NALC Health Benefit Plan

Fredric V. Rolando, President Brian Hellman, Director

This is YOUR Health Benefit Plan

NALC Constitution

Article 2 Section 1. To unite fraternally all letter carriers who are members in good standing in the National Association of Letter Carriers.

Section 2. To establish Health Benefit Funds from which to pay contributing members holding Health Benefit Certificates who become lawfully entitled thereto, certain benefits as indemnity against loss resulting from the expense of hospital, surgical and other medical expense due to bodily injuries or sickness of the members and enrolled dependent members of his/her family, and from which to defray the necessary running expenses of the Plan.

NALC HBP History

Where we started: 1950 – NALC started its own independent health benefits plan with 2 employees housed in a single room. At the close of the initial open enrollment membership totaled 4,116

History 1950’s

(continued NALC HQ’s Building Mid 50’s – Membership grew to 30,000. The independent health plan employed 26 employees and occupied 3 rooms located in the NALC Headquarters building at 100 Indiana Ave, NW Washington, DC.

History 1960’s

(continued) Early 60’s – Became part of the Federal Employees Health Benefit Program with passage of public law PL 86-382. Enrollment quadrupled to 101,503. The Plan used every available office space at the headquarters building. The auditorium became the file room.

In 1963 the NALC added an eight (8) story annex to the NALC Headquarters Building. We occupied four (4) floors in the annex and space in the main building.

History 1970’s

(continued) 1972 – The NALC HBP continued to grow in the Federal program. The entire Plan moved to Reston, Virginia by the end of the year. The entire staff comprised of 229 employees and membership totaled 141,177.

NALC HBP Reston, VA

History 1980’s

(continued) 1980’s – The computer age hit the Plan. All analysts were equipped with computer terminals and claims were processed through a computerized system.

Computer Terminals

As technology grew, so did the Plan. If fact, by the late 1980’s the Plan was growing to the point that we needed to locate to an even bigger facility.

History 1990’s

(continued)

The NALC HBP was “bustin at the seams” with 520 employees and a membership of 220,000. The Reston building was inadequate, so the Plan moved to Ashburn, Virginia on June 8, 1990.

NALC HBP Ashburn, VA

Where we are now - 2013

 Over sixty (60) years later we are still going strong. We have endured and prospered. Currently, we have 346 employees at the Plan and we cover a total of 115,932 members or 223,545 lives  2012 Open Season = 3,295 New Members

2012 NALC HBP Facts

 We issued $1.2 Billion in benefits.

 Processed 4,631,975 claims  Mailed 8,668,435 pieces of mail (includes checks, explanation of benefits , temporary Identification cards and letters).

 Answered 858,075 incoming calls from members, physicians and hospitals.

Average tenure of an NALC HBP employee is 20 Years

Employees

NALC HBP wall of 30 year plaques These three employees have 130 combined years of services

Employees

NALC HBP Mission

The Plan’s mission is to provide our members accessibility to quality medical care while maintaining a comprehensive benefit package.

We pride ourselves in offering excellent benefits with affordable premiums and excellent customer service.

The Plan is . . .



Union Operated

 

Union Owned Not-for-Profit Plan

High Option 2014 Plan Partnerships

Cigna

The CIGNA Shared Administration Open Access Plus network which offers 1,875,900 PPO providers nationwide. To locate a PPO provider call 1-877-220 NALC (6252) or visit our website at www.nalc.org/depart/hbp

CVS/Caremark

And, CVS/Caremark, our prescription benefit manager, provides access to more than 67,800 network pharmacies. In 2012, Walgreens was added to our retail pharmacy network. Call 1-800-933-NALC (6252) to locate the nearest network pharmacy.

OptumHealth

OptumHealth Behavioral Solutions, our mental health and substance abuse partner, gives more than 7,000 in-network facilities and more than 120,000 in-network clinicians to choose from to receive maximum benefits. Call 1-877-468-1016 to locate an in-network provider

NALC Health Benefit Plan is the right choice:



Comprehensive benefits



Competitive premiums

High Option Plan

PPO Office Visit $20 Copayment

Your office visit copayment for a PPO provider is just $20. When your PPO physician or PPO specialist bills for: • an office visit • an office consultation • a second surgical opinion • Outpatient individual or group therapy, or • Outpatient medication management

Lab Services

The NALC Benefit Plan covers 100% of medically necessary lab services billed by either Quest Diagnostics or LabCorp.

