Health plan issues settled in precontract talks.
* The attending physician will be required to complete a "Precertification form" prior to each nonemergency admission to a hospital. The form will be reviewed by the plan's staff. Any questions on admission, care, or proposed length of stay will be referred to a reviewing physician, who will discuss a possible modification of treatment with the attending physician. If they are unable to agree, the attending physician's opinion will prevail.
* Employees and retirees will have to obtain company-paid second opinions prior to specified nonemergency surgical procedures. Employees will be paid for up to 4 hours worktime lost while obtaining the second opinion.
* Before nonemergency surgery, workers and retirees will have to obtain from the surgeon a form indicating the diagnosis, operating procedures, and amount to be charged. If the proposed charge is higher than the allowable amount, the plan administrator will attempt to resolve the difference. If this cannot be accomplished, the worker or retiree will not have to pay the difference.
* Preadmission tests prior to nonemergency surgery will be performed on an outpatient basis, with participants becoming immediately eligible for sickness and accident benefits, rather t han after a waiting period. As before, participants receive a $50 bonus for certain surgical procedures if they are performed on an outpatient basis.
* Plan participants must generally obtain all prescription drugs through the plan's mail order film, either by mailing in or telephoning in the prescription. The drugs, which are free to the participant, will be mailed by the plan in postage free envelopes. The mail order firm also offers toothpaste, shampoo, and similar items at reduced prices.
* Claims administration will be improved to cut costs.
* Health maintenance organizations that provide better benefits at competitive costs will continue to be reviewed.
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|Publication:||Monthly Labor Review|
|Date:||Mar 1, 1985|
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