1. NALC Health Benefit Plan
Welcome audience and make opening comments.
Fredric V. Rolando, President
Brian Hellman, Director

2. This is YOUR Health Benefit Plan

3. NALC Constitution Article 2
Section 1. To unite fraternally all letter carriers who are members in good standing in the National Association of Letter Carriers.
Section 2. To establish Health Benefit Funds from which to pay contributing members holding Health Benefit Certificates who become lawfully entitled thereto, certain benefits as indemnity against loss resulting from the expense of hospital, surgical and other medical expense due to bodily injuries or sickness of the members and enrolled dependent members of his/her family, and from which to defray the necessary running expenses of the Plan. 

4. NALC HBP History
Where we started: 1950 – NALC started its own independent health benefits plan with 2 employees housed in a single room. At the close of the initial open enrollment membership totaled 4,116.
In the family Plan had a monthly premium of $6.35 and benefits included a $10.00 daily hospital room payment, $ in misc benefits (x-rays, lab fees, etc.), and a surgical schedule with a $ limit. The total maternity benefits were $ Letter carriers paid 100% of the premium out of their own pocket. Wow, what a ways we have come!!

5. History 1950’s (continued)
NALC HQ’s Building
Mid 50’s – Membership grew to 30,000. The independent health plan employed 26 employees and occupied 3 rooms located in the NALC Headquarters building at 100 Indiana Ave, NW Washington, DC.
By mid – 1950 the NALC was established in its own building in the shadow of the Nation’s Capitol.

6. History 1960’s (continued)
Early 60’s – Became part of the Federal Employees Health Benefit Program with passage of public law PL Enrollment quadrupled to 101,503. The Plan used every available office space at the headquarters building. The auditorium became the file room.
In 1963 the NALC added an eight (8) story annex to the NALC Headquarters Building. We occupied four (4) floors in the annex and space in the main building.
The NALC Health Benefit Plan became part of the Federal Employees Health Benefit Program in 1960 and letter carriers joined the Plan in unprecedented number. Overnight the Plan went from an enrollment of 30,000 to 101,503 members. As the membership quadrupled, so did the staff requirements and need for office space. The Plan used every square foot of unused space, including hallways, storage rooms in the basement, and the auditorium as the new file room. In 1963, the NALC added an eight story annex to the HQ building . The Plan now occupied four floors of the annex, plus space in the building.

7. History 1970’s (continued)
NALC HBP Reston, VA
1972 – The NALC HBP continued to grow in the Federal program. The entire Plan moved to Reston, Virginia by the end of the year. The entire staff comprised of 229 employees and membership totaled 141,177.
During the 1970’s, the NALC Health Benefit Plan grew, matured, and took its rightful place as one of the most respected plans in the Federal program. However, the success also meant that the Plan was once again running out of space. Early in 1972, plans were well underway to move to Reston, VA. By the end of 1972, the entire staff (229 employees) relocated to the Reston site on Sunset Hills Road.

8. History 1980’s (continued)
Computer Terminals
1980’s – The computer age hit the Plan. All analysts were equipped with computer terminals and claims were processed through a computerized system.
By the 1980s advances in data processing dramatically changed the claims processing procedures. Expansion of the operation was essential as new record keeping or monitoring demands were placed on the computerized system. More data processing capabilities were in demand, more storage space and memory were required and additional analysts were trained and added to the processing staff. Additional computer terminals were also needed for this increase in staff and once again, space was at a premium.

9. History 1980’s (continued)
As technology grew, so did the Plan. If fact, by the late 1980’s the Plan was growing to the point that we needed to locate to an even bigger facility.
Once again we were on the search for another facility that would be able to accommodate our needs.
What a great typewriter in the pic.. 

10. History 1990’s (continued)
The NALC HBP was “bustin at the seams” with 520 employees and a membership of 220,000. The Reston building was inadequate, so the Plan moved to Ashburn, Virginia on June 8, 1990.
With 520 employees and a membership of 220,000 by 1990, the Reston building was totally inadequate for our needs. In June of 1990, the Plan moved to Ashburn, VA. For the first time the Plan had a building specifically designed for them.
NALC HBP Ashburn, VA

11. Where we are now
Over sixty (60) years later we are still going strong. We have endured and prospered. Currently, we have 346 employees at the Plan and we cover a total of 115,932 members or 223,545 lives
2012 Open Season = 3,295 New Members
While in our Ashburn building, the Plan has made great strides and launched many improvements. The Plan currently has 346 employees and the amount of covered lives is at 223, ,932 is the total members, while 223,545 is the total covered lives. Members + Dependants = covered lives

