B   M   W   E
JOURNAL
 
ONLINE VERSION VOLUME 106 - NUMBER 5 - JUNE 1997
 
Managed Care - New Sites Effective July 1, 1997
 
The next phase of sites eligible for the Managed Medical Care Program will be introduced under the Railroad Employees National Health and Welfare Plan July 1. Employees and dependents in the metropolitan areas of Lincoln, Nebraska; Pensacola, Florida; Springfield, Missouri; Topeka, Kansas; and in areas of Southwestern Indiana, east Texas and the state of Maine will have a choice of health care coverage. Now employees living in these United HealthCare network areas can choose between the coverage they have today--the Comprehensive Health Care Benefits (CHCB)--and the Managed Medical Care Program (MMCP). The selection will take effect July 1, 1997 and will be effective through December 31, 1997. Employees in other areas of the country will be advised when additional sites are available.

Here is some information that will help you understand the new Managed Medical Care Program:

What is Managed Care? Managed Care is a way for you and your dependents to obtain quality medical care at a low cost with expanded coverage. Doctors who are part of a Managed Care network work together to give you and your dependents just the right care when you need it.

How Managed Care Works: If you are in the Managed Medical Care Program, you and your dependents will need to select a doctor from the network. This doctor is called a "Primary Care Physician" (PCP), and will be your personal doctor. Your PCP will keep all your medical records and know your health history. When you need medical care, you see your Primary Care Physician first. This doctor will treat you and, if necessary, refer you to a network specialist or facility.

Advantages of the Managed Medical Care Program:

  • No Claim Forms - After you enroll, there are no claim forms to file when you receive care through your PCP.
  • Low Cost - As long as you go to your Primary Care Physician, you'll only pay $15.00, called a "co-payment", for an office visit, and there is no annual deductible or maximum.
  • Quality Care - You'll have a doctor to turn to when you are sick and need care or advice. For instance, when you are faced with having an operation, you have access, through your PCP, to a wide range of network specialists and facilities.
  • No Patient Advocate - There is no need to call Patient Advocate. Your PCP makes the call if needed.

Doctors in Managed Care Plans: Doctors in Managed Care networks are reviewed every year to make sure that they continue to meet certain high quality standards. You receive a directory listing all the Primary Care Physicians in the network. You select a Primary Care Physician from this directory. You can pick a different PCP for each dependent. For example, you may want to choose a pediatrician for your children.

Joining the Managed Medical Care Program: If you live in an area where the Managed Medical Care Program is available, your medical benefits will be provided through MMCP unless you choose to remain in CHCB. If you live outside one of these areas, you will continue to be covered by the CHCB.

Coverage for Hospital Association Members: If you are a member of a Hospital Association, your benefits will remain unchanged. This new program applies only to your dependents, not to you.

If you receive information about the new Managed Medical Care Program, be sure to read it. That'll help you make an informed decision about whether the Managed Medical Care Program is right for you and your dependents.

 
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