Health Risk Assessment (HRA)

We will pay the Self Only premium for the CignaPlus Savings sm Assessment (HRA).

discount dental program when you are enrolled in a Self Only option with the Plan and you complete the Health Risk We will pay the Self and Family premium for the CignaPlus Savings family members. sm discount dental program when you are enrolled in a Self and Family option with the Plan and an HRA is completed for two

PPO Inpatient $200 Copayment

When an illness or injury results in a hospitalization, you will pay just $200 per admission to a PPO hospital and nothing when services are related to the delivery of a newborn.

PPO Benefit Level

You will receive reimbursement at the PPO benefit level when non-PPO pathologists, radiologists and emergency room physicians bill for services rendered at a PPO hospital or a PPO ambulatory surgery center.

Maternity Benefits

The Plan’s 100% benefit package for maternity includes payment in full for: • • • • • • • • • • Routine prenatal visits Delivery Routine postnatal visits Amniocentesis Anesthesia related to delivery or amniocentesis Group B Streptococcus infection screening Sonograms Fetal monitoring Rental of breastfeeding equipment

Tetanus-diptheria, pertussis (Tdap) – 2014 one dose during each pregnancy NEW FOR

Maternity Benefits Cont.

Screening Tests for Pregnant Women when Billed by a PPO Provider

• • • • • • Gestational diabetes Hepatitis B Iron deficiency anemia Rh screening Syphilis and Urine culture for bacteria

Family Planning Services

• • • • • • 100% Coverage for Female Voluntary Family Planning Services when rendered by a PPO provider Limited to: Voluntary female sterilization Surgical placement of implanted contraceptives Insertion of intrauterine devices (IUDs) Administration of an injectable contraceptive drug (such as Depo provera) FDA-approved prescription contraceptive product Removal of a birth control device and for services related to follow up management of side effects of birth control (NEW for 2014

Preventive Benefits

• • • We continue to focus and understand that preventive care services are significant steps that member’s can take to protect themselves and their families. The NALC pays 100% for the following when rendered by a PPO provider: An annual routine physical, Certain routine screening tests, and Certain routine immunizations

Preventive care, adult

Some of the preventive screenings the Plan pays in full when rendered by a PPO provider include: • • • • • • One routine colonoscopy screening (with or without polyp removal) every ten years , age 50 and older.

An annual EKG and chest x-ray Mammograms for women age 35 and older as follows: o Ages 35 through 39 – one during this five year period o Ages 40 and older – one every calendar year Osteoporosis screening for women: o Age 40 -64 at increased risk o Age 65 and older PSA testing, one annually for men, age 40 and older Annual Biometric Screening (NEW for 2014)

Preventive care, adult

• • • Certain adult routine immunizations endorsed by the Centers for Disease Control and Prevention and administered by a PPO provider are paid in full by the Plan.

Hepatitis A and B are covered for adults age 19 and older Herpes Zoster (shingles) vaccine for adults age 60 and older (and Medicare Part D is not the primary payor) Whooping Cough (Tdap) booster one, for adults age 19 and older

Preventive care, adult

• • • Adult routine immunizations: Varicella (chickenpox) vaccine for adults age 19 and older… Human Papillomavirus (HPV) vaccine for adult women age 26 and younger, and … Human Papillomavirus (HPV4) vaccine for adult men age 26 and younger … are just some of the adult immunizations covered in the 2014 benefit year.

Preventive Benefits

(Pneumococcal and Seasonal Flu) CDC recommends that everyone 6 months of age

and older get a seasonal flu vaccine. And the NALC Health Benefit Plan makes it easier to get your flu and pneumococcal vaccines by partnering with more than 52,000 local NALCPreferred and NALC CareSelect pharmacies (including more than 7,000 CVS Pharmacies) to provide vaccines at no cost.

Preventive care, children

• • • Our 100% PPO preventive coverage for children’s vaccinations includes: an annual camp, school or sports physical, All American Academy of Pediatrics (AAP) recommended routine examinations through age 2 and all routine immunizations recommended by the AAP for children through the age of 21, including the meningococcal immunization and the HPV4 vaccine for males age 9 through 21 Initial hospital examination of newborn child

Preventive care, children

• • • • • • • Also paid in full when rendered by a PPO provider are several routine screening tests for children which include: One vision screening for amblyopia (or its risk factors) for children between the ages of 3 and 5 years, A newborn screening hearing test , High blood pressure screening, HIV screening Pap test, and An annual urinalysis for children age 5 through 21.

Hemoglobin/hematocrit for females age 11 through 21

Preventive care, children

The American Academy of Pediatrics Bright Futures is a national health promotion and disease prevention initiative that addresses children's health needs. The Plan now covers several new preventive screenings for children in full as recommended by Bright Futures/AAP when rendered by a PPO provider. These screenings include:

Preventive care, children

Screenings Recommended by bright futures/AAP • • • Alcohol and drug use assessment age 11 through 21 Developmental screening (including screening for autism) through age 3 Fasting lipoprotein profile (total cholesterol, LDL, HDL and triglycerides): One, age 18 through 21 Age 17 and younger with medical indications

Preventive care, children

Screenings recommended by Bright Future/AAP Cont.

• • • • Hearing screening Lead screening test age 6 and younger , and TB screening through age 21 Vision Screening for children age 3 through 18

Prescription Benefit

It is important that you realize the difference between a brand name drug and a generic drug.

Prescription Benefit

Like most other Fee-For-Service FEHB Plans, the Plan classifies all prescription drugs into one of four categories, or tiers based on quality, safety, clinical effectiveness and cost

Prescription Benefit

Tier 1 - consists of generic drugs. Tier 2 - drugs are brand drugs that appear on the Plan’s formulary. We call them formulary brand drugs.. Tier 3 - drugs are brand drugs that do not appear on the Plan’s formulary. We call them non-formulary brand drugs. You will pay more for these non formulary brand drugs.

Tier 4 - is specialty drugs.

Quit for Life Tobacco Cessation Program

• • A free program offered to our members and their eligible dependent age 18 or older. The program includes: Five professional 30 minute telephonic counseling sessions Direct shipment of 8 weeks of nicotine replacement therapy (NRT) patch or gum For more information go to

www.quitnow.net/nalc

call 1-866-784-8454.

or

Alere Weight Talk Program

® The Weight Talk Program® through Alere is a personal coaching program designed to achieve measurable, sustainable weight loss. It is delivered through regular phone-based coaching sessions with a dedicated coach. Participants set realistic weight goals and through small multiple behavior changes learn how to achieve and maintain a healthy weight for the rest of their lives.

Alere Weight Talk Program

® Individuals can enroll in the Weight Talk Program® online at www.nalc.org/depart/hbp or call the toll-free number at 1-855-948-8255. A personal dedicated coach is available Sunday through Friday 7:00 a.m. through 3:00 a.m. and Saturday 9:00 a.m. through 12:00 a.m. Eastern Time.

Additional Benefit Highlights for 2014

We now cover skin cancer preventive medicine counseling for adults age 24 and younger and for children age 10 and older as recommended by the USPSTF. We now cover fall prevention preventive medicine counseling for adults age 65 and older. We now cover a combined total of 75 rehabilitative and habilitative physical, occupational and speech therapy visits per calendar year. We now cover the initial office visit or consultation for acupuncture. You now pay nothing for educational classes and nutritional therapy for self management of diabetes, hyperlipidemia, hypertension, and obesity when rendered by a PPO provider.

Additional Benefit Highlights for 2014

We now cover over-the-counter vitamin D supplements (600 to 800 IU per day) when purchased at a preferred or network retail pharmacy for adults age 65 and older as recommended by the USPSTF (prescription required). We now cover over-the-counter aspirin when purchased at a preferred or network retail pharmacy for men age 45 through 79 and women age 55 through 79 as recommended by the USPSTF (prescription required).

We now cover over-the-counter folic acid (0.4 to 0.8 mg) when purchased at a preferred or network retail pharmacy for women planning a pregnancy or capable of becoming pregnant (prescription required).

Additional Benefit Highlights for 2014

We now cover over-the-counter iron supplements when purchased at a preferred or network retail pharmacy for children age 6 to 12 months (prescription required).

NOTE: The “Additional Benefit Highlights” do not reflect all of the changes for 2014.