12. 2012 NALC HBP Facts We issued $1.2 Billion in benefits.
Processed 4,631,975 claims
Mailed 8,668,435 pieces of mail (includes checks, explanation of benefits , temporary Identification cards and letters).
Answered 858,075 incoming calls from members, physicians and hospitals.
As you can see by the total on the screen, the Plan is not just a small “mom and pop” business. As we spoke about on the previous slide and as you look at the numbers, I think you will have to agree, the Plan has grown and continues to take its rightful place as a respected plan in the federal program.
Claims 1.2 Billion / 116,000 members = $10,344.83
Processed Claims 4,631,975 / 116,000 members = Average of 40 claims
Mailed Pieces of mail 8,668,435/ 116,000 members = Average of 75 pieces of mail
Phone Calls / 116,000 members = Average of 7.4 calls

13. Average tenure of an NALC HBP employee is 20 Years

14. Employees NALC HBP wall of 30 year plaques
At the Plan there is not a high employee turnover rate. As you can see by the photo on the screen of the 30 year plaques, the employees of the Plan are highly trained and have much experience. Many of the Customer Service analysts you may talk to when you call in have over 10 years experience.
These three employees have 130 combined years of services

15. Just a few of the Plan’s departments highlighted
Just a few of the Plan’s departments highlighted. The employees of the NALC Health Benefit Plan are dedicated to one thing – prompt and accurate service for the members. These men and women know the letter carriers’ needs and are trained to give them the individual attention they deserve. Should a member have a question on coverage, representatives from the Customer Service Department are available to assist.
Employees

16. NALC HBP Mission
The Plan’s mission is to provide our members accessibility to quality medical care while maintaining a comprehensive benefit package. We pride ourselves in offering excellent benefits with affordable premiums and excellent customer service.

17. The Plan is . . .
Union Operated
Union Owned
Not-for-Profit Plan

18. High Option 2014 Plan Partnerships
Emphasize that the following slides for “ High Option” only applies to the Traditional High Option Plan. These slides do not cover the CDHP or Value Option choices.

19. Cigna
The CIGNA Shared Administration Open Access Plus network which offers 1,875,900 PPO providers nationwide.
To locate a PPO provider call NALC (6252) or visit our website at
By choosing In-Network providers you receive the best benefit with the lowest out-of-pocket cost. Cigna HealthCare Shared Administration OAP network for the NALC Health Benefit Plan offers 1,875,900 providers nationwide.

20. CVS/Caremark
And, CVS/Caremark, our prescription benefit manager, provides access to more than 67,800 network pharmacies. In 2012, Walgreens was added to our retail pharmacy network.
Call NALC (6252) to locate the nearest network pharmacy.
CVS/Caremark offers access to more than 67,800 network pharmacies. Whether your needs are for short or long-term medications, the Plan provides their members with coverage that meets letter carrier needs in a safe and easy manner.

21. OptumHealth
OptumHealth Behavioral Solutions, our mental health and substance abuse partner, gives more than 7,000 in-network facilities and more than 120,000 in-network clinicians to choose from to receive maximum benefits. Call to locate an in-network provider.
The Plan’s mental health and substance abuse benefits are administered by OptumHealth Behavioral Solutions offering quality programs and services at your fingertips. There are over 7,000 in-network facilities and over 120,000 in-network clinicians from which to choose. They have available assistance 24 hours a day, 7 days-a-week to lend support in finding the right clinician that best meets the member’s needs. Optum Health is designed to help members take control of their life in managing a broad range mental health and substance abuse conditions such as: depression, eating disorders, alcohol abuse, bipolar disorders, grief etc. (THIS IS NOT A TOTAL LIST OF CONDITIONS THEY HELP WITH).

22. NALC Health Benefit Plan is the right choice:
Comprehensive benefits
Competitive premiums

23. High Option Plan
Make sure the audience understands that the following benefit sections and information only applies to the Traditional High Option Plan.

24. PPO Office Visit $20 Copayment
Your office visit copayment for a PPO provider is just $20. When your PPO physician or PPO specialist bills for:
an office visit
an office consultation
a second surgical opinion
Outpatient individual or group therapy, or
Outpatient medication management
Your office visit copayment for a PPO provider is just $ The good news is this does not increase because you are seeing a specialist or having a second surgical opinion. Unlike some insurance companies, the Plan’s copayment amount for any of the office visits listed is always $20.00.

25. Lab Services
The NALC Benefit Plan covers 100% of medically necessary lab services billed by either Quest Diagnostics or LabCorp.
If LabCorp or Quest Diagnostics performs the medically necessary lab services, the patient will have no out-of-pocket expense and will not have to file a claim. Always ask your doctor to use LabCorp or Quest Diagnostics to process covered lab services.

