Joint Council #28 - Retiree's Welfare Trust--Non-Medicare Plan Comparison

NON-MEDICARE PLAN COMPARISON
RWT-29 vs RWT-PLUS

The information on this page is designed to provide a side-by-side comparison of Retiree Benefit Plan (RWT-29) and Retiree Benefit Plan (RWT-Plus). The information is for illustrative purposes only and is NOT intended to be construed as an all-inclusive description of the Plan benefits or any limitations/exclusions that may apply.

It is NOT to be used for general distribution purposes or in lieu of a Plan booklet.

To determine CURRENT Employee and Retiree Contribution Rates, please contact NW Administrators.

Every effort has been made to insure the information is accurate as of the date of issue, however, in all cases the applicable Plan booklet(s) (inclusive of all revisions or modifications made subsequent to the latest printed editions) shall govern the eligibility for the benefits payable. The board of Trustees retains the right of final determination in question of interpretation and to increase contribution rates or implement benefit and eligibility modifications depending on the financial condition of the Trust. No Plan participant should believe they have a vested right in these Plans or that the benefits of the Plans will necessarily be granted indefinitely.

BENEFITS/SERVICES

RWT-29—Non-Medicare

RWT-PLUS—Non-Medicare

PPO

NON-PPO

PPO

NON-PPO

Employer Contribution Rate
(Provides for Medicare and non-Medicare Coverage)

$29.00 per month per active employee.
Increasing $5.00 PEPM beginning 01/01/03, depending on contract effective date. Must be at $54 PEPM on January 1, 2008.

New Rates Increasing $10.00 PEPM*

1/1/09 $64.00
1/1/10 $74.00
1/1/11 $84.00

*29 Plan Closed to New Entrants

$39.85 per month per active employee.
Increasing $5.00 PEPM beginning 01/01/03, depending on contract effective date. Must be at $64.85 PEPM on January 1, 2008.

New Rates Increasing $10.00 PEPM

1/1/09 $74.85
1/1/10 $84.85
1/1/11 $94.85

Retiree Contribution Rate *4

•$379.00 per month per Retiree/Spouse 60-64
•$379.00 per month per Retiree under 60
•$556.00 per month per Spouse under 60

•$359.00 per month per Retiree/Spouse
•$192.00 per month per Dependent Child

Lifetime Maximum Benefits

$150,000 (Prescription benefits are not accumulated toward the $150,000 in determining when a person has reached the lifetime maximum.)

$1,000,000 (Includes benefits under Medicare supplemental plan.) (Prescription benefits are not accumulated toward the $1,000,000 in determining when a person has reached the lifetime maximum.)

Managed Care Plan

Yes

BENEFITS/SERVICES

RWT-29 —Non-Medicare

RWT-PLUS—Non-Medicare

PPO

NON-PPO

PPO

NON-PPO

Deductibles

$250 annual deductible per person.

No annual deductible through 12/31/06.

Effective 1/1/07

$250

Hospital Admission - $100 per admission

ER Care - $50 per visit

Physician services and other charges $100 per visit, $300 per family, per calendar year, 3-month carryover.

Effective 1/1/07

Additional Annual Deductible

$250

Hospitalization

Part of $250 total annual deductible per person.

None

$100 per admission

Emergency Room Care

Part of $250 total annual deductible per person.

None

$50 per visit.

Note: Waived if patient is transported to the nearest accredited facility by an emergency vehicle, such as an ambulance.

Physician Services, Surgery, X-Ray, Lab and Other Charges

Part of $250 total annual deductible per person.

$10 co-pay per office visit.

Part of $100/$300.

Out-of-Pocket Maximum

None

$5,500 per person.

$7,500 per person. Combined PPO and Non-PPO.

Note: In this comparison, "80%/100%" or "60%/100%" indicates that payment increases to 100% after the "out-of-pocket" maximum is reached during a calendar year. "Out-of-Pocket" excludes penalty for not pre-certifying hospital admissions, alternative housing, prescription drugs, charges over usual and customary (UCR), special treatment benefits and non-covered expenses.

BENEFITS/SERVICES

RWT-29—Non-Medicare

RWT-PLUS —Non-Medicare

PPO

NON-PPO

PPO

NON-PPO

Hospital Pre-certification

Hospital pre-certification required. $100 penalty when admission not preauthorized.

