2010 Physician Benefits

Refer to the 2010 NALC Health Benefit Plan brochure (RI 71-009) for complete details. 2009 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, outpatient consultation or visits	$15 copayment per office visit	30% after $300 deductible
X-rays, other diagnostic services	15% after $300 deductible	30% after $300 deductible
Laboratory Services Lab Corp Quest Diagnostics Other lab facility	Nothing Nothing 15% after $300 deductible	30% after $300 deductible
Maternity Care (complete)	Nothing	30% after $300 deductible
Accidental Injury (nonsurgical care, simple laceration repair and immobilization of a sprain, strain, or fracture)	Nothing within 72 hours	Any amount over the Plan allowance
Accidental Dental Injury (outpatient care)	15% when treatment incurred within 72 hours of an accidental injury	30% after $300 deductible
Surgery	15%	30% after $300 deductible
Mental Health and Substance Abuse Care Office visit Other diagnostic services	$15 copayment 15% after $300 deductible	30% after $300 deductible
Preventive Care Routine Physical Exam Well Child Care (through age 2) Routine immunizations (up to age 22) Adult routine immunizations	$15 copayment Nothing Nothing Nothing	30% after $300 deductible Any amount over the Plan allowance Any amount over the Plan allowance 30% after $300 deductible

CIGNA HealthCare Shared Administration Network

In 2010, you have access to more PPO providers and improved discounts, which means less out-of-pocket for you. The NALC Health Benefit Plan offers our members a nationwide PPO provider network with greater discounts through our partnership with the CIGNA HealthCare Shared Administration PPO Network. Your identification card displays the CIGNA HealthCare Shared Administration PPO Network logo that allows you to receive network discounts.

Our preferred provider organization (PPO) provides you with over 6,670 hospitals and 12,327 facilities and 1,205,094 specialists and primary care physicians nationwide.

Maternity Benefits for hospitalization, delivery, anesthesia and other services-100% Benefits
Non-Maternity admissions-100% Benefits with the exception of a $200 copayment per admission!
Only $15 copayment - per office, outpatient visit or consultation
Only $15 copayment - for physical, occupational, or speech therapy visit
Anesthesia, Surgery and Other Health Care Professionals services-85% Benefits!
Lab Corp and Quest Diagnostics laboratory services that they perform-100% Benefits!

OptumHealthSM Behavioral Solutions

Our network provider for mental health and substance abuse benefits is OptumHealthSM Behavioral Solutions. The network has 4,600 facilities and 78,000 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 OptumHealthSM Behavioral Solutions. 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.