26. Health Risk Assessment (HRA)
We will pay the Self Only premium for the CignaPlus Savingssm discount dental program when you are enrolled in a Self Only option with the Plan and you complete the Health Risk Assessment (HRA).
We will pay the Self and Family premium for the CignaPlus Savingssm discount dental program when you are enrolled in a Self and Family option with the Plan and an HRA is completed for two family members.
The Health Risk Assessment is an online program that analyzes your health related responses and gives you a personalized plan to achieve specific health goals. The HRA profile provides information to put the member on path to good physical and mental health. Once you complete the HRA, the Plan will pay the self only premium for the cingnaplus savings discount dental program when you are enrolled in the self only option. The Plan will pay the self and family premium for the cigna plus savings discount dental program when you are enrolled in a self and family option and an HRA is completed for two family members.

27. PPO Inpatient $200 Copayment
When an illness or injury results in a hospitalization, you will pay just $200 per admission to a PPO hospital and nothing when services are related to the delivery of a newborn.

28. PPO Benefit Level
You will receive reimbursement at the PPO benefit level when non-PPO pathologists, radiologists and emergency room physicians bill for services rendered at a PPO hospital or a PPO ambulatory surgery center.
When a member uses a PPO hospital, some of the professionals that provide related services may not be preferred providers ; however, the Plan will process charges for radiology, pathology, the administration of anesthesia, and the emergency room visit billed by non-PPO providers at the PPO benefit level, based on Plan allowance, if the services are rendered at a PPO hospital or PPO ambulatory surgical center.

29. Maternity Benefits
The Plan’s 100% benefit package for maternity includes payment in full for:
Routine prenatal visits
Delivery
Routine postnatal visits
Amniocentesis
Anesthesia related to delivery or amniocentesis
Group B Streptococcus infection screening
Sonograms
Fetal monitoring
Rental of breastfeeding equipment
Tetanus-diptheria, pertussis (Tdap) – one dose during each pregnancy NEW FOR 2014
Compared to 1950 when the total maternity benefit was $50.00, the Plan has come a long way.

30. Maternity Benefits Cont.
Screening Tests for Pregnant Women when Billed by a PPO Provider
Gestational diabetes
Hepatitis B
Iron deficiency anemia
Rh screening
Syphilis and
Urine culture for bacteria
More screenings paid at 100% for pregnant women.

31. Family Planning Services
100% Coverage for Female Voluntary Family Planning Services when rendered by a PPO provider
Limited to:
Voluntary female sterilization
Surgical placement of implanted contraceptives
Insertion of intrauterine devices (IUDs)
Administration of an injectable contraceptive drug (such as Depo provera)
FDA-approved prescription contraceptive product
Removal of a birth control device and for services related to follow up management of side effects of birth control (NEW for 2014
THe following family planning services are covered at 100% when rendered by a PPO provider.

32. Preventive Benefits
We continue to focus and understand that preventive care services are significant steps that member’s can take to protect themselves and their families. The NALC pays 100% for the following when rendered by a PPO provider:
An annual routine physical,
Certain routine screening tests, and
Certain routine immunizations
The Plan understands that it is important to see your health care regularly to check for potential health problems such as high blood pressure, high blood sugar, or cholesterol etc. These conditions don’t often produce any symptoms in their initial stages, but a preventive exam may detect future problems. As we go through the next few slides check off what the Plan pays in full when rendered by a PPO provider.

33. Preventive care, adult
Some of the preventive screenings the Plan pays in full when rendered by a PPO provider include:
One routine colonoscopy screening (with or without polyp removal) every ten years , age 50 and older.
An annual EKG and chest x-ray
Mammograms for women age 35 and older as follows:
Ages 35 through 39 – one during this five year period
Ages 40 and older – one every calendar year
Osteoporosis screening for women:
Age at increased risk
Age 65 and older
PSA testing, one annually for men, age 40 and older
Annual Biometric Screening (NEW for 2014)

34. Preventive care, adult
Certain adult routine immunizations endorsed by the Centers for Disease Control and Prevention and administered by a PPO provider are paid in full by the Plan.
Hepatitis A and B are covered for adults age 19 and older
Herpes Zoster (shingles) vaccine for adults age 60 and older (and Medicare Part D is not the primary payor) 
Whooping Cough (Tdap) booster one, for adults age 19 and older

35. Preventive care, adult Adult routine immunizations:
Varicella (chickenpox) vaccine for adults age 19 and older…
Human Papillomavirus (HPV) vaccine for adult women age 26 and younger, and …
Human Papillomavirus (HPV4) vaccine for adult men age 26 and younger
… are just some of the adult immunizations covered in the benefit year.

