2008 Benefits at a Glance

Certain deductibles, copayments and coinsurance amounts do not apply if Medicare is your primary coverage for medical services (pays first).

Refer to the 2008 NALC Health Benefit Plan brochure (RI 71-009) for complete details. 2007 Benefits at a Glance and Previous brochures are also available.

Benefit Description	YOU PAY
Benefit Description	PPO	Non-PPO
Preventive Care
Routine Physical Exam, age 22 or older	$20 copayment	30% after $300 deductible
Well Child Care (up to age 2)	Nothing	Any amount over Plan allowance
Routine immunizations (up to age 22)	Nothing	Any amount over Plan allowance
Adult Routine Immunizations	15% after $250 deductible	30% after $300 deductible
Inpatient Hospital Care (precertification required)
Maternity	Nothing	30% after $100 per admission copay
Medical/Surgery Room and Board Other Services and Supplies	Nothing 10%	30% after $100 per admission copay 30% after $100 per admission copay
Mental Health/Substance Abuse Room & Board Other Services and Supplies	Nothing 10%	50% after $500 per admission copay; all charges after 50 days 50% after $500 per admission copay; all charges after 50 days
Outpatient Hospital Care
Medical	15% after $250 deductible	30% after $250 deductible
Emergency (auto accident, acute myocardial infarction & concussion)	15% after $250 deductible	15% after $250 deductible
Chiropractic Care
Initial office visit	$20 copayment	30% after $300 deductible
Initial set of spinal x-rays	15% after $250 deductible	30% after $300 deductible
Spinal manipulations (12 per calendar year)	15% after $250 deductible	30% after $300 deductible
Physician Care
Office visits	$20 copayment per office visit	30% after $300 deductible
X-rays, other diagnostic services	15% after $250 deductible	30% after $300 deductible
Laboratory Services Quest Diagnostics Other lab facility	Nothing 15% after $250 deductible	30% after $300 deductible
Maternity Care (complete)	Nothing	30% after $300 deductible
Accidental Injury (nonsurgical care)	Nothing within 72 hours	Any amount over the Plan allowance
Surgery	10%	30% after $300 deductible
Mental Health and Substance Abuse Care Office visit Other diagnostic services	$20 copayment 15% after $250 deductible	50% after $300 deductible All charges after 30 visits

Prescription Drugs This is a mandatory generic program with a 30-day limit at local retail	Network	Non-Network
Retail Pharmacy	1st and 2nd fill 25% of cost	Full cost at time of purchase 50% after $25 deductible
Mail Order Program	60-day supply: $8 generic/$24 name brand 90-day supply: $12 generic/$35 name brand
Catastrophic Limits
Medical/Surgical	You pay nothing after coinsurance expenses total: $4,000 per person or family for services of PPO/providers/facilities.* $6,000 per person or family for services of PPO and non-PPO providers/facilities combined.*
Mental Health and Substance Abuse	You pay nothing after coinsurance expenses total: $4,000 per person or family for services of network mental health and substance abuse providers/facilities.* $8,000 per person for out-of-network mental health and substance abuse inpatient hospital treatment (to a maximum of 50 days).
*Your coinsurance expenses for inpatient services billed by a network hospital facility will never exceed $2000 per calendar year.