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2013 Benefits at a Glance
2013 Changes to this Plan
Your share of the NALC Postal premium will decrease for Self Only and decrease for Self and Family.
Your share of the non-Postal premium will decrease for Self Only and decrease for Self and Family.
We now base our non-PPO Plan allowance on the MultiPlan negotiated rate for providers/facilities who participate in the MultiPlan network. Previously, we based our Plan allowance on the lesser of the 80th percentile of data gathered from health care sources or the MultiPlan negotiated rate.
We now cover preventive medicine counseling for women as recommended by Health Resources and Services Administration (HRSA).
We now cover Hepatitis B vaccine for all adults age 19 and older. Previously, we only covered this vaccine when you had medical indications as recommended by the CDC.
We now cover Measles, Mumps and Rubella (MMR) vaccine for all adults age 19 through 56 and adults age 57 and older with medical indications as recommended by the CDC. Previously, we covered this vaccine for adults age 19 through 49.
You now pay nothing for a colonoscopy screening with polyp removal—one every 10 years, age 50 and older, when rendered by a PPO provider. Previously, you paid 15%
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We now cover Human Papillomavirus (HPV) testing for women age 30 and older. Previously, we covered this test once every 3 years for women age 30 through 70.
You now pay nothing for the initial examination of a newborn child covered under a family enrollment when rendered by a PPO provider. Previously, you paid 15%.
We now cover alcohol and drug use assessment for children age 11 through 21.
We now cover developmental screening (including screening for autism) for children under age 3
We now cover developmental surveillance and behavioral assessment for children age 21 and younger.
We now cover one fasting lipoprotein profile (total cholesterol, LDL, HDL and triglycerides) for children age 18 through 21. We cover this screening for children age 17 and younger with medical indications as recommended by AAP.
We now cover hearing screening for children age 4 through 10 and all other ages when the child is at high risk for hearing loss as recommended by Bright Futures/AAP.
We now cover one hemoglobin or hematocrit screening for children age 12 months.
We now cover lead screening tests for children age 6 and younger with medical indications as recommended by Bright Futures/AAP.
We now cover one newborn metabolic screening panel, age 2 months and younger.
We now cover tuberculosis screening for children at high risk as recommended by Bright Futures/AAP, through age 21.
We now cover vision screening for children age 3 through 18 as recommended by Bright Futures/AAP. Previously, we covered one vision screening for children age 3 through 5.
You now pay nothing for the rental of breastfeeding equipment when you use a PPO provider. Previously you paid 15% of the Plan allowance.
We now cover gestational diabetes screening for women who are 24 to 28 weeks pregnant or are at high risk of developing gestational diabetes.
We now cover lactation support and counseling as recommended by the USPSTF.
You now pay nothing for hearing aids and the related examination up to the maximum Plan payment of $500 per ear with replacements covered every 3 years. Previously, you paid 15% (after the calendar year deductible) and all charges after we paid $1000 in a lifetime.
We will now cover one pair of custom functional foot orthotics, including casting, every 5 years when prescribed by a physician.
We now cover extraspinal chiropractic manipulations.
You now pay nothing for voluntary female sterilization, surgical placement of implanted contraceptives, insertion of an IUD, and administration of an injectable contraceptive drug when rendered by a PPO provider. Previously, you paid 15%.
You now pay nothing for outpatient professional anesthesia services for a voluntary female sterilization when rendered by a PPO provider. Previously, you paid 15%.
You now pay nothing for outpatient services and supplies for a voluntary female sterilization when rendered by a PPO provider. Previously, you paid 15%.
You now pay the Specialty drug copayment for specialty drugs dispensed in an outpatient hospital setting. Previously, you paid 15% when dispensed or administered by a PPO hospital or 35% when dispensed or administered by a non-PPO hospital.
You now pay nothing for lab charges related to mental health or substance abuse billed by Quest and LabCorp. Previously, you paid 15%.
Our brand name drug formulary is open and voluntary. You now pay more for non-formulary brand name drugs. You now pay 30% of the cost of formulary brand name drugs purchased at an NALC CareSelect network pharmacy.
You now pay 45% of the cost of non-formulary brand name drugs purchased at an NALC CareSelect network pharmacy. Previously, you paid 30%.
You now pay 20% for formulary brand name drugs purchased at an NALC CareSelect network pharmacy when Medicare Part B is primary.
You now pay 30% for non-formulary brand name drugs purchased at an NALC CareSelect network pharmacy when Medicare Part B is primary. Previously, you paid 20%.
You now pay $43 for up to a 60-day supply and $65 for a 90-day supply of formulary brand name drugs purchased through our mail order program.
You now pay $58 for up to a 60-day supply and $80 for a 90-day supply of non-formulary brand name drugs purchased through our mail order program. Previously, you paid $43 for a 60-day supply and $65 for a 90-day supply.
You now pay $37 for up to a 60-day supply and $55 for a 90-day supply of formulary brand name drugs purchased through our mail order program when Medicare Part B is primary.
You now pay $52 for up to a 60-day supply and $70 for a 90-day supply of non-formulary brand name drugs purchased through our mail order program when Medicare Part B is primary. Previously, you paid $37 for a 60-day supply and $55 for a 90-day supply.
You now pay nothing for FDA-approved prescription contraceptive drugs for women. Previously, you paid the applicable cost-share for generic and brand name drugs.
You now pay nothing for prescription injectable contraceptive drugs, implantable contraceptives, diaphragms or intrauterine devices purchased through our mail order program or at an NALC CareSelect pharmacy. Previously, you paid 15% when performed, administered or dispensed by a PPO provider.
We now cover prescription oral fluoride supplements for children from age 6 months through 5 years purchased at a network pharmacy.
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