36. Preventive Benefits (Pneumococcal and Seasonal Flu)
CDC recommends that everyone 6 months of age and older get a seasonal flu vaccine. And the NALC Health Benefit Plan makes it easier to get your flu and pneumococcal vaccines by partnering with more than 52,000 local NALCPreferred and NALC CareSelect pharmacies (including more than 7,000 CVS Pharmacies) to provide vaccines at no cost.
Getting a flu shot is the best way to keep you and your family healthy. In fact, the Centers for Disease Control and Prevention (CDC) recommends that every person age 6 months or older receive a flu shot every year. The NALC Health Benefit Plan offers influenza, pneumococcal, and seasonal flu vaccines to NALC Health Benefit Plan members and their eligible dependents at NO COST when the NALC Health Benefit Plan is the primary payer for medical expenses

37. Preventive care, children
Our 100% PPO preventive coverage for children’s vaccinations includes:
an annual camp, school or sports physical,
All American Academy of Pediatrics (AAP) recommended routine examinations through age 2 and all routine immunizations recommended by the AAP for children through the age of 21,
including the meningococcal immunization and the HPV4 vaccine for males age 9 through 21
Initial hospital examination of newborn child
We talked about keeping adults healthy with a preventive benefits, but the Plan also cares about the children. The next few slides we will look at will show some of the Plan’s preventive Care benefits for children that are paid at 100% when rendered by a PPO provider.

38. Preventive care, children
Also paid in full when rendered by a PPO provider are several routine screening tests for children which include:
One vision screening for amblyopia (or its risk factors) for children between the ages of 3 and 5 years,
A newborn screening hearing test ,
High blood pressure screening,
HIV screening
Pap test, and
An annual urinalysis for children age 5 through 21.
Hemoglobin/hematocrit for females age 11 through 21

39. Preventive care, children
The American Academy of Pediatrics Bright Futures is a national health promotion and disease prevention initiative that addresses children's health needs. The Plan now covers several new preventive screenings for children in full as recommended by Bright Futures/AAP when rendered by a PPO provider. These screenings include:

40. Preventive care, children
Screenings Recommended by bright futures/AAP
Alcohol and drug use assessment age 11 through 21
Developmental screening (including screening for autism) through age 3
Fasting lipoprotein profile (total cholesterol, LDL, HDL and triglycerides):
One, age 18 through 21
Age 17 and younger with medical indications

41. Preventive care, children
Screenings recommended by Bright Future/AAP Cont.
Hearing screening
Lead screening test age 6 and younger , and
TB screening through age 21
Vision Screening for children age 3 through 18

42. Prescription Benefit
It is important that you realize the difference between a brand name drug and a generic drug.
Generic equivalents are dispensed unless the member’s physician specifically indicates on the prescription “Dispense as Written” or “No Substitutions.” Why use generic drugs? Generic drugs offer a safe and economic way to meet prescription needs, they must meet the same standards for safety, purity, strength, and effectiveness, and cost the member and Plan less than a brand name prescription.

43. Prescription Benefit
Like most other Fee-For-Service FEHB Plans, the Plan classifies all prescription drugs into one of four categories, or tiers based on quality, safety, clinical effectiveness and cost

44. Prescription Benefit
Tier 1 - consists of generic drugs. Tier 2 - drugs are brand drugs that appear on the Plan’s formulary. We call them formulary brand drugs.. Tier 3 - drugs are brand drugs that do not appear on the Plan’s formulary. We call them non-formulary brand drugs. You will pay more for these non- formulary brand drugs. Tier 4 - is specialty drugs.

45. Quit for Life Tobacco Cessation Program
A free program offered to our members and their eligible dependent age 18 or older.  The program includes:
Five professional 30 minute telephonic counseling sessions
Direct shipment of 8 weeks of nicotine replacement therapy (NRT) patch or gum
For more information go to or call
A voluntary tobacco cessation program offered by the Plan which includes (reference bullets on slide)
Note: (You can also pull statistics from the American Cancer Society to reference about smoking. The statistics etc.)

46. Alere Weight Talk Program®
NEW for 2014
The Weight Talk Program® through Alere is a personal coaching program designed to achieve measurable, sustainable weight loss. It is delivered through regular phone-based coaching sessions with a dedicated coach. Participants set realistic weight goals and through small multiple behavior changes learn how to achieve and maintain a healthy weight for the rest of their lives.

