Group Policy GA-23111 holds an open enrollment period in
December of every even calendar year. The next open enrollment period will be in December,
1998. Coverage for individual enrolling in December, 1998 will be effective January 1,
1999. No proof of insurability is required. There are no preexisting condition
limitations.
The following individuals may enroll in December 1998:
- Employees and dependents whose coverage under GA-23000 ended because of furlough or
retirement
- Amtrak employees and dependents whose coverage under Amplan ended because of furlough or
retirement.
- Employees currently covered under GA-23000, GA-23111, GA-107300 or Amplan may enroll any
parent or parent-in-law who is eligible for Medicare.
There are three GA-23111 plans available:
- Plan E covers individuals who are also eligible under Ga-46000, or Amplan Early
Retirement Benefits.
- Plan D covers individuals who are eligible for Medicare.
- Plan C covers individuals who are not eligible for Ga-46000, Amplan Early Retirement
Benefits or Medicare.
Complete details of the GA-23111 eligibility and benefit
provisions can be found in the booklet titled Group Health Insurance Plans for
Furloughed and Retired Railroad Employees and their Dependents. You may obtain this
booklet from your organization headquarters, or by calling United HealthCare toll-free at
1-800-842-5252.
Following is a brief summary of the current coverage under each GA-23111 plan.
Benefits under any of these plans may change in the future.
Plan C For Individuals Not Eligible for GA-46000 Amplan Early
Retirement Benefits or Medicare
Major Medical Benefits:
- Maximum Amount per lifetime - $150,000
- Cash deductible per calendar year - $500
- Out-of-Pocket Maximum per calendar year - $5,000
- Percentage of Covered Expenses payable - 75% (65% if Medical Management is not called
when required).
- Percentage of Covered Expenses payable after Out-of-Pocket Maximum is reached - 100%.
Plan D For Individuals Eligible for Medicare
Hospital Benefits reimburse the Part A Medicare Deductible and Coinsurance amounts in
full for Hospital confinements up to 90 days, and for the 60 Medicare lifetime reserve
days.
Skilled Nursing Facility Benefits reimburse the Part A Medicare Coinsurance amounts in
full for Skilled Nursing Facility confinements up to 100 days.
Treatment Center Benefits cover Treatment Center confinements, up to $55 per day, for
up to 30 days per lifetime.
Major Medical Benefits:
- Maximum Amount per lifetime - $300,000
- Cash Deductible per calendar year - $100
- Percentage of Covered Expenses payable: all expenses other than out-patient treatment of
mental and nervous disorders - 80% out-patient treatment of mental and nervous disorders -
65%.
Pharmacy Benefits:
- Car Program - up to a 21-day supply for a $5 copayments for generic drugs and $10 for
brand name drugs.
- Mail Order Program - up to a 120-day supply for a $10 copayment for generic drugs and a
$20 copayment for brand name drugs.
- Maximum Amount per calendar year $3,000.
Plan E For Individuals Eligible for GA-46000 or
Amplan Early Retirement Benefits
Major Medical Benefits:
- Maximum Amount per lifetime - $200,000
- Cash Deductible per calendar year - $100
- Out-of-Pocket Maximum per calendar year $5,000
- Percentage of Covered Expenses payable: all expenses other than out-patient treatment of
mental and nervous disorders - 70% out-patient treatment of mental and nervous disorders -
50%
- Percentage of covered Expenses payable after the Out-of-Pocket Maximum is reached -
100%.
Treatment Center Benefits cover Treatment Center confinements up to $55 per day, for up
to 30 days per lifetime.
For more information including payment rates, or to obtain an Enrollment Form, call
United HealthCare toll-free at 1-800-842-5252. |