BMWE Northeastern System Federation

Railroad Employees National Health and Welfare Plan

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The Railroad Employees National Health and Welfare Plan ("The Plan") is a series of health care benefits provided for employees represented by participating labor organizations covered by a collective bargaining agreement with a participating employer that provides these Plan benefits. The Brotherhood of Maintenance of Way Employes Division is a participating labor organization and Canadian Pacific Railroad is a participating employer.


Eligible Employees: All Maintenance of Way Employees in good standing on the Delaware and Hudson are Eligible Employees under the plan. When an eligible employee becomes covered is outlined in a summary below. This is just a summary and you are instructed to consult your collective bargaining agreement, and contact One of the Health Care Benefit Administrators for the most detailed information and a plan booklet.
Generally you and your eligible dependents, become covered the first month after the month you render seven calendar days of compensated service (Requisite amount of Compensated Service, or Requisite amount of Vacation Pay). You and your eligible dependents continue to be covered during the month following each month you render or receive, Requisite amount of Compensated Service, or Requisite amount of Vacation Pay.
Requisite amount of Comepensated service is: Compensated service rendered for an aggregate (total) of at least seven calendar days during a calendar month. Requistie amount of Vacation Pay is: Vacation pay received for an aggregate (total) of at least seven calendar days during a calandar month.
Furloughed Employees: If you are a furloughed employee and if you rendered compensated service for three months as an eligible employee, you will be covered for Employee and Dependents Health Care Benefits during your furlough until the end of the fourth month following the month in which you last rendered compensated service.
If you received Vacation Pay before the date on which you are furloughed, but in a month subsequent (after) to the month in which you last rendered compensates service, the continued coverage described above will be measured from the month in which you received the Vacation Pay.
If you return to work as an Eligible Employee before your coverage ends, you will continue to be covered during the month in which you again render compensated service.
If you return to work as an eligible employee after your coverage ends, you will not be covered again until the month following the month in which you render the Requisite amount of Compensated Service. (You will again be covered the month after you receive seven calendar days of compensated service).
Additional information is provided in the Collective bargaining Agreement Rule 39 and Appendix "L", and from the health care administrators on how benefits are handled for the following: * Suspended or Dismissed Employees * Pregnant Employees * Disabled Employees * Retired Employees * Deceased Employees * Employees Under Compensation Maintenance Agreements * Returning Veterans * Employees Taking Family or Medical Leave Pursuant to the Family and Medical Leave Act of 1993. You are instructed to consult Your employer, Your union Representative and your health care provider for questions regarding how benefits are handled in the above listed conditions.
There are four Categories under the plan: 1. Comprehensive Health Care Benefit ("CHCB") The comprehensive health care benefits provided under "The Plan", are available in geographical areas where managed care networks are not available to Plan participants and their dependents, or in cases where a Plan participant has elected to be covered, along with his or her dependents, by such comprehensive benefits rather then a managed care network. Please refer to Collective Bargaining agreement Rule 39 and "Appendix L" starting on page 137 for additional information. For the most detailed information about the "CHCB" Contact United Health Care at: On the Web at: United Health Care Or Phone: (800)-842-9905 Toll Free
2. Managed Medical Care Program ("MMCP") Managed care networks that meet certain standards concerning quality of care, access to health care providers, and cost-effectiveness, shall be established wherever feasible as soon as practicable. Until a managed care network is established in a given geographical area, individuals in that area who are covered by the plan will have the comprehensive health care benefits coverage. Each employee in a given geographical area who is a Plan participant at the time a managed care network is established in that area will be enrolled in the network, (along with his covered dependents) unless the employee provides timely written notice to the employer of an election to have the comprehensive health care benefit. A employee who chooses the "CHCB" rather than to be enrolled in a network shall have an opportunity to revoke his/her enrollment in the managed care program by providing a written notice to the employer sixty days before January 1 of the calendar year of which the revocation shall become effective. Covered individuals enrolled in a managed care network have a point of service option allowing them to choose an out-of-network provider to perform any covered health care service that they need. The Plan does not provide 100% coverage for out-of-network services and there are annual individual and familial deductibles as well as other costs that are not covered. You are directed to the collective bargaining agreement Appendix "L" page 137 for additional information, or contact a health care administrator for a plan booklet. Newly Hired Employees Each newly hired Eligible Employee who, at the time he/she first renders the requisite amount of compensated service, lives in an area where the Plans MMCP is available, will be enrolled, along with his/her Eligible Dependents, in an Interim MMCP starting with the first day of the month following the month