabriel associates’ Margie Horton at firstname.lastname@example.org or (215) 773-0900 before 5 pm on April 29. Examples of changes include adding or deleting a dependent, a change of address or opting out of the plan due to other medical coverage.
If you have no changes at this time the changeover will occur automatically on June 1 – you will receive your new Aetna cards before the end of May – and you do not have to contact anyone.
The Trustees say again that none of these changes were undertaken without a great deal of thought and comparison shopping and we are confident that we are still providing excellent coverage at an excellent price.
Thank you for your cooperation during this transition.