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Health care reform continues to be at the center of national debate from the kitchen table to the halls of Congress. Nearly 50 million people remained uninsured in 2010, and many Americans find their health benefits slashed or eliminated. Health care reform will remain a hot-button issue in today’s political climate and one that the UAW will continue to stridently support. The UAW believes that access to affordable and quality health care is a moral right for all. The institution has been a constant champion for health care reform and strongly supports the Patient Protection and Affordable Care Act (PPACA), signed into law by President Obama in 2010.
During this round of negotiations, it was a priority of the union to maintain benefi s and negotiate enhanced health care coverage that would supply our members with above-standard care and provide a direct tie-in with the PPACA.
Prescription drug coverage
(See Health Care Attachment, page 138)
The UAW GM bargaining team held firm on no new increases in health care prescription drug costs for the life of the proposed agreement. The team was also able to expand the maintenance drug list.
(See Health Care Attachment, page 31)
Effective Jan. 1, 2012, modifications to health care for hourly active employees and their dependents will be provided with unlimited office visits by in-network providers at a $25 co-payment per visit. Also, an annual wellness physical will be included and paid in full.
Coverage will expand to include an urgent care benefi t at participating providers with a co-payment of $50, and emergency services now also carry a co-payment of $100 if the patient is not admitted to the hospital for treatment.
Increased coverage for hyperbaric oxygenation treatment
(See Health Care Attachment, page 123)
Outpatient hyperbaric oxygenation treatment will now include the following conditions: diabetic wound care, chronic refraction osteomyelitis, osteoradionecrosis and soft tissue radionecrosis.
Improved and expanded Lifesteps program
(See Health Care Attachment, page 282)
The Lifematch program will continue to be funded through the GM Foundation, and all plants will now be eligible for annual screenings through Lifesteps.
(See Health Care Attachment, page 162)
The age restriction for wig benefits has been removed with adults now eligible. Wigs and appropriate related supplies for enrollees suffering from the effects of chemotherapy, radiation or other treatments for cancer will now be covered with maximum benefits for the first purchase of a wig set at a $200 maximum benefit and up to $125 thereafter.
(See Health Care Attachment, page 77)
Coverage for pre-hospice consists of evaluation, consultation, education and support services with a lifetime maximum of 28 visits available prior to the enrollee electing hospice care. Pre-hospice coverage allows concurrent continuation of curative treatment until the enrollee is ready to forgo curative care.
(See Health Care Attachment, page 89)
UAW GM members will now be eligible for hospice if life expectancy is 12 months or less (changed from six (6) months). There is a lifetime maximum of 365 days which may be extended through case management. It was previously 210 days.
Hearing aid coverage
(See Health Care Attachment, page 155)
Physical, occupational and speech therapy benefit expanded
(See Health Care Attachment, page 109)
Enrollees are entitled to now receive physical therapy, occupational and speech therapy services provided in a doctor’s offi ce setting in addition to all PTO therapy facilities. Diagnosis codes for physical therapy will also be expanded to include things such as wound therapy and debridement.
Improved dental care coverage
(See Health Care Attachment, page 194-197)
Dental care coverage was upgraded so that UAW GM hourly members now receive composite resins for all fillings when restoring posterior teeth, regardless of surface. Additionally, enrollees at risk for oral cancer or with unresolving oral lesions or ulcerations, will now have coverage for one (1) brush biopsy per calendar year.
Other improvements include:
Fluoride trays for patients undergoing radiation therapy treatment for head and neck will now be covered at 100 percent.
(See Health Care Attachment, page 295-302)
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA) health care reform bill. The PPACA gives access to insurance for over 30 million Americans with numerous provisions to take effect over several years and broadens private and public health insurance coverage, including increasing coverage of pre-existing conditions.
With the additional coverage provided because of the PPACA, the UAW negotiated the following additions to the health care program for hourly active employees and their dependents:
Expanded coverage with PPACA
During this round of negotiations, GM Hourly active workers will now be provided with up to five (5) well-baby visits for children from 13 months of age through 35 months of age. Within a calendar year, for children ages 36 months through age 17, one (1) well-child visit is allowed.
Additional coverage includes an annual, routine physical exam per calendar year for enrollees age 18 or older. All female enrollees will be provided with annual, routine gynecological exams.
Cholesterol screening coverage has been expanded to include children ages 24 months to 21 years, in addition to men over the age of 35. Screenings will also be provided for men, ages 21 to 35, with potential increased risk of coronary heart disease, and at-risk women over the age of 20.
In addition, specified lab services will now be covered including one (1) abdominal, aortic aneurysm by ultrasound per lifetime, osteoporosis screenings for women and infectious screenings for all enrollees.
There were also gains in prenatal care with the addition of prenatal screenings, infectious screenings, and consultations regarding healthy diet, breastfeeding and tobacco use. Newborns will now be eligible for developmental screening and evaluation up to age 30 months, along with prevention screening at birth for congenital hypothyroidism, metabolic/hemoglobin, phenylketonuria and sickle cell.
Preventative services and care was expanded to include infectious screenings, autism screening, obesity screening, blood pressure screening and depression screening. These preventative services are covered as part of the routine physical exam and not separate, billable items per the carrier.
Retiree health care
(See the statement by the VEBA Trust)
Retiree health care benefits are controlled by the Voluntary Employee Beneficiary Association, or VEBA, which is administered by an independent board of trustees and is not part of the UAW GM collective bargaining agreeement. The VEBA board holds regular meetings to assess retiree health care benefits and will keep you informed as progress is made toward finding solutions to health care concerns expressed by UAW GM retirees.