New Portlet added to the NALC Health Benefit Plan’s Electronic Health Record: Deductible and Out-of-Pocket Amounts Applied Year to Date

A new feature has been added to the NALC Health Benefit Plan’s website, http://www. nalc.org/depart/hbp, which will now display real time individual and family deductible and out-of-pocket amounts applied year to date. This new feature is available to all current members, spouses, and dependents age 18 and older.

To access this new feature, an individual must login to the NALC HBP website. If an account has not been created, then the individual must first create an account (register). Once logged in, the individual should select the Electronic Health Record – Claims tab. The Deductible and Out-of-Pocket Amounts Applied Year to Date portlet will display just under the Claims Summary portlet.

The Deductible and Out-of-Pocket Amounts Applied Year to Date tool will default to display deductible and out-of-pocket amounts for the individual that logged in for the current year. The informational display box shown below displays:

- PPO Calendar Year Deductible;
- PPO Catastrophic Provision (OOP);
- PPO Inpatient Catastrophic Provision (OOP) – for 2007 and 2008 only;
- PPO/Non-PPO C calendar Year Deductible;
- PPO/Non-PPO C catastrophic Provision (OOP)

These amounts are listed for the individual under the Patient column and listed for the entire family under the Family column. The selected year Plan maximums will display for the patient as a referral under the Plan Patient Max column and for the family under the Plan Family Max column.

The Deductible and Out-of-Pocket Amounts Applied Year to Date tool will default to display information for the individual that logged in for the current calendar year. Additional family members may be selected from the Select Patient drop-down box. Additional calendar years may be selected from the Select Year drop-down box.  Calendar years will be available in a rolling 5 year increment. Currently, for 2009, the available years for viewing are 2005 – 2009. For 2010, the available years for viewing will be 2006 – 2010. If the individual and/or family has no deductible or out-of-pocket for the selected calendar year, the display will simply show $0.00 for all categories under Patient and Family columns.

The available deductible and out-of-pocket amounts that will display are for claims where NALC has paid as the primary carrier. Double Coverage and Medicare claims are not included. The following message will display alerting individuals that may have Medicare or another primary carrier that these claims are not included: Amounts for claims processed by the Plan as the secondary or tertiary (third) payer will not display. Amounts shown are only for claims processed by the Plan as the primary payer.

The deductible and out-of-pocket amounts are displayed in real-time. Corrected claims where deductible and/or out-of-pocket amounts have been changed will be immediately updated to the Deductible and Out-of-Pocket Amounts Applied Year to Date tool.

A link has been provided to the Plan’s Official Brochure Page giving individual’s quick access to PDF copies of the current Plan brochure, RI 71-009. Dependents 18 and older must give permission for other family members age 18 and older to view their information.

The deductible and catastrophic out-of-pocket amounts showing under 'Patient' and 'Family' are the real-time amounts for the selected patient and year. If the Plan corrects or voids a claim, these amounts may change. 'Plan Patient Max' and 'Plan Family Max' show the required amount needed to meet or satisfy the selected year's Deductible and Catastrophic maximums. For information regarding the Plan's deductible and out-of-pocket expenses, please refer to the Plan brochure RI 71-009 for the selected year or contact the Plan at 1-888-636-6252.