Hospital pre-certification required. $200 penalty when admission not preauthorized.

Hospital

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible

80%/100% of discounted charges for days certified by Beech Street

60%/100% of UCR charges1 in excess of deductible for days certified by Beech Street

Preadmission Testing

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible.

Testing must be done within 72 hours of hospitalization and be consistent with the reason for surgery.

Testing done within four days of hospitalization and related to the condition requiring hospitalization will be paid at 100%. No deductible.

2nd Surgical Opinion

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible.

If required by Beech Street paid at 100% no deductible, otherwise paid at regular benefit level.

Alternate Treatment Settings

If approved, 90% of discounted charges in excess of deductible.

If approved, 85% of UCR charges in excess of deductible.

80%/100% of discounted charges.

60%/100% of UCR charges. *1

Pays covered charges in skilled nursing facilities. Other alternative treatment settings such as hospice and home healthcare are not covered unless recommended by Beech Street in lieu of hospitalization, and approved by the Trust.

In lieu of hospitalization pays covered charges in alternate treatment settings, including skilled nursing facilities, hospice, and home health care. The care must be certified by Beech Street. No deductible. Limits described below apply to each setting.

Skilled Nursing Facility

Up to a maximum of 70 days per confinement (combined PPO/Non-PPO).

Up to $100 per day for 180 days (combined PPO/Non-PPO).

Home Health Care

Not specifically covered, except for RN, but paid if recommended by Beech Street and approved by Trust.

Maximum 130 visits per calendar year (combined PPO/Non-PPO).

Hospice Care

Not specifically covered, except for RN, but paid if recommended by Beech Street and approved by Trust.

Limited to $10,000 (combined PPO/Non-PPO).

Alternate Housing Facility

Not specifically covered, except for RN, but paid if recommended by Beech Street and approved by Trust.

$60 per day, maximum 70 days (combined PPO/Non-PPO).

*1 80%/100% where no PPO access.
*4 Higher "dropped employer" rates apply if a Retiree's employer ceases to contribute to the Trust
Note: Use of a PPO provider will eliminate the potential for charges over UCR, which are non-covered expenses and, generally speaking, result in less out-of-pocket costs to the participant.

BENEFITS/SERVICES

RWT-29 —Non-Medicare

RWT-PLUS —Non-Medicare

PPO

NON-PPO

PPO

NON-PPO

Physician Services

Inpatient

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible.

80%/100% of discounted charges.

60%/100% of UCR charges1 in excess of deductible.

Outpatient

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible.

80%/100% of discounted charges after $10 co-pay.

60%/100% of UCR charges*1 in excess of deductible.

Surgery

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible.

80%/100% of discounted charges.

60%/100% of UCR charges *1 in excess of deductible.

Preventative Care
    Outpatient: Physical
    Exams and
    Immunizations

Not covered.

80%/100% of discounted charges after $10 co-pay.

60%/100% of UCR charges *1 in excess of deductible.

$250 per person per year maximum benefit (combined PPO/Non-PPO).

Spinal Treatment Benefit

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible.

80%/100% of discounted charges. No co-pay.

60%/100% of UCR charges *1 in excess of deductible. Maximum 15 treatments per calendar year.

$10,000 lifetime maximum (combined PPO/Non-PPO).

Maximum of $5,000 per treatment series and $10,000 lifetime (combined PPO/Non-PPO).

Diagnostic X-Ray/Lab

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible.

80%/100% of discounted charges.

60%/100% of UCR charges *1 in excess of deductible.

Durable Medical Equipment

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible.

80%/100% of discounted charges.

60%/100% of UCR charges *1 in excess of deductible.

*1 80%/100% where no PPO access.

RWT-29—Non-Medicare

RWT-PLUS—Non-Medicare

PPO

NON-PPO

PPO

NON-PPO

Special Treatment Benefits

Chemical Dependency

50% of discounted charges in excess of deductible.

50% of UCR charges in excess of deductible.

80% of discounted charges. No deductible.

60% of UCR charges.*2 No deductible.

$10,000 lifetime maximum (combined PPO/Non-PPO).

Maximum of $5,000 per treatment series and $10,000 lifetime (combined PPO/Non-PPO).

Mental & Nervous

• Inpatient
• Hospital

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible.

1st 30 cumulative days per calendar year paid at 80% of discounted charges. After 30, paid at 50%.

1st 30 cumulative days per calendar year paid at 60% of UCR charges.*2
After 30, paid at 50%.

• Professional Fees

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible.

80% of discounted charges.

60% of UCR charges.*2

• Outpatient

50% of discounted charges in excess of deductible.

50% of UCR charges in excess of deductible.

80% of discounted charges. No deductible.

60% of UCR charges*2 in excess of deductible.

Maximum 50 outpatient visits per calendar year (combined PPO/Non-PPO).

Maximum 25 outpatient visits per calendar year (combined PPO/Non-PPO).

*2 80%/100% where no PPO access. *2 80% where no PPO access.

BENEFITS/SERVICES

RWT-29 — Non-Medicare

RWT-PLUS — Non-Medicare

PPO

NON-PPO

PPO

NON-PPO

Jaw Treatment
(Surgical & non-surgical)

All Jaw Treatment, Including Temporomandibular Joint Syndrome (TMJ) And Myofascial Pain Disorder (MPD)

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible.

80% of discounted charges. No deductible.

60% of UCR charges.*2 No deductible.

$6,000 lifetime maximum (combined PPO/Non-PPO). Regular benefits apply in cases of an accident.

Organ Transplant

90% of discounted charges in excess of deductible.

85% of UCR charges in excess of deductible.

Special eligibility rules & limitations. $200,000 per transplant maximum (combined PPO/Non-PPO benefit).

FWT-29 — Non-Medicare

RWT-PLUS — Non-Medicare

$1,000 Annual Max

$1,500 Annual Max

Prescription Drug

FORMULARY

NON-FORMULARY

FORMULARY

NON-FORMULARY

RWT-29 Network Retail
(34 Day supply/100 units)

RWT-PLUS Network Retail
(34 Day supply/100 units)

Generic

95% after $13 co-pay per Rx.

Generics all paid at Formulary

100% after $10 co-pay

Generics all paid at Formulary

Brand

80% after $25 co-pay per Rx

50% after $25 co-pay per Rx.

80% ($25 co-pay per Rx on brands over $30).

50% ($25 co-pay per Rx on brands over $30).

RWT-29 Network Mail Order
(100 Day Supply)

RWT-PLUS Network Mail Order
(100 Day supply)

Generic

100% after $10 co-pay.

Generics all paid at Formulary

100% after $10 co-pay.

Generics all paid at Formulary

Brand

100% after $30 co-pay per Rx.

60% after $30 co-pay per Rx.

100% after $30 co-pay per Rx.

60% after $30 co-pay per Rx.

Note: Plan deductible and lifetime major medical maximum do not apply to prescription drug benefits. Retail prescriptions are limited to a maximum 34-day supply. Mail order prescriptions are limited to a 100-day supply. Reimbursement percentages are applied after co-pay. Prescription benefits are limited to $1,000 per calendar year.

Non-network (Non PPO) prescription drugs not covered by plan except in an emergency, then at 50% after applicable co-pays.

Note: Plan deductibles and lifetime maximum do not apply to prescription drug benefits. Retail prescriptions are limited to a maximum 34-day supply. Mail order prescriptions are limited to a 100-day supply. Reimbursement percentages are applied after co-pay. Prescription benefits are limited to $ 1,500 per person per calendar year.

Non-network (Non PPO) prescription drugs not covered by plan except in an emergency, then at 50% after applicable co-pays.

*2 80% where no PPO access.

NOTE: This worksheet is designed to provide a side by side comparison of the existing Retiree Benefit Plan, RWT-29, and Retiree Benefit Plan, RWT-Plus, which became available for negotiation July 1, 1998. The worksheet is for illustrative purposes only and is NOT intended to be construed as an all-inclusive description of the Plan benefits or any limitations/exclusions that may apply. It is not to be used for general distribution purposes or in lieu of a Plan booklet. Every effort has been made to insure the information is accurate as of the date of issue, however, in all cases the applicable Plan booklet(s) (inclusive of all revisions or modifications made subsequent to the latest printed editions) shall govern the eligibility for the benefits payable. The Board of Trustees retains the right of final determination in question of interpretation and to increase contribution rates or implement benefit and eligibility modifications depending on the financial condition of the Trust. No Plan participant should believe they have a vested right in these Plans or that the benefits of the Plans will necessarily be granted indefinitely.