Jun 182015
 
 June 18, 2015

This year UAW Local 4121 has filed multiple grievances and an Unfair Labor Practice charge in response to learning that Lifewise Assurance Company had unilaterally changed (for the worse) several GAIP health insurance benefits from the 2013/14 plan year to the 2014/15 plan year in violation of State Law and the Collective Bargaining Agreement.

To resolve the charge and grievances the University has agreed to direct Lifewise to reprocess all claims covered by these benefits. We are working with UW and Lifewise to review and finalize the set of benefits and charges for which claims will be reprocessed.

Please take a minute to review the list of benefits below, which we’ve already identified as having changed during the 2014/15 plan year.  If you have experienced any other benefits changes in 2014/15, that you do not believe were consistent with the negotiated GAIP benefits from 2013/14, please let us know by Monday, June 22nd.  We are meeting with UW the following day to finalize our analysis.

Again, member input has been invaluable in this process.  Thank you for your continued engagement!

In solidarity,

UAW 4121 Executive Board

David Parsons
Lei Cheng
Toni Ferro
Dylan Mayer
Kristin Lindenmuth
Elizabeth Scarbrough
Viral Shah
Bradley Dickerson
Phil Harding

 

Benefit Changes

Here is a list of negative  benefits changes (from 2013/14-2014/15) we have identified so far:

  • Out of pocket maximum for 2014/15 (should be $1,200 per individual and $2,400 per family)
  • Hall Health services (should be covered in full for first $1,000 with no deductible)
  • Nursing facility coverage (should be covered 90% in network and 60% out of network after $300 copay)
  • Durable medical equipment coverage (should be covered 90% after deductible)
  • Abortion coverage (should be covered 90% in network and 80% out of network)
  • Outpatient rehabilitation coverage (after deductible should be covered 100% at Hall Health, 90% in network and 60% out of network)
  • Transplant coverage (all approved transplant centers should be covered at in-network benefit level: 90% after deductible)
  • Dental accident coverage (should be covered in full, even when out of network)
  • Alcohol and chemical dependency coverage (should be paid 100% of allowable charge, with deductible waived at Hall Health)
  • Trans* health benefits (surgeries, hormone replacement therapy, etc should be covered in the same manner as with any other benefit)
  • Prescription Drugs (there should not be a specialty drug category; no prior authorization should be required for any drugs; and all prescription drugs should be subject to a copay of $10-$35 at Hall Health and covered 60-80% for in-network and out-of-network providers depending on drug category)
  • Oral Chemotherapy (should be covered at 100% at Hall Health)
  • Certain Outpatient Services at Hall Health (should be covered at 100%):
    • treatment by a doctor or surgeon
    • office and clinic  visits
    • outpatient services,
    • diagnostic x-ray and lab
    • surgical services
    • surgical dressings and casts
    • prosthetic appliances
    • rehabilitative care when prescribed by physician
  • Pediatric Dental (should be covered at same rate and subject to same deductible as any other dental, and with no annual limit)
  • Necessary contact lenses limit(should be $250)
  • Lab work (covered lab charges incurred at or referred from Hall Health should be covered at 100% for covered services)
  • Coinsurance at Hall Health (should be 100% rather than 90% for the following benefits since 2011/12):
    • contraception management and sterilization
    • diagnostic, x-ray lab and imaging
    • prescription drugs (preventive)
    • hospital services (outpatient)
    • surgery services (outpatient hospital, ambulatory, professional services)
    • mental health office visits and outpatient facility
    • chemical dependency treatment
    • rehabilitation therapy (outpatient)