DIRECTOR'S REPORT–Thomas H. Young, Director

Mark Your Calendars Now – Open Season is Coming!

Now is the time to get serious about promoting the Plan to your fellow branch members.

Once again, while the FEHBP-wide increase is in excess of 11%, the NALC Health Benefit Plan has been able to hold our increase to below that level and provide to our membership a great value of benefits and premiums.

From November 11 to December 9, active and retired members have the opportunity to join us for 2003.

As always, we are eager to have every active letter carrier make us their health plan of choice. The active segment of our membership has again begun to grow and with good reason. So, active letter carriers need to make some comparisons and give us a good look.

Speaking of good looks, those who are currently on Medicare, or will be next year, should really focus on being part of the NALC Health Benefit Plan. I firmly believe that the Plan is far and away the best value for all who are in this category. The fixed income situation of the retiree really underscores what a value the NALC Health Benefit Plan is, especially when the premiums and prescription benefits are closely examined.

Without a doubt, the retirees’ situation was scrutinized very carefully as we looked toward 2003. In particular, was our concern about the drug program and the pressures placed upon it by increasing prices and utilization.

Even with those obstacles, the Plan was able to maintain the co-pay on generic drugs while, at the same time keeping the brand name co-pay at a highly competitive level.

In a nutshell, the history and philosophy of the NALC Health Benefit Plan is to cater to the health coverage needs of our union brothers and sisters. So, you can see, the NALC Health Benefit Plan is the place to be for letter carriers and their families.

Attend your branch meetings during this coming Open Season and do everything you can to promote your union-owned, union-operated health insurance plan. We’ll provide you with the materials you will need — YOU provide the "TALK."

How the Plan Changes for 2003

(Note: Please do not rely on these change descriptions, this page is not an official statement of benefits. Always refer to the Plan’s official brochure for clarification of benefits.)

Program Wide Changes

• A notice of the Office of Personnel Management’s Privacy Practices is included.
• By law, the DOD/FEHB demonstration project ends on December 31, 2002.
• Three states are added to the list of medically underserved areas: Louisiana, Maine and West Virginia. Georgia is no longer medically underserved. (Section 3)
• Program information on Medicare is revised. (Sections 4 and 9)
• Program information on TRICARE and CHAMPVA explains how annuitants or former spouses may suspend their FEHB Program enrollment. (Section 9)
• A section on the Children’s Equity Act describes when an employee is required to maintain Self and Family coverage. (Section 11)

Changes to this Plan

• Your share of the NALC Postal premium will increase by 1.8% for Self Only and decrease by 2.3% for Self and Family.
• Your share of the non-Postal premium will increase by 5.6% for Self Only or 4.5% for Self and Family.
• We now offer a PPO network in Maine.
• A Notice of the NALC Health Benefit Plan’s Privacy Practices is included. (Section 1)
• We added a definition of freestanding ambulatory facility in our listing of covered facilities. (Section 3)
• You will have no out-of-pocket costs for services Medicare covers as the primary payer. Previously you may had out-of-pocket costs for services that Medicare covered and we did not. (Section 4)
• We added coverage for fasting lipoprotein profile under preventive care, adult. (Section 5(a))
• We increased our colorectal cancer screening coverage to include colonoscopy and double contrast barium enema. (Section 5(a))
• We eliminated your copayment for certain preventive care screenings and immunizations for adults when you see a PPO provider. After the deductible has been met, you pay 15% of the Plan allowance.
• After the deductible has been met, you pay the applicable coinsurance for a routine pap test. Previously, you paid nothing for the first $35 in charges. (Section 5(a))
• We clarified that limited benefits apply for organ/tissue transplants when other coverage is the primary payer. (Section 5(b))
• We changed the copayment for mail order prescription drugs and supplies. For a 60-day supply, you pay $7 for generic drugs and $20 for name brand; for a 90-day supply, you pay $10 for generic drugs and $30 for name brand. Previously, you paid $8 for generic drugs and $17 for name brand for a 60-day supply, and $12 for generic and $25 for name brand for a 90-day supply. (Section 5(f))
• If you have Medicare, your mail order copayment for a 60-day supply is $5 for generic and $17 for name brand. For a 90-day supply, you pay $7.50 for generic drugs and $25 for name brand. Previously, you paid $5 for generic drugs and $13 for name brand for a 60-day supply, and $7.50 for generic and $19.50 for name brand for a 90-day supply. (Section 5(f))
• We removed the exclusion for coverage of services for illness or injury sustained as a result of an act of war within the United States, its territories or possessions. (Section 6)
• When you have other coverage and we are the secondary payer, our payment determination period is now per claim. Previously, it was based on a calendar year. (Section 9)

HEALTH IN THE NEWS

Food of the Month

Squash

Baked squash makes an attractive holiday entree. ?Geologists say the remains of squash in Mexican caves are at least 7,000 years old. With corn and beans, it was one of the basics of early American diets.

