Health Care Protected, Benefits Improved

Comprehensive Coverage Maintained

Health care was extremely contentious in this round of bargaining. The corporation’s primary goal was to shift substantial costs to our members. Our bargaining committee resisted this effort at major cost-shifting, and made key improvements while maintaining comprehensive health care coverages.

Primary Care Access Improved

The primary care network was improved, allowing advanced practice nurses and physician assistants to fully practice under the scope of their licenses. This means members can go to these practitioners for diagnosis, prescriptions, tests and treatment for acute conditions (like infections) and chronic diseases (like diabetes and heart disease).

No New Co-payments for Prescription Drugs

Despite the efforts of the corporation to significantly increase prescription drug co-payments for active workers, your bargainers maintained co-payments at the present level. (Retired workers: See Message to Retirees for information about your benefits.) In addition, they negotiated improvements in the Maintenance Drug List. Thirty-three drugs were added and three were removed from the current list.

A new specialty pharmacy retail network will be implemented as soon as practicable. The network will be developed to preserve broad access while securing better pricing.

The joint prescription drug review process has been maintained so that any programs or proposals that have a clinical impact are reviewed by an outside independent expert. The expert will make recommendations to the parties, who will then jointly decide what to do. Several items will be reviewed for safety, quality and cost concerns.

Certain over-the-counter antihistamines and vitamins will no longer be covered on the prescription drug program.

Higher Dental Maximums

The annual maximum and orthodontic maximums for dental coverage were increased to keep pace with inflation. Effective Jan. 1, 2008, the annual maximum will increase to $1,850 and the orthodontic maximum will increase to $2,200.

There were other dental changes, including:

• Bitewing X-rays will be available once every two years for ages 15 and older.

• Coverage for crown replacement limited to every five years.

• Topical fluoride will now be limited to enrollees under age 15.

• Dental HMOs will be eliminated.

Air Ambulance Expanded

Currently, air ambulance services are covered with a 50 percent member co-payment for the first 100 miles and a 100 percent member co-payment for travel above 100 miles. Under the proposed agreement, qualified air ambulance services will be fully covered with no mileage limit.

Immunizations Updated

Immunization coverage was expanded to include new doses and new vaccines per national recommendations.

Hearing Aid Coverage

Hearing aid coverage was improved so that members receive a single $2,000 allowance for hearing aids, ear molds and associated devices every three years. If members go to network providers, hearing aids are available at discounted network rates. In addition, the allowed amount for the hearing evaluation test was updated to $139, effective Oct. 1, 2007. This amount will be updated each October for inflation increases.

Changes in Eligibility for Dependent Children

There were changes to eligibility for certain dependent eligible children. Effective Jan. 1, 2009, children 19 and older will be covered only if they are full-time students. Full-time student coverage will be available until age 24. In addition, legal guardianship has been limited to people related by blood to the primary enrollee or spouse.

Office Visits

Effective Jan. 1, 2008, the Traditional Care Network (TCN) will provide five office visits per family per year at a cost of $25 per visit. This benefit does not apply to future or current retirees in the TCN. HMO office visit co-pays were also increased to $25.

PPO and Select HMO Enrollees Transferred to TCN

All PPOs and select HMOs will be eliminated. UAW-represented GM workers and their dependents who are currently enrolled in these programs will now participate in the Traditional Care Network, with broad access to medical providers. There will be no interruption in health care coverage as a result of this change.

Additional Improvements

To enhance health care protections for UAW-represented members and their families, MRI scan limits were removed, PET scan coverage was expanded and hospice coverage was improved.

Community Health Initiatives Maintained

The Community Health Initiatives sites were maintained. The Anderson, Ind., site will focus more on the Indianapolis area.

DME and P&O Updated

Durable medical equipment and prosthetic and orthotic coverages have been updated to the Medicare levels.

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