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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