YourTrackToHealth

Benefits for 2018: What’s important to know

The benefits presented on this page apply only to those Railroads/Labor Unions that have reached new collective bargaining agreements effective on or after January 1, 2018.

Clickbenefit lookup here to go to the Summary of Benefits & Coverage (SBC) Lookup and find out if your 2018 benefits have changed.

Click on one of the following links to access the Summary of Material Modification (SMM) Letter that applies to you:

Overview of Benefits - The National Railroad Plans (Benefits Effective January 1, 2018; See Note (1))

Medical - Benefit Design Features, including Mental Health Care and Substance Abuse Care MANAGED MEDICAL CARE PROGRAM (MMCP) COMPREHENSIVE HEALTH CARE BENEFIT
(CHCB)
In-Network Out-of-Network
Annual Deductible (does not apply toward Out-of-Pocket Maximum) $325 Individual / $650 Family (1/1/18)
$350 Individual / $700 Family (1/1/19)
$650 Individual / $1,300 Family (1/1/18)
$700 Individual / $1,400 Family (1/1/19)
$325 Individual / $650 Family (1/1/18)
$350 Individual / $700 Family (1/1/19)
Percent of Eligible Medical Expenses Paid Plan pays 90% (after deductible is met and only on expenses for which no copay applies); Member pays 10% Plan pays 70% after deductible is met; Member pays 30% Plan pays 80% after deductible is met; Member pays 20%
Annual Out-of-Pocket Maximum (2) $1,800 Individual / $3,600 Family (1/1/18)
$2,000 Individual / $4,000 Family (1/1/19)
$3,600 Individual / $7,200 Family (1/1/18)
$4,000 Individual / $8,000 Family (1/1/19)
$2,800 Individual / $5,600 Family (1/1/18)
$3,000 Individual / $6,000 Family (1/1/19)
Services when copays apply (MMCP In-Network):
Telemedicine Visit
Member pays $10 per visit Not Applicable Member pays 20% (no deductible applies)
Office Visit to a Primary Care Physician (PCP)
Member pays $25 per visit Member pays 30% after deductible is met Member pays 20% after deductible is met
Office Visit to a Mental Health/Substance Abuse Counselor
Member pays $25 per visit Member pays 30% after deductible is met Member pays 20% after deductible is met
Office Visit to a Specialist
Member pays $40 per visit Member pays 30% after deductible is met Member pays 20% after deductible is met
Convenient Care Clinic
Member pays $10 per visit Member pays 30% after deductible is met Member pays 20% after deductible is met
Urgent Care Facility
Member pays $25 per visit Member pays 30% after deductible is met Member pays 20% after deductible is met
Emergency Care Facility
Member pays $100 per visit Member pays 30% after deductible is met Member pays 20% after deductible is met
Medical - Other Benefit Features
Hospice Care Member pays 10% after the deductible is met (up to $3,000) Member pays 30% after the deductible is met (up to $3,000) Member pays 20% after the deductible is met (up to $3,000)
Home Health Care Member pays 10% after deductible is met Member pays 30% after deductible is met (up to 40 visits per calendar year) Member pays 20% after deductible is met
Skilled Nursing Facility Member pays 10% after deductible is met (up to 60 days per calendar year) Member pays 30% after deductible is met (up to 60 days per calendar year) Member pays 20% after deductible is met (up to 31 days per hospitalization)
Certain Preventive Services (3) Certain Preventive Services Covered at 100% Limited Scope of Services Covered at 70% Certain Preventive Services Covered at 100%
Centers of Excellence (4) Up to 100% Not Applicable Up to 100%
Lifetime Benefit Maximum Unlimited Unlimited Unlimited
Care Coordination/Medical Management (5) Not Applicable Notification requirements for certain services Notification requirements for certain services
Prescription Drugs - Benefit Design Features (6)
Retail (21-Day Supply):
Generic
Brand (Formulary)
Brand (Non-formulary)
Member pays $10 per prescription
Member pays $30 per prescription
Member pays $60 per prescription
Member pays 25% of R&C
(reasonable & customary) (7)
In-Network and Out-of-Network Prescription Drug benefits under CHCB are identical to the prescription drug benefits shown under MMCP.
Mail Order (Up To 90-Day Supply):
Generic
Brand (Formulary)
Brand (Non-formulary)
Member pays $10 per prescription
Member pays $60 per prescription
Member pays $120 per prescription
Additional Programs (Voluntary, Member-Initiated):
Expert Second Opinion
No cost to member Not Applicable No cost to member
Health Advocacy
No cost to member Not Applicable No cost to member
End of Life Counseling
No cost to member Not Applicable No cost to member
  1. The benefits presented within this document apply only to those Railroads/Labor Unions that have established new collective bargaining agreements under the National Health and Welfare Plan or
    NRC/UTU Health and Welfare Plan effective on or after January 1, 2018.
  2. The Out-of-Pocket maximums apply solely to coinsurance amounts paid by the member and does not apply to deductibles or fixed dollar copayments.
  3. Call the number on the back of your health plan ID card to determine which preventive care services are covered by your plan
  4. Certain complex conditions that are treated at various Centers of Excellence may qualify for this 100% benefit.
  5. Certain services require the employee to provide advance notification to the company administering the medical benefits or the benefit payment will be reduced by 20% under the Managed Medical Care Program
    (out-of-network services only) or under the Comprehensive Health Care Benefit.
  6. Out-of-pocket expenses for prescription drugs do not apply to the MMCP or CHCB out-of-pocket maximums. Certain drugs are subject to prior authorization rules, step therapy requirements and/or quantity/dose limits.
  7. Reasonable and customary costs are determined by the average cost of similar services in your geographic area.
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