47. Alere Weight Talk Program®
Individuals can enroll in the Weight Talk Program® online at or call the toll-free number at A personal dedicated coach is available Sunday through Friday 7:00 a.m. through 3:00 a.m. and Saturday 9:00 a.m. through 12:00 a.m. Eastern Time.

48. Additional Benefit Highlights for 2014
We now cover skin cancer preventive medicine counseling for adults age 24 and younger and for children age 10 and older as recommended by the USPSTF. We now cover fall prevention preventive medicine counseling for adults age 65 and older. We now cover a combined total of 75 rehabilitative and habilitative physical, occupational and speech therapy visits per calendar year. We now cover the initial office visit or consultation for acupuncture. You now pay nothing for educational classes and nutritional therapy for self- management of diabetes, hyperlipidemia, hypertension, and obesity when rendered by a PPO provider.

49. Additional Benefit Highlights for 2014
We now cover over-the-counter vitamin D supplements (600 to 800 IU per day) when purchased at a preferred or network retail pharmacy for adults age 65 and older as recommended by the USPSTF (prescription required). We now cover over-the-counter aspirin when purchased at a preferred or network retail pharmacy for men age 45 through 79 and women age 55 through 79 as recommended by the USPSTF (prescription required). We now cover over-the-counter folic acid (0.4 to 0.8 mg) when purchased at a preferred or network retail pharmacy for women planning a pregnancy or capable of becoming pregnant (prescription required).

50. Additional Benefit Highlights for 2014
We now cover over-the-counter iron supplements when purchased at a preferred or network retail pharmacy for children age 6 to 12 months (prescription required).
NOTE: The “Additional Benefit Highlights” do not reflect all of the changes for 2014.

51. High Option General Information
To obtain claim forms, claims filing advice or answers about our benefits, you can contact the Plan at :
NALC Health Benefit Plan
20547 Waverly Court
Ashburn, VA 20149
NALC (6252)
or at our website at
Any questions for the Traditional High Option Plan would go to the above address and phone number. All CDHP and Value Option questions or concerns would be addressed to the information located on slide 74

52. CDHP and Value Option Plan
The following sections only cover the CDHP and Value Option Plan Choices. The benefits and slides discussed in the next slides do not reflect the benefit structure for the Traditional High Option Plan

53. CDHP and Value Option Plans
Why add two (2) additional options?
The NALC CDHP and Value Option were built for the City Carrier Assistants as low cost options since they may have to pay entire premiums which includes both the employer share and the government share.
So, how did we keep the premiums low?
High Deductible
Higher out-of-pocket maximum
Benefit structure not as rich
From the beginning stages of this project/planning the Plan had one goal, and that is to offer our CCA employees an affordable insurance option. The answer, create high deductibles, high out-of –pocket maximums, and a benefit structure that was acceptable, not amazing.

54. Consumer Driven Plan What is a Consumer Driven Plan?
A health plan that provides coverage for medical/pharmacy expenses, with in-network preventive care services covered at 100%, plus...
A Personal Care Account (PCA) funded by NALC to pay for eligible health care expenses.
Deductible - If you are enrolled in the CDHP/Value Option, you must satisfy your calendar year deductible and exhaust your Personal Care Account (PCA) before the Plan starts paying benefits under the Traditional Health Coverage. Once the deductible is met, you and NALC will share the cost of the eligible expenses.

55. Consumer Driven Plan Personal Care Account (PCA)
Depending on the plan option chosen, each year the Plan will add a certain amount to your Personal Care Account (PCA)
New Option 1 – Consumer Driven Health Plan
$1, per year for Self Only or
$2, per year for Self and Family
New Option 2 – Value Option Plan
$ per year for Self Only or
$ per year for Self and Family
The two accounts lists, CDHP and Value Option have different dollar amounts that will be added to your PCA account. Although the Value Option’s premium may be a little less, there is a lot more deductible to meet before traditional benefits will apply.

56. Consumer Driven Plan Personal Care Account (PCA)
CDHP and Value Option PCA Rollover Maximum:
Money in the account rolls over each year if you do not spend it, up to a maximum of :
Single - $5,000
Family - $10,000
If you have a healthy year and do not use the funds in your PCA, they will roll over to the next year for future use. However, the maximum amount that can be accrued is as the chart above states – Self $5,000 and Self and Family $10,000

57. Consumer Driven Plan Personal Care Account (PCA)
You must use any available PCA benefits, including any amounts rolled over from previous years, and exhaust any remaining deductible before
Traditional Health Coverage begins.
You cannot pick and choose which claims to be sent through your PCA account. All claims will go in paid date order through the PCA, then any remaining deductible will apply before the Plan will begin paying their portion.