High Option

General Information To obtain claim forms, claims filing advice or answers about our benefits, you can contact the Plan at : NALC Health Benefit Plan 20547 Waverly Court Ashburn, VA 20149 703-729-4677 1-888-636-NALC (6252) or at our website at

www.nalc.org/depart/hbp

CDHP and Value Option Plan

CDHP and Value Option Plans

Why add two (2) additional options?

The NALC CDHP and Value Option were built for the City Carrier Assistants as low cost options since they may have to pay entire premiums which includes both the employer share and the government share.

So, how did we keep the premiums low?

- High Deductible - Higher out-of-pocket maximum - Benefit structure not as rich

Consumer Driven Plan

What is a Consumer Driven Plan?

A health plan that provides coverage for medical/pharmacy expenses, with in-network preventive care services covered at 100%, plus...

A Personal Care Account (PCA) funded by NALC to pay for eligible health care expenses. Deductible - If you are enrolled in the CDHP/Value Option, you must satisfy your calendar year deductible and exhaust your Personal Care Account (PCA) before the Plan starts paying benefits under the Traditional Health Coverage. Once the deductible is met, you and NALC will share the cost of the eligible expenses.

Consumer Driven Plan

Personal Care Account (PCA) Depending on the plan option chosen, each year the Plan will add a certain amount to your Personal Care Account (PCA)

New Option 1 – Consumer Driven Health Plan

  $1,200.00 per year for Self Only or $2,400.00 per year for Self and Family

New Option 2 – Value Option Plan

 $100.00 per year for Self Only or  $200.00 per year for Self and Family

Consumer Driven Plan

Personal Care Account (PCA)

CDHP and Value Option PCA Rollover Maximum:

Money in the account rolls over each year if you do not spend it, up to a maximum of : Single - $5,000 Family - $10,000

Consumer Driven Plan

Personal Care Account (PCA)

You must use any available PCA benefits, including any amounts rolled over from previous years, and exhaust any remaining deductible before Traditional Health Coverage begins .

Consumer Driven Plan Deductible

Still confused? Think of it like this…..

Your deductible is your bridge between your Personal Care Account and Traditional Health Coverage. After you exhaust your PCA, you must pay any remaining deductible before Traditional Health Coverage begins.

Deductible

CDHP Deductible CDHP Out-of-Pocket Value Option Deductible Value Option Out-of-Pocket

Consumer Driven Plan

Deductible and Out-of-Pocket Amounts

In-Network

Self - $2,000 Self and Family -$4,000 Self - $6,000 Self and Family - $12,000 Self - $2,000 Self and Family -$4,000 Self - $6,000 Self and Family - $12,000

Out-of-Network

Self - $4,000 Self and Family -$8,000 Self - $12,000 Self and Family – $24,000 Self - $4,000 Self and Family -$8,000 Self - $12,000 Self and Family – $24,000

Consumer Driven

CDHP Plan Example Member goes to Doctor Cost of Visit - $50 PCA Self Only Balance $1,200 Claim sent through PCA first $1,200 - $50 Remaining PCA Balance = $1,150 Member Liability $0.00

Consumer Driven

Value Option Plan Example Member goes to Doctor Cost of Visit - $50 PCA Self Only Balance $100 Claim sent through PCA first $100 - $50 Remaining PCA Balance = $50 Member Liability $0.00

CDHP and Value Option 2014 Plan Partnerships

2014 Partnerships

The NALC Health Benefit Plan CDHP/Value Option has partnered with Cigna HealthCare to provide ….

The Cigna Open Access Plus PPO network which offers 1,875,900 participating family doctors and specialists, and more than 22,600 general acute care hospitals, and facilities nationwide.

And, CVS/Caremark, our prescription benefit manager, provides our membership access to more than 67,800 network pharmacies.

Chances are your medical provider or pharmacy is already eligible to receive In-network benefits from the Plan.

CDHP and Value Option

Benefit Structure Highlights

Preventive Care with an In-Network health care professional is covered at 100%

When the doctor bills your visit as preventive care, your PCA will not be used.

Examples of Preventive Benefits include but are not limited to: • • • • Well Baby and Well Child visits Well Man and Well Woman visits Routine Immunizations Routine Screenings:  Cholesterol Screening: Ages 20+, every 5 years     Diabetes Screening Mammogram: Once a year for women age 40+ Prostate Screening: Once a year for men age 40+ Colonoscopy: Ages 50+, every 10 years Note: Benefits will be reduced, if an In-Network provider is not used.

