FOR RETIREES
FROM THE TRUSTEES OF THE WESTERN TEAMSTERS WELFARE TRUST

BENEFIT CHANGES FOR 2003 - 2004
Each year the Board of Trustees evaluates the benefit program and the financial outlook of the Trust. One of our goals is to provide the best benefits the Trust can afford. Unfortunately, we've reached a point where we simