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