Master Union Align Medical Plan Co-Pay Reimbursements

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DATE:              February 10, 2023

TO:                   All CWA Local 1168 Members at Kaleida Health Enrolled in the Master Union Align Medical Plan

FROM:             Executive Board and Special Directors of CWA Local 1168

RE:                   Co-pay Reimbursements

All Kaleida Employees covered under the Master Union Align Medical Plan have the option to submit for co-pay reimbursements as captioned in the chart below from Article 29 of the Collective Bargaining Agreement.

Also attached is the form needed for submission.

Chart From Article 29 – Medical and Prescription Drug Benefits:

Benefit Level Premium Medical and Prescription

Drug Plan Design

Master Union Align Plan Design
In-Network (deleting CHS) Out-of-Network Optimum Choice (deleting CHS) Flexible Choice Out of Network
Up Front Refund Up Front Refund Up Front Refund
Deductible N/A $750/$1250 N/A $1000/$2000 $1000/$2000
Coinsurance N/A 30% N/A 30% 30%
OOP Maximum  

$6,350 single/

$12,700 Family

$2,500/$5,000 $2,500/$5,000 $2,500/$5,000 $2,500/$5,000

 

Medical Services
PCP Office Visits  $20 Ded/Coinsurance  $20 N/A  $35 $15 Ded/Coinsurance
Specialist Office visits  $20 Ded/Coinsurance  $35 $15 $65 $45 Ded/Coinsurance
Preventative Office Visits & Immunizations $0 Ded/Coinsurance $0 N/A $0 N/A Ded/Coinsurance
Diagnostic x-rays, including MRI $20 Ded/Coinsurance $30 $10 Ded/Coinsurance Ded/Coinsurance
Laboratory testing * $0 Ded/Coinsurance $0 N/A Ded/Coinsurance Ded/Coinsurance
Occupational, speech, physical therapy $15 Ded/Coinsurance $30 $15 $30 $15 Ded/Coinsurance
Chiropractor Office Visits $15 Ded/Coinsurance $30 $15 $30 $15 Ded/Coinsurance
Hospital Care
Inpatient     $500 First Family Discount $500 Ded/Coinsurance $500 N/A Ded/Coinsurance Ded/Coinsurance
Outpatient surgery facility $15 Ded/Coinsurance $75 $60 Ded/Coinsurance Ded/Coinsurance
Emergency room visit (waived if admitted) $75 $75 $120 $45 $120 $45 $120 $45
Emergency ambulance (medically necessary) $75 $75 $120 $45 $120 $45 $120 $45
Other Services
Durable medical equipment 50% Ded/50% 50% 50% Ded/50%
Annual maximum $1,000 $1,000
Home health care $15 Ded/Coinsurance $15 N/A Ded/Coinsurance Ded/Coinsurance
Orthotics Not covered Not covered Not covered Not covered Not covered
Urgent Care $45 $45 $60 $15 Ded/Coinsurance Ded/Coinsurance
Away from Home Guest Membership Not Available Not Available Available
OB Deliveries at CHS (Notes below) Considered In-Network Ded/Coinsurance Considered In-Network Ded/Coinsurance Ded/Coinsurance
Medical Services & Cancer Center

(conditions under treatment prior to 1/1/2020)

Considered In-Network Ded/Coinsurance Considered In-Network Ded/Coinsurance Ded/Coinsurance
Prescription Drugs
Retail Pharmacy through December 31, 2022

 

Retail Pharmacy effective January 1, 2023

$10/$20/$40

 

$5/$15/$35

Not covered $5/$20/$40

 

$0/$15/$35

N/A N/A

RVA/mg   UAW 55   DATA\BANDRUSZKO\ALIGN MEDICAL CO-PAY REIMBURSEMENT MEMO

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