You May Be Owed Money for Health Care Services

Feb 22, 2015 | Membership Updates

University’s violation of the collective bargaining agreement means you might be owed money

In October 2014, Lifewise and the University implemented benefits cuts to the Graduate Appointee Insurance Program (GAIP), the health insurance plan for UW academic student employees, without notifying or bargaining with UAW 4121.

Benefits changes include, but are not limited to:

  • Individual out-of-pocket maximum raised $300 per term, from $1,125 to $1,425

  • Family out-of-pocket maximum raised $600 per term, from $2,250 to $2,850

  • Office and clinic visits at Hall Health: Coverage cut from 100% to 90%

  • Diagnostic x-ray, lab, and imaging services at Hall Health: Coverage cut from 100% to 90%

  • Out-of-network alcohol and chemical dependency: Coverage cut from 100% to 60%

  • Out-of-network abortion: Coverage cut from 80% to 60%

  • Out-of-network organ transplants: Coverage cut from 60% to 0%

These changes—which violate Washington state law and the UAW 4121 contract—must be reversed, and academic student employees who have suffered any harm or loss from these cuts must be compensated. (A more detailed but not exhaustive list of changes can be found below.)

So what can you do?

  1. If you think that you have been affected by these cuts (including, but not limited to: paying higher copays, paying a higher out-of-pocket maximum, delaying medical care due to anticipated costs), let us know by sending an email describing your experience to healthcare@uaw4121.org.

  2. If you know someone in your department or workplace who may be affected by these cuts, share this notice with them.

  3. Participate in the Health Care Work Group.


 

 

Description of Change 2013-14 Benefits
(Page numbers reference 2013-14 Benefits Booklet)		 2014-15 Benefits
(Page numbers reference 2014-15 Benefits Booklet)
Increase in individual out-of-pocket maximum (Both Hall Health and In-network) Maximum: $1,125(p. 10) Maximum: $1,425(p. 1)
Increase in family out-of-pocket maximum (Both Hall Health and In-network) Maximum: $2,250(p. 10) Maximum: $2,850(p. 1)
GAIP no longer considered to be secondary or excess coverage ‘Note: This coverage is blanket disability insurance. Coverage provided is “excess” only and does not contain a
“coordination of benefits” provision.'(first page – no page number)		 See Coordination of Benefits (p. 41)
Skilled Nursing Facility coverage reduced Limited to 90 days/plan year(p. 15) Limited to 60 days/plan year(p. 4)
Durable Medical Equipment coverage reduced Lifewise covers 90% of allowable charge after deductible for both in-network and out-of-network (p. 14) Lifewise covers 90% in-network and 60% out-of-network(p. 4)
Abortion (Out-of-network) coverage reduced Lifewise covers 80% of allowable charge after deductible(p. 13) Lifewise covers 60% (Listed as 40% coinsurance)
(p. 5)
Removal of $1,000 Hall Health benefit “If your benefits at Hall Health exceed $1,000 in a plan year (services that meet the federal preventive guidelines do not accrue to this maximum), any additional services received at Hall Health will be paid at the network provider benefit level in the student Medical Plan Summary, subject to the deductible and coinsurance.”
(p. 10)		 $1,000 Hall Health benefit removed
Outpatient Rehabilitation at Hall Health coverage reduced Lifewise covers 100% of allowable charge after deductible up to 12 visits/plan year(p. 15) Lifewise covers 90% (Listed as 10% coinsurance), up to 25 visits/plan year(p. 4)
Transplants (Office Visits at Hall Health) coverage reduced “Paid as any other sickness”
(p. 15)Relevant coverage category would be the “Outpatient” coverage category (p. 13), which covers 100% of allowable charge after deductible		 Lifewise covers 90% (Listed as 10% coinsurance)(p. 5)
Transplants (Out-of-network) coverage eliminated “Paid as any other sickness”
(p. 15)Relevant coverage categories would be the “Inpatient” coverage category (p. 12) and the “Outpatient” coverage category (p. 13). For both categories, out-of-network coverage is 60% of allowable charge after deductible		 Not covered(p. 5)
Dental Accidents coverage reduced For Hall Health, in-network, and out-of-network, Lifewise covers 100% of allowable charges after deductible up to $1,500/plan year
(p. 14)		 Not available for Hall Health. For in-network and out-of-network, “Covered as any other service”
(p. 5)Presumably, this means “Office and Clinic Visits” (p. 1), which covers 90% for in-network and 60% for out-of-network (Listed as 10% and 40% coinsurance, respectively).
Family Deductible (In-network and out-of-network) “Family Deductible” is not specified in 13-14. Instead, there is a deductible of $75/person each quarter, up to $300/person each plan year(p. 12) “Family Deductible” added:  $150 per quarter, $600 per plan year(p. 1)
Prior Authorization added No prior authorization required Some drugs may require prior authorization
(p. 10)
Specialty Drugs “Specialty drugs” is not a category in the 13-14 booklet. Drugs are covered as follows (p. 13):
Hall Health

  • Generic: $10 copay
  • Formulary: $25 copay
  • Nonformulary: $35 copay

In-network

  • Generic: Lifewise covers 80% after deductible
  • Formulary: Lifewise covers 80% after deductible
  • Nonformulary: Lifewise covers 60% after deductible

Out-of-network

  • Generic, Formulary, and Nonformulary: Lifewise covers 60% after deductible
 Lifewise covers 50% (Listed as 50% coinsurance)(p. 3)
Oral Chemotherapy Drugs “Oral Chemotherapy Drugs” is not a category in the 13-14 booklet. Drugs are covered as follows (p. 13):
Hall Health

  • Generic: $10 copay
  • Formulary: $25 copay
  • Nonformulary: $35 copay

In-network

  • Generic: Lifewise covers 80% after deductible
  • Formulary: Lifewise covers 80% after deductible
  • Nonformulary: Lifewise covers 60% after deductible

Out-of-network

  • Generic, Formulary, and Nonformulary: Lifewise covers 60% after deductible
 Lifewise covers 90% (Listed as 10% coinsurance)(p. 3)
Hearing Care (Out-of-network) coverage reduced Lifewise covers 75% of allowable charge after deductible(p. 14) Since “Hearing Care” only covers annual hearing testing, the equivalent category for 14-15 is “Preventative Care”. Out-of-network preventative care is not covered(p. 2)
Alcohol and Chemical Dependency coverage reduced Both in-network and out-of-network: Lifewise covers 100% of allowable charge after deductible(p. 13) In-network: Lifewise covers 90% after deductible (Listed as 10% coinsurance). Deductible waived for the subcategory of “Outpatient Facility.”Out-of-network: Lifewise covers 60% after deductible (Listed as 40% coinsurance).
(p. 3)
Hall Health Outpatient Services coverage reduced Lifewise covers “100% of allowable charge after deductible for the following services/supplies: 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”
(p. 13)		 Relevant 14-15 categories:
Office and Clinic Visits: Lifewise covers 90% after deductible (Listed as 10% coinsurance)(p. 1)
Diagnostic X-ray, Lab and Imaging (All diagnostic x-ray, lab, and imaging except for preventative screening and tests): Lifewise covers 90% after deductible (Listed as 10% coinsurance)(p. 2)
Surgery Services: Lifewise covers 90% after deductible (Listed as 10% coinsurance)(p. 3)

Hospital Services (Outpatient Care): Lifewise covers 90% after deductible (Listed as 10% coinsurance)
(p. 3)