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    June 1, 2006      
2006
Benefit Topics:
 
Official Brochure
Benefits at a Glance
Medicare at a Glance
Physicians
Hospital
Prescription Drugs
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2006 Hospital Benefits
(View 2006 Benefit Chart)

Refer to the 2006 NALC Health Benefit Plan brochure (RI 71-009) for complete details.
2005 Hospital Benefits at a Glance and Previous brochures are also available..

Precertify Your Admission:

You, your representative, your physician or your hospital must call us before you are admitted to the hospital. If you have an emergency admission, you must precertify within 2 days of the admission. Call us at 1-800-622-6252, unless the admission is related to a mental health or substance abuse condition. In that case, call 1-877-468-1016. We will reduce benefits if the hospital stay is not precertified.

You do not need to precertify when you are admitted to a hospital outside of the United States or when another group health insurance, such as Medicare Part A, is the primary payer for the hospital stay. If you exhaust your Medicare hospital benefits and do not want to use your Medicare lifetime reserve days, you need to precertify by calling 1-800-622-6252.

More information about the precertification process follows the benefit chart below. For a complete explanation of Physician Benefits or the precertification process, please view our official brochure.

Medical/Maternity Hospital Benefits
Benefit
You pay at
PPO Provider
You pay at
Non-PPO Provider

Inpatient hospital room, board and other miscellaneous services (Precertification required)

  • No deductible/no copayment
  • 10% of negotiated rate
  • No Limit on Days
  • $100 copayment per admission
  • 30% of Plan Allowance
  • No Limit on Days
Outpatient - surgery performed; Outpatient - no surgery; Medical emergency treatment
  • 15% of negotiated rate
  • Calendar year deductible applies (1)
  • 30% of Plan Allowance
  • Calendar year deductible applies (2)

(1) Subject to the $250 PPO calendar year deductible.
(2) Subject to the $300 Non-PPO calendar year deductible.

First Health:

The First Health® Network offers broad access as one of the nation's largest directly contracted Preferred Provider Organization (PPO) networks. There are currently more than 4,300 hospital in the network. First Health Utilization Management is accredited through the American Accreditation Health Care Commission/URAC.

Participating PPO providers agree to provide services for Plan members at negotiated rates. PPO rates are usually lower than non-network providers in the area for the same service. You may choose a PPO provider or a non-PPO provider at the time medical care is needed. Benefits will be greater when you use a PPO provider.

United Behavioral Health:

The NALC Health Benefit Plan selected United Behavioral Health (UBH) to manage your Mental Health and Substance Abuse Care benefits utilizing their national network. UBH provides access to 2,900 facilities. UBH achieved accreditation by the Joint Commission on Accreditation of Healthcare Organizations and URAC.

As with our other benefits, you must precertify and use a network provider to receive the maximum benefit. Call 1-877-468-1016 to precertify a hospital confinement, authorize treatment or locate a UBH network provider.