All squashes with hard rinds are loaded with vitamin C and beta carotene, antioxidant vitamins that have been shown to help prevent cancer, heart disease, and age-related eye problems. They also contain plenty of iron, potassium, and fiber.

There is a big variability in the amount of beta carotene found in squash. It can range from 0.5 to 5 milligrams. The darker the squash, the more beta carotene it contains. The shell of an acorn squash should be very dark green. Butternut squash should be butterscotch tan. Hubbards should be deep orange.

October is Breast Cancer Awareness Month

Separating myths from the facts

Breast cancer is the subject of an endless flow of magazine articles, TV shows, web sites, and books. Some of this information, however, is entirely false. For example:

The stress myth. There is no evidence that emotional upset or severe stress causes breast cancer or causes it to recur after treatment. Studies published in Psycho-Oncology show that 42 percent of women who survived breast cancer erroneously blamed stress.

The high-fat diet myth. Long suspected of raising breast cancer risk, fat now seems to have no direct connection. A diet low in animal fats is beneficial in other ways, but there’s no proof that it protects against breast cancer.

Internet myths. Some web sites claim antiperspirants and underwire bras cause breast cancer. They don’t.

The exercise factor. Regular exercise over a lifetime may be protective. But researchers think it’s because exercise controls weight.

The age myth. The idea that breast cancer is a young women’s disease is false. Breast cancer risk rises dramatically with age.

The facts

• Mammograms are still the gold standard for detecting breast cancer, according to the National Academy of Sciences. They have reduced mortality by one-third in women aged 55 to 70.
• The causes of breast cancer are unknown, but genetics and lifetime estrogen levels play major roles.
• Good health practices are the best protection. Women who get regular blood pressure checks, exercise, avoid being overweight, don’t smoke, and get regular mammograms have a lower risk.

Get a free copy of the DASH diet

DASH is an acronym for Dietary Approaches to Stop Hypertension. It’s a plan proven to lower blood pressure and helps reduce blood cholesterol. It can also help you lose weight, particularly in conjunction with regular exercise. To get a free copy of the DASH diet, including menus, simple recipes, and helpful tips, write to NHLBI Health Information, P.O. Box 30105, Bethesda, MD 20824-0105, or call (301) 592-8573.

The booklet can be downloaded at www.nhlbi.nih.gov/health/public/heart/hbp/dash.

Fever Facts: To treat or not to treat

People don’t like feeling feverish, so they try cool baths, washcloths, or fans to bring their temperature down. Because fever resets the body’s thermostat, external cooling forces the body to work harder to maintain the fever.

Anti-fever medications such as aspirin, acetaminophen and ibuprofen cool more effectively. They short-circuit fever-producing chemicals called prostaglandins. These drugs can, however, cause stomach distress and aspirin may cause Reye’s syndrome in children. Acetaminophen in small doses is recommended for children.

There is evidence that treating fever may be counter-productive. A study published in Pharmacotherapy found that people infected with influenza A stayed sick longer if their fever was brought down. People with colds had decreased immune responses when their fever was treated, and studies reported in the Journal of Pediatrics show that children with chickenpox who took acetaminophen had longer-lasting lesions than those who didn’t.

Fever higher than 104 can damage the central nervous system and requires immediate attention from a physician.

Calm restless legs so you get more sleep

Leg muscles that feel tense and creepy are familiar torture for some 12 million Americans.

The medical name for this condition is restless legs syndrome (RLS). Many doctors aren’t familiar with it, so people often suffer, lose sleep over it, and become chronically sleep deprived.

Researchers at Johns Hopkins University say RLS can get worse, stay the same, or improve. Self-help tactics:

• Move. Trying to resist the urge to move is pointless. Getting up and walking around could ease symptoms.
• Stretching and massaging leg muscles may relieve or prevent symptoms.
• A hot bath can relieve symptoms or keep them at bay long enough to let you go to sleep, according to Prevention.
• Regular exercise seems to lessen the frequency of RLS attacks.
• Avoid alcohol, caffeine, and nicotine in the hours before bedtime. They make symptoms worse.
• Antidepressants and antihistamines can make symptoms worse.
• Go to sleep at the right time. If you are sleepy at 10 p.m., don’t stay up until 11 p.m. when many symptoms begin.
• Check for iron deficiency, which may play a role.
• Ask your doctor about drugs that could relieve symptoms.
• Check with a chiropractor. Pinched nerves in the spine may be the cause.

SAFETY FACTS:

How worried should you be about trick-or-treating?

With multiple child abductions reported during the summer, parents might think child abduction by strangers is more common than it is.

According to national crime statistics, 3,200 and 4,600 successful non-family abductions occur during a year. In a country of 285 million people, this is a very small number.

Still Halloween remains a holiday when children may be especially at risk since they are supposed to do exactly what parents tell them not to–take candy from strangers.

Supervision is crucial, police say. In small, isolated neighborhoods, parents can establish a trick-or-treat time and all adults can watch the street during that time. In urban neighborhoods, parents can take their children to public Halloween parties.