58. Consumer Driven Plan Deductible
Still confused? Think of it like this…..
Your deductible is your bridge between your Personal Care
Account and Traditional Health Coverage.
After you exhaust your PCA, you must pay any remaining
deductible before Traditional Health Coverage begins.
Deductible
After exhausting all the money in the PCA account, you must meet your deductible (the bridge that links your PCA to traditional benefits) before any Plan payment can be processed.
Traditional Benefit Begin
Personal Care Account

59. Consumer Driven Plan Deductible and Out-of-Pocket Amounts
In-Network
Out-of-Network
CDHP
Deductible
Self - $2,000
Self and Family -$4,000
Self - $4,000
Self and Family -$8,000
Out-of-Pocket
Self - $6,000
Self and Family - $12,000
Self - $12,000
Self and Family – $24,000
Value Option
As you can see by this chart, the deductible amounts and out-of-pocket amounts are higher than the traditional high option plan.

60. Consumer Driven CDHP Plan Example
Member goes to Doctor
Cost of Visit - $50
PCA Self Only Balance $1,200
Claim sent through PCA first
$1,200 - $50
Remaining PCA Balance
= $1,150
Member Liability
$0.00
All charges excluding In-Network Preventive Care will always go through member’s PCA account first. After PCA has been exhausted/is at a zero balance, member must then meet deductible before traditional benefits will apply. Reiterate deductible and out-of-pocket amounts.

61. Consumer Driven Value Option Plan Example
Member goes to Doctor
Cost of Visit - $50
PCA Self Only Balance $100
Claim sent through PCA first
$100 - $50
Remaining PCA Balance
= $50
Member Liability
$0.00
All charges, excluding In-Network Preventive care, will always go through member’s PCA account first. After PCA has been exhausted/is at a zero balance, member must then meet deductible before traditional benefits will apply. Reiterate deductible and out-of-pocket amounts.

62. CDHP and Value Option 2014 Plan Partnerships

63. 2014 Partnerships
The NALC Health Benefit Plan CDHP/Value Option has partnered with Cigna
HealthCare to provide ….
The Cigna Open Access Plus PPO network which offers 1,875,900
participating family doctors and specialists, and more than 22,600 general
acute care hospitals, and facilities nationwide.
And, CVS/Caremark, our prescription benefit manager, provides our
membership access to more than 67,800 network pharmacies.
Chances are your medical provider or pharmacy is already
eligible to receive In-network benefits from the Plan.

64. CDHP and Value Option Benefit Structure Highlights
Preventive Care with an In-Network health care professional is covered at 100%
When the doctor bills your visit as preventive care, your PCA will not be used.
Examples of Preventive Benefits include but are not limited to:
Well Baby and Well Child visits
Well Man and Well Woman visits
Routine Immunizations
Routine Screenings:
Cholesterol Screening: Ages 20+, every 5 years
Diabetes Screening
Mammogram: Once a year for women age 40+
Prostate Screening: Once a year for men age 40+
Colonoscopy: Ages 50+, every 10 years
Note: Benefits will be reduced, if an In-Network provider is not used.
All preventive benefits will be paid at 100% as long as an In-Network provider is used. These benefits will not reduce or be processed through your personal care account (PCA)

65. CDHP and Value Option Benefit Structure Highlights
Professional Services of physicians (Including specialists) or urgent care centers
Office or outpatient visits
Office or outpatient consultations
Second surgical Opinions
In-Network
Out-of-Network
You Pay
20% of Plan Allowance
50% of Plan Allowance
And any difference, if any between our allowance and charge
Note: Your PCA must be used first and your deductible exhausted before traditional benefits will apply. Your deductible applies to all benefits listed above.
Co-Pay amounts DO NOT apply to office visits. After your PCA has been exhausted (is at a zero balance) and your deductible met, the above In-Network and Out-of-Network “You Pay” columns will apply.

66. CDHP and Value Option Benefit Structure Highlights
Lab, x-ray, and other diagnostic tests (the below list is a summary and not inclusive).
Blood tests
Urinalysis
X-Rays
Pathology
Bone Density Study ……
In-Network
Out-of-Network
You Pay
20% of Plan Allowance
50% of Plan Allowance
And any difference, if any between our allowance and charge
Note: Your PCA must be used first and your deductible exhausted before traditional benefits will apply. Your deductible applies to all benefits listed above.
*Not covered - Routine tests except as listed in the official brochure under Preventive Care, Section 5.
Remind audience…The above only highlights the Lab, X-Ray and Diagnostic tests listed in the official brochure. Please see the Official (RI ) for a complete listing. Unlike the Traditional High Option Plan, there is not a specific Laboratory (LabCorp and Quest Diagnostics) you can use that will be paid at 100%.

