2008 Physician Benefits

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

The NALC Health Benefit Plan offers comprehensive coverage for your medical needs whether you need diagnostic and treatment services, maternity care, or well-child care. You can see a provider that is in our network or one that is not, but by choosing physicians and facilities that are in our network of preferred providers, you'll save money and avoid having to file claims.

Benefit	You pay at PPO Provider	You pay at Non-PPO Provider
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

CIGNA HealthCare Shared Administration Network

Now in 2008, you have access to more PPO providers and improved discounts, when means less out-of-pocket for you. Effective January 1, 2008, the NALC Health Benefit Plan has expanded its nationwide PPO provider network with greater discounts by providing the CIGNA HealthCare Shared Administration PPO Network to our members. Your new CIGNA access card now displays the CIGNA HealthCare Shared Administration PPO Network logo.

Our preferred provider organization (PPO) provides you with over 7,000 hospitals and facilities and over 980,000 doctors and physicians nationwide. Benefits have increased for hospitalization, surgery, and maternity so when you choose a network hospital or a network provider, you will have less out-of-pocket for:

Hospitalization for room and board
Surgical procedures (we no longer apply the calendar year deductible)
Anesthesia for delivery of a newborn

United Behavioral Health (UBH)

Our network provider for mental health and substance abuse benefits is United Behavioral Health (UBH). The network has 73,000 professionals—specialists recognized for their clinical specialty and quality rating to ensure that each patient receives the most skilled clinician possible.

To receive the maximum benefit, you must follow a treatment plan authorized by UBH. Call 1-877-468-1016 to locate network clinicians and to receive authorization to see a provider. An Intake Counselor will assess your needs and refer you to an appropriate hospital or practitioner. A Care Manager will evaluate the practitioner's clinical assessment and the recommended treatment plan, and will certify the appropriate care.