CDHP and Value Option

Benefit Structure Highlights Professional Services of physicians (Including specialists) or urgent care centers  Office or outpatient visits  Office or outpatient consultations  Second surgical Opinions

In-Network Out-of-Network

You Pay 20% of Plan Allowance 50% of Plan Allowance And any difference, if any between our allowance and charge Note: Your PCA must be used first and your deductible exhausted before traditional benefits will apply. Your deductible applies to all benefits listed above.

CDHP and Value Option

Benefit Structure Highlights Lab, x-ray, and other diagnostic tests (the below list is a summary and not inclusive). • Blood tests • Urinalysis • • • X-Rays Pathology Bone Density Study ……

In-Network Out-of-Network

You Pay 20% of Plan Allowance 50% of Plan Allowance And any difference, if any between our allowance and charge Note: Your PCA must be used first and your deductible exhausted before traditional benefits will apply. Your deductible applies to all benefits listed above. *Not covered - Routine tests except as listed in the official brochure under Preventive Care, Section 5.

CDHP and Value Option

Benefit Structure Highlights Maternity Care: • Routine prenatal visits • Delivery • • Routine postnatal visits Amniocentesis • • • • Anesthesia related to delivery or amniocentesis Group B streptococcus infection screening Sonograms Fetal Monitoring

In-Network Out-of-Network

You Pay 20% of Plan Allowance 50% of Plan Allowance And any difference, if any between our allowance and charge Note: Your PCA must be used first and your deductible exhausted before traditional benefits will apply. Your deductible applies to all benefits listed above.

CDHP and Value Option

Benefit Structure Highlights Physical, Speech, and Occupational Therapies: A combined total of 50 rehabilitative and habilitative visits per calendar year for treatment provided by a licensed registered therapist or physician for the following: Physical Therapy Occupational Therapy Speech Therapy The attending physician must - Order the care, Identify the specific skills the patient requires and the medical necessity for skilled services, and Indicate the length of time the services are needed.

In-Network Out-of-Network

You Pay 20% of Plan Allowance (All charges after 50 max visits have been met) 50% of Plan Allowance And any difference, if any between our allowance and charge(All charges after 50 max visits have been met) Note: Your PCA must be used first and your deductible exhausted before traditional benefits will apply. Your deductible applies to all benefits listed above.

CDHP and Value Option

Benefit Structure Highlights The NALC Health Benefit Plan CDHP/Value Option includes coverage for hearing aids and related examination up to a maximum Plan payment of $500 per ear with replacements covered every 3 years.

We will also cover custom functional foot orthotics including the casting up to a Plan payment of $200 every 5 years.

Our chiropractic benefit includes coverage for 12 spinal or extraspinal manipulations per calendar year.

Note: All of these benefits are payable first through your Personal Care Account and then subject to the calendar year deductible and applicable coinsurance.

CDHP and Value Option Benefit Structure Highlights

Prescription Drug Plan: All prescription drugs are classified into one of four categories, or tiers,…. based on quality, safety, clinical effectiveness and cost.

 Tier 1 consists of generic drugs.  Tier 2 drugs are brand drugs that appear on the Plan’s formulary. We call them formulary brand drugs.

 Tier 3 drugs are brand drugs that do not appear on the Plan’s formulary. We call them non-formulary brand drugs.  Tier 4 is specialty drugs.

CDHP and Value Option Benefit Structure Highlights

Your 2014 Drug Cost-Share for the NALC CDHP and Value Option Plans.

Generic Drug: You Pay:

Network Retail Mail Order

Formulary Brand Drug:

up to 30-day supply 90-day supply $10* $20* Network Retail Mail Order

Non-Formulary Brand Drug:

up to 30-day supply 90-day supply $40* $80* Network Retail Mail Order up to 30-day supply 90-day supply $60* $120*

* Prescription drugs are subject to the calendar year deductible. Your PCA must be used first and then you must meet the remainder of your deductible before your Traditional Health Coverage begins.