All children, even as old as 16- or 17-years-old, should be cautioned to stay in their own neighborhood to trick-or-treat. Here are some other tips from law enforcement:

• Adults do not need directions from children or teenagers. They do not need help of any kind. If anyone asks for their help, young children should run home.
• Young children and teenagers should never approach a car.
• Never speak to an adult whose name they do not know.
• Never enter the house of a teenager or adult.
• Never accept candy, or a gift, from an adult or a teenager.

Plan Premiums 2003

How we arrive at premiums and benefits —

The annual "Call Letter" is received from the Office of Personnel Management at the end of March for the next contract year. This letter offers guidance on benefits, coverage issues and how and when to submit our proposal. The process to be followed is extremely precise and all benefit changes must be supported by actuarial figures. Once the proposal is submitted, negotiations can begin with OPM. These negotiations are generally completed by mid-August.

The process of writing benefit changes and clarification is extremely tedious. It is mandated by the Office of Personnel Management that our submissions must be in a specific format and in clear, precise language that can be fully understood by our membership and by any federal employee interested in joining the Plan.

When the proposal is submitted, we also submit our proposal for premiums rates. Through the negotiation process, OPM looks at our proposed benefit structure and the reserves held. The Plan’s intent has always been to put ourselves in a position to stabilize premiums as much as possible for our members while providing the best possible coverage for our letter carrier family.

Listed below are the Plan Premiums for 2003:

Postal — Bi-Weekly Premium
		Total Premium	USPS Pays	Employee Pays
	Self Only	$157.74	$129.03	$28.71
	Self & Family	$337.07	$294.70	$42.37
For Other Federal Employees — Bi-Weekly Premium
		Total Premium	Govt. Pays	Employee Pays
	Self Only	$157.74	$109.30	$48.44
	Self & Family	$337.07	$249.62	$87.45
For Annuitants and Survivor Annuitants
		Total Premium	Govt. Pays	Employee Pays
	Self Only	$341.77	$236.82	$104.95
	Self & Family	$730.32	$540.84	$189.48

THE PHARMACY CORNER

Check out the benefits of CarePatterns –

Over the last several years, the NALC Health Benefit Plan has offered our members access to the CarePatterns Disease Management Programs administered by Caremark. Working with Caremark we have helped them identify the programs and disease management services that most impact our unique members needs. The Number One industry-ranked CarePatterns disease management programs have become very popular with our membership. To date, over 10,500 NALC members have enrolled in one of these helpful programs.

NALC offers CarePatterns Programs for Disease Management to assist in improving member Quality of Care and Quality of Life while reducing overall health care presource use for members with chronic medical conditions. The CarePatterns Programs target high-incidence, high-cost diseases including: adult asthma, ulcers, diabetes and arthritis. The new additions for the 2003 benefit year will be Congestive Heart Failure (CHF), Coronary Artery Disease (CAD) and Chronic Obstructive Pulmonary Disease (COPD).

As with the first four, these new CarePatterns programs center on those in the Health Benefit Plan membership whose drug profile indicates that they may be a candidate for the help these programs can provide.

Once identified, the member is contacted to see if they would be interested in volunteering to enter the appropriate program. Note I said, volunteer, as no one is required to participate.

However, the response we have had from those who have chosen to be part of CarePatterns have indicated that they believe it has been a positive and beneficial experience. Make no mistake, CarePatterns is not a substitute for your physician’s care. Often participation becomes a collaborative effort between the member, their doctor and Caremark, which enhances the possibility of better results from the treatment regime.

Of course, not every member or one of their family members will meet the criteria for one of these programs, but you should know they are available if health circumstances should change.

Note to our Health Benefit Representatives

PPO Directories:

New PPO directories will be mailed to all enrollees during the next few weeks. If you live in an area that borders another state, enrollees can be supplied directories for both states. Please let the Plan know if you need this additional directory.

Also, as always, I find it necessary to once again put forth this admonition — do not rely on the PPO directory as the final word on which providers participate in the network.

To put it bluntly, by the time you receive the directory, some of the providers listed may no longer be participants in the network or there may have been additions that were too late for the printing deadline. Therefore, to avoid a nasty surprise that some of your claims are being paid at the non-PPO benefit level, it is important to do one of two things. Call the 1-800-622-6252 PPO locator number to verify the provider’s participation or go to the First Health website. The website can be accessed by going to www.nalc.org, selecting the department bar and clicking on Health Benefit Plan, there you will find a link to First Health.

Health Benefit Representatives’ 2003 Reference Manual

While the Health Benefit Plan will not be conducting a Health Benefit Seminar this year, Health Benefit Representatives will once again be provided with an excellent reference manual to use during the upcoming benefit year. Our Department Heads have been busy compiling an excellent tool for your use. This manual will contain a complete guide to the 2003 benefits, as well as sections on eligibility, the HBRs’ role in the privacy issue, Medicare and double coverage information, frequently asked questions and other information that will assist you in carrying out your duties as your branch Health Benefit Representative.