Date :              December 1, 2004

To :                 I.B.T. Local No. 145 Health Services & Insurance Plan Membership

From :             Board of Trustees

Re:                  Plan Changes Effective January 1, 2005

 

 

In April 2004, the Trustees started a series of communications to the membership regarding improving the longterm stability of the Health Fund.   As part of that communication, several plan design changes were introduced to help offset the ongoing dramatic increases in health care costs.    Part of the message delivered was that the Trustees were also going to continue to evaluate other possible cost containment measures to address the concern.

Since that time, the Trustees have conducted several plan audits and researched other possible carrier and/or plan design changes.   As an outcome of that process, it has been concluded that the Fund can make changes in the way the plan is administered and save money and improve service to our membership.   Therefore, as of January 1, 2005, the Fund will no longer be processing claims directly.   Rather, our network partner, Anthem Blue Cross Blue Shield of Connecticut, will be processing our claims on behalf of the Fund.

These changes in process will provide for :

·        Reductions in overall administrative costs, allowing for more of the Fund’s money to be used for benefits;

·        Improvements in service, as Blue Cross Blue Shield has a dedicated Taft-Hartley unit to respond to member concerns; 

·        Simplicity, as all of our Medical Plan features will be managed by Blue Cross Blue Shield (we will no longer use Envisioncare for UR as these services will be part of the overall Blue Cross Blue Shield package); 

·        Improved health management, as the Fund membership will have access to the entire suite of Blue Cross Blue Shield health improvement and disease management programs; 

·        Standardization of benefits, so that our plan design will better mirror the benefits and claims processing that local providers are used to using. 

Note that the change in the medical plan service does not affect the processing or payment of any other benefits provided to you and your family through the Fund, such as prescription drugs, dental and vision benefits.

For those long time members of the Fund, this announcement may feel like a departure from past practices.    In order to become comfortable with this change, below is a summary of how this change will affect the Fund and its members : 

What is Staying the Same

 

What is Changing

·         The Blue Cross Blue Shield network of hospitals, doctors and specialists is the same.

 

·         Blue Cross Blue Shield will adjudicate and process the claims rather than Fund personnel processing claims.

 

·         The Fund’s ability to be flexible in setting the plan design.  Although there are a few changes to make the plan more standard, there are little changes being made to the coverage.

 

·         If you have questions about a claim status or a claim payment, you should call Blue Cross Blue Shield FIRST to get it resolved.   If not satisfied with the response, the Fund is here to assist you.

 

·         There are still some services that need to be pre-authorized, such as inpatient stays.

·         Envisioncare will no longer be the service provider for pre-authorization.  This function will be provided by Blue Cross Blue Shield.  This list of services requiring pre-authorization is changing slightly to the Blue Cross Blue Shield standard listing.

 

·         The prescription drug benefit will stay the same and will continue to be administered by Caremark PCS.

 

 

·         Although initial member complaints and questions should go through Blue Cross Blue Shield member services, the Trustees will continue to hear appeals from members who adhere to the established appeals process.

 

 

 The Trustees are supportive of this change and believe that the adoption of a more standard, well managed and cost effective program will improve the care and service provided to our members.   We also believe that paying less for administrative services will benefit the Fund longer term.  

As we get closer to January 1, 2005, you will be receiving a new Blue Cross Blue Shield ID card and booklet.   This new card will have a new ID number.  It is important for you to share this information with your doctors.

Additional information will be forthcoming.  Please call if you have questions.