he/she first renders the requisite amount of compensated service and continuing until the completion of enrollment in the MMCP, but not beyond the end of the third month following the month the Eligible employee first renders the requisite amount of compensated service. This Interim MMCP is identical to the MMCP except that the payments for Out-of-network services are paid by the Plan at an increased percentage. (Please consult Collective Bargaining Agreement and your health care administrator for additional information). You are required to pay certain co-payments Under the MMCP.. The Managed Medical Care Program is administered by either United Health Care or Aetna, depending on your geographical location. The most detailed information is available from United Health Care or Aetna. Please refer to Collective Bargaining agreement Rule 39 and "Appendix L" starting on page 137 for additional information. For the most detailed information and to find a health care provider contact United Health Care or Aetna at: United Health Care On the Web: United Health Care Phone: (800)-842-9905 Toll Free Aetna On the Web: Aetna Phone: (800)-842-4044 Toll Free
3. Mental Health and Substance Abuse Care Benefit ("MHSA") The MHSA, is administered by ValueOptions, and pays for certain Eligible Expenses for mental health care or substance abuse care. This benefit does not cover Medical Care; nor does it cover Prescription Drugs obtained as part of outpatient mental health care or substance abuse care. The Plan does cover these expenses to the extent of they are covered under the MMCP, CHCB, and The Prescription Drug benefit listed in the fourth category. Different Levels of benefits are paid under the MHSA depending upon whether you obtain In-network services or Our-of-network services. To receive the highest benefit level, you must use In-network services. To receive the maximum benefit that is payable when you use Out-of-network services, you must comply with ValueOptions Certification or Pretreatment Outpatient Assessment requirements. You are instructed to contact ValueOptions for the most detailed information at: Value Options On the Web: ValueOptions Phone (800)-934-7245 Toll Free
4. Managed Pharmacy Services Benefit ("MPSB") The MPSB covers Prescription Drugs that are medically necessary and that are given for the treatment or prevention of an injuryor sickness. There are no deductibles, annual out-of-pocket maximums, or lifetime maximum benefits, applicable to the MPSB. This program, administered by Medco, pays for outpatient prescription drugs filled at either an In-network pharmacy or an Out-of-network Pharmacy. The prescription drug identification card that you have or will receive under the MPSB may be used only at In-network pharmacies. In-network pharmacies fill prescriptions for supplies up to 21 days. In-network Pharmacies dispense Generic Drugs whenever possible. Generic Drugs Co-payment $5.00. Brand Name Drug Co-payment $10.00 Limitations on Brand Name Drugs. You are instructed to contact medco to get most complete information.
Out-of-network pharmacies are pharmacies that do not participate in the Medco Pharmacy Network. If you go to an Out-of-network pharmacy you must pay the entire cost of the prescription at the time it is filled. Then you must submit a claim. The MPSB pays 75% of the Eligible Expenses for up to a 21-day supply of a prescription drug that you buy at an Out-of-network pharmacy. If you buy a supply of prescription drugs for a period in excess of 21 days at an In-network or Out-of-network pharmacy, you will receive no benefits under the plan. Mail Order Prescription Drug Program Under the mail order prescription drug program, administered by Medco, you may obtain prescription drugs by mail. Mail order prescription Drug program will supply no less than 22, and no more than 90, days of prescription medicine. Generic Drugs Co-payment $10.00 Brand-Name Drugs Co-payment $15.00
Generic Drugs, if available, will be dispensed unless the written prescription requires otherwise. Certain Restrictions apply to all Pharmacy Services. You are instructed to consult medco for all coverage and limitation questions. You must also contact Medco for all order forms for Mail order prescriptions and claims forms.
Please refer to Collective Bargaining agreement Rule 39 and "Appendix L" starting on page 137 for additional information.
You are instructed to contact Medco regarding any questions on the Managed Pharmacy Services Benefit at: Medco On the Web: Medco Phone: (800)-842-0070 Toll Free
Optional Continuation Coverage Under COBRA COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a "qualifying event". After a qualifying event has been determined, continuation coverage must be offered to each person who is a "qualified beneficiary". Specific qualifying events and beneficiary information are available from United Healthcare. Common qualifying events for COBRA if you are an employee: * Yours hours of employment are reduced, * Your employment ends for any reason other than your gross misconduct. For additional information on other qualifying events and general information on COBRA you should contact United Healthcare at: United Healthcare Railroad Administration P.O. Box 150453 Hartford, CT 06115-0453 Phone (800)-842-9905 Toll Free
For more information about your rights under COBRA and other laws affecting group health plans, contact your nearest regional or district office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) in your area or visit the website listed below. Addresses are available at the website. www.dol.gov/ebsa

Important Please Read! There are many limitations on coverage and covered benefits. This is a brief summary of benefits and coverage. For more complete information consult your Collective Bargaining agreement and contact the Plan Administrators listed above for complete details on The National Health and Welfare Plan.

If you believe you are wrongfully being denied benefits you are instructed to contact your local union representatives or the General Chairman.