67. CDHP and Value Option Benefit Structure Highlights
Maternity Care:
Routine prenatal visits
Delivery
Routine postnatal visits
Amniocentesis
Anesthesia related to delivery or amniocentesis
Group B streptococcus infection screening
Sonograms
Fetal Monitoring
In-Network
Out-of-Network
You Pay
20% of Plan Allowance
50% of Plan Allowance
And any difference, if any between our allowance and charge
Note: Your PCA must be used first and your deductible exhausted before traditional benefits will apply. Your deductible applies to all benefits listed above.
Unlike the traditional High Option Plan, Maternity Care is NOT paid at 100%.

68. CDHP and Value Option Benefit Structure Highlights
Physical, Speech, and Occupational Therapies:
A combined total of 50 rehabilitative and habilitative visits per calendar year for treatment provided by a licensed registered therapist or physician for the following:
Physical Therapy
Occupational Therapy
Speech Therapy
The attending physician must - Order the care, Identify the specific skills the patient requires and the medical necessity for skilled services, and Indicate the length of time the services are needed.
In-Network
Out-of-Network
You Pay
20% of Plan Allowance
(All charges after 50 max visits have been met)
50% of Plan Allowance
And any difference, if any between our allowance and charge(All charges after 50 max visits have been met)
Note: Your PCA must be used first and your deductible exhausted before traditional benefits will apply. Your deductible applies to all benefits listed above.

69. CDHP and Value Option Benefit Structure Highlights
The NALC Health Benefit Plan CDHP/Value Option includes coverage for hearing aids and related examination up to a maximum Plan payment of $500 per ear with replacements covered every 3 years.
We will also cover custom functional foot orthotics including the casting up to a Plan payment of $200 every 5 years.
 Our chiropractic benefit includes coverage for 12 spinal or extraspinal manipulations per calendar year.
Note: All of these benefits are payable first through your Personal Care Account and then subject to the calendar year deductible and applicable coinsurance.

70. CDHP and Value Option Benefit Structure Highlights
Prescription Drug Plan:
All prescription drugs are classified into one of four categories, or tiers,…. based on quality, safety, clinical effectiveness and cost.
Tier 1 consists of generic drugs.
Tier 2 drugs are brand drugs that appear on the Plan’s formulary. We call them formulary brand drugs.
Tier 3 drugs are brand drugs that do not appear on the Plan’s formulary. We call them non-formulary brand drugs.
Tier 4 is specialty drugs.

71. CDHP and Value Option Benefit Structure Highlights
Your 2014 Drug Cost-Share for the NALC CDHP and Value Option Plans.
Generic Drug: You Pay:
Network Retail up to 30-day supply $10*
Mail Order 90-day supply $20*
Formulary Brand Drug:
Network Retail up to 30-day supply $40*
Mail Order 90-day supply $80*
Non-Formulary Brand Drug:
Network Retail up to 30-day supply $60*
Mail Order day supply $120*
*Prescription drugs are subject to the calendar year deductible. Your PCA must be used
first and then you must meet the remainder of your deductible before your Traditional
Health Coverage begins. P

72. CDHP and Value Option Benefit Structure Highlights
Specialty Drugs** You Pay: Caremark Specialty Pharmacy Mail Order 30-day supply $200* 90-day supply $400* *Prescription drugs are subject to the calendar year deductible. Your PCA must be used first and then you must meet the remainder of your deductible before your Traditional Health Coverage begins. **All specialty drugs require prior authorization. Specialty drugs, including biotech, biological biopharmaceutical and oral chemotherapy drugs, are generally defined as high-cost prescription drugs that treat complex conditions and require special handling and administration and can cost thousands of dollars for a single dose. Call CVS Caremark Specialty Pharmacy Services at to obtain prior approval.

