Microsoft word - nu_actives_ut.doc

2004 Health Care Changes
Nonunion Active Employees in Utah
These changes are effective January 1, 2004. This list shows only what’s changing. For more details about your 2004 medical and dental plan benefits, logon to the “Your Benefits Resources” web site and access a personalized plan comparison. Your enrollment packet has a printed list of key 2004 medical changes, including new dependent child eligibility rules. Tip: To view changes to your dental plan, press CTRL + F and type in “dental”—you’ll jump to that section of
the list.
Medical Plans
Location and Plan
Benefit Change or Clarification
Utah
• Network retail pharmacy prescription drugs will be covered as follows for – $5 copayment for generic drugs. – $15 copayment for brand formulary drugs. – $30 copayment for brand nonformulary drugs. • Network mail service program prescription drugs will be covered as – $10 copayment for generic drugs. – $30 copayment for brand formulary drugs. – $60 copayment for brand nonformulary drugs. • Zyban, a smoking cessation aid, will be covered under the prescription • Network retail pharmacy prescription drugs will be covered as follows for – $5 copayment for generic drugs. – $15 copayment for brand formulary drugs. – $30 copayment for brand nonformulary drugs. • Network mail service program prescription drugs will be covered as – $10 copayment for generic drugs. – $30 copayment for brand formulary drugs. – $60 copayment for brand nonformulary drugs. • Zyban, a smoking cessation aid, will be covered under the prescription drug benefit to a maximum of 90 tablets per year. Location and Plan
Benefit Change or Clarification
• The prescription drug program continues to be offered with the addition of • The following network retail pharmacy coverage levels will apply (after the deductible) for each 34-day prescription drug supply: – 90 percent for generic drugs. – 80 percent for brand formulary drugs. – 70 percent for brand nonformulary drugs. • Network mail service program prescription drugs will be covered as – $10 copayment for generic drugs. – $30 copayment for brand formulary drugs. – $60 copayment for brand nonformulary drugs. • Manipulation of the spine and extremities will be limited to 26 chiropractic visits each year, network and nonnetwork combined. • Acupuncture services for a covered illness or in place of covered anesthesia when performed by a licensed acupuncturist (L.A.C.), a doctor of medicine (M.D.), or a doctor of osteopathy (D.O.) will be covered. • Insulin dependency for those with diabetes will be considered a qualifying condition for erectile dysfunction benefits regardless of age. • Hospice care benefits will be provided for respite care for a minimum of two hours per day, limited to a combined total of 120 hours in each three-month period. • Nonnetwork mental health treatment will be covered at 60 percent after • Network substance abuse treatment will be covered at 100 percent for up to $7,500 per course of treatment, to a maximum of two courses of treatment. • Nonnetwork substance abuse treatment will be covered at 60 percent for up to $2,500 per course of treatment; this $2,500 maximum will count against the $7,500 per course of treatment network maximum. Dental Plans
There are no 2004 dental plan changes.

Source: http://www.gnieob.com/assets/pdf/companyoffices/empinfo/benefits/health_welfare/pdf_files/NonUnionActive/nu_actives_ut.pdf