CDHP and Value Option Benefit Structure Highlights

Specialty Drugs**

Caremark Specialty Pharmacy Mail Order 30-day supply Caremark Specialty Pharmacy Mail Order 90-day supply

You Pay:

$200* $400*

*Prescription drugs are subject to the calendar year deductible. Your PCA must be used first and then you must meet the remainder of your deductible before your Traditional Health Coverage begins. **All specialty drugs require prior authorization. Specialty drugs, including biotech, biological biopharmaceutical and oral chemotherapy drugs, are generally defined as high-cost prescription drugs that treat complex conditions and require special handling and administration and can cost thousands of dollars for a single dose. Call CVS Caremark Specialty Pharmacy Services at 1-800-237-2767 to obtain prior approval.

CDHP and Value Option Benefit Structure Highlights

Want to be Tobacco Free?

    A voluntary tobacco cessation program offered by the Plan which includes: Unlimited professional 20 – 30 minute telephonic counseling sessions per quit attempt Online tools Over- the Counter nicotine replacement therapy For more information on the program visit mycigna.com

1-855-246-1873 or call

Health Risk Assessment (HRA)

We will pay the Self Only premium for the CignaPlus Savings sm Assessment (HRA).

discount dental program when you are enrolled in a Self Only option with the Plan and you complete the Health Risk We will pay the Self and Family premium for the CignaPlus Savings family members. sm discount dental program when you are enrolled in a Self and Family option with the Plan and an HRA is completed for two

CDHP and Value Option

Please keep in mind, the CDHP and Value Option benefits highlighted are only a summary of the plans. Please see our 2014 NALC Health Benefit Plan CDHP/Value Option brochure for a complete description of benefits to find out why the NALC Health Benefit Plan is the right choice for letter carriers.

CDHP and Value Option

General Information To obtain claim forms, claims filing advice or answers about our benefits, you can contact Cigna at: NALC Consumer Driven Health Plan or Value Option P.O. Box 182223 Chattanooga, TN 37422-7223 1-855-511-1893

Rate Information

Year

High Option NALC HBP Premiums

Bi – Weekly Postal Premium (Active) Self Family Monthly Annuitant Premium Self Family 2011 $51.56

$100.57

$160.64

$327.32

2012 2013 2014 $54.04

$52.95

$58.02

$105.16

$103.26

$114.59

$161.68

$160.66

$161.22

$327.60

$326.04

$327.27

CDHP and Value Option NALC HBP Premiums

Year CDHP Value Option 2014 Self $36.19

Family $78.58

Self $31.16

Family $67.66

The above rates only apply to Career Postal employees. City Carrier Assistants (CCA) should contact the HRSSC employing office for premium information at 1-877-477-3273, option 5

Dare to Compare

We encourage each individual to take the “Director’s Challenge” and “Dare to Compare” your current plan against the NALC Health Benefit Plan. You will see that the NALC Health Benefit Plan is both a comprehensive plan with quality service, benefits, and reasonable premiums. To accept the challenge go to: http://www.opm.gov/insure

Dare to Compare

http://www.opm.gov/insure     On the right side of page click on the QUICK LINK “Compare Health Plans” Insert your Zip Code. Hit Enter. Then Select the Plans you wish to compare (up to 4 plans).

Choose an Employee Type such as “U.S. Postal Service or Annuitant.” Click Next.

Choose a pay frequency such as Bi Weekly or Monthly.

The comparison will be shown on your screen.

How USPS Employees Enroll in NALC HBP?

If you are currently not a member sign up the next Open Season.

Enroll through PostalEASE:  On the Intranet (from the blue page)  By phone – 1-877-477-3273  At an Employee Self-Service Kiosk; or  Visit - http://liteblue.usps.gov

Open Season November 11 –December 9



Is the second Monday of November and runs through the second Monday of December each year.

If you need more information call the Plan at 1-888-636-NALC

NALC Health Benefit Plan

Our objective is to unite fraternally all Letter Carriers who are members in good standing in the National Association of Letter Carriers.

I belong to both the NALC Union AND the NALC Health Benefit Plan. Do You?????

I’m 100% UNION!!!

This is a summary of some of the features of the NALC Health Benefit Plan. Detailed information on the benefits for the NALC Health Benefit Plan can be found in the official brochure (RI 71-009). All benefits are subject to the definitions, limitations, and exclusions set forth in the official brochure.