73. CDHP and Value Option Benefit Structure Highlights
Want to be Tobacco Free?
A voluntary tobacco cessation program offered by the Plan which includes:
Unlimited professional 20 – 30 minute telephonic counseling sessions per quit attempt
Online tools
Over- the Counter nicotine replacement therapy
For more information on the program visit mycigna.com or call

74. Health Risk Assessment (HRA)
We will pay the Self Only premium for the CignaPlus Savingssm discount dental program when you are enrolled in a Self Only option with the Plan and you complete the Health Risk Assessment (HRA).
We will pay the Self and Family premium for the CignaPlus Savingssm discount dental program when you are enrolled in a Self and Family option with the Plan and an HRA is completed for two family members.
The Health Risk Assessment is an online program that analyzes your health related responses and gives you a personalized plan to achieve specific health goals. The HRA profile provides information to put the member on path to good physical and mental health. Once you complete the HRA, the Plan will pay the self only premium for the cingnaplus savings discount dental program when you are enrolled in the self only option. The Plan will pay the self and family premium for the cigna plus savings discount dental program when you are enrolled in a self and family option and an HRA is completed for two family members. As with the Traditional High Option Plan, the CDHP and Value Option Plan offers a bonus for filling out the HRA.

75. CDHP and Value Option
Please keep in mind, the CDHP and Value Option benefits highlighted are only a summary of the plans. Please see our 2014 NALC Health Benefit Plan CDHP/Value Option brochure for a complete description of benefits to find out why the NALC Health Benefit Plan is the right choice for letter carriers.

76. CDHP and Value Option General Information
To obtain claim forms, claims filing advice or answers about our benefits, you can contact Cigna at: NALC Consumer Driven Health Plan or Value Option P.O. Box Chattanooga, TN
This Plan is administered by Cigna. All questions or inquiries should be directed to the above phone number. If enrolled in the Traditional High Option Plan, all questions or concerns should be directed to the information located on Slide 51

77. Rate Information

78. High Option NALC HBP Premiums
Year
Bi – Weekly Postal
Premium
(Active)
Monthly Annuitant Premium
Self
Family
2011
$51.56
$100.57
$160.64
$327.32
2012
$54.04
$105.16
$161.68
$327.60
2013
$52.95
$103.26
$160.66
$326.04
2014
$58.02
$114.59
$161.22
$327.27
As you can see, from 2011 to 2014 we have increased minimally.

79. CDHP and Value Option NALC HBP Premiums
Year
CDHP
Value Option
Self
Family
2014
$36.19
$78.58
$31.16
$67.66
What you have all been waiting for, the cost of these new plans. “Stress to audience” …….Although the above slide reflects lower premiums, the benefits are not as rich as the High Option. Make sure the audience understands that the above rates only apply to Career Employees.
The above rates only apply to Career Postal employees.
City Carrier Assistants (CCA) should contact the HRSSC employing office for premium information at , option 5

80. Dare to Compare
We encourage each individual to take the “Director’s Challenge” and “Dare to Compare” your current plan against the NALC Health Benefit Plan. You will see that the NALC Health Benefit Plan is both a comprehensive plan with quality service, benefits, and reasonable premiums.
To accept the challenge go to:
This is a great tool. If you are unsure what your costs will be with the Plan vs another Plan, take the time to Dare to Compare.
(When talking to audience, do not call another insurance company’s name. Let them know they must do the comparison themselves, as you cannot compare name vs name.)

81. Dare to Compare http://www.opm.gov/insure
On the right side of page click on the QUICK LINK “Compare Health Plans”
Insert your Zip Code. Hit Enter. Then Select the Plans you wish to compare (up to 4 plans).
Choose an Employee Type such as “U.S. Postal Service or Annuitant.” Click Next.
Choose a pay frequency such as Bi Weekly or Monthly. The comparison will be shown on your screen.
Here is where to find the Dare to Compare and the simple steps.

82. How USPS Employees Enroll in NALC HBP?
If you are currently not a member sign up the next Open Season.
Enroll through PostalEASE:
On the Intranet (from the blue page)
By phone –
At an Employee Self-Service Kiosk; or
Visit -
Go over each bullet point to show them how easy it is to join the Plan.

83. Open Season November 11 –December 9
Is the second Monday of November and runs through the second Monday of December each year.
If you need more information call the Plan at NALC
It’s that time of the year. Time to join the Plan, or if you are already in the Plan stay in the Plan.

84. I’m 100% UNION!!! NALC Health Benefit Plan
Our objective is to unite fraternally all Letter Carriers who are members in good standing in the National Association of Letter Carriers.
I belong to both the NALC Union AND the NALC Health Benefit Plan. Do You?????
I’m 100% UNION!!!
The goal of the Plan is to bring all Letter carriers into the Plan. If the audience is not in the Plan encourage them to request a brochure and review it in this Open Season.

85. This is a summary of some of the features of the NALC Health Benefit Plan. Detailed information on the benefits for the NALC Health Benefit Plan can be found in the official brochure (RI ). All benefits are subject to the definitions, limitations, and exclusions set forth in the official brochure.
In closing let the audience know that all the benefits discussed in the presentation are only a summary and details must be found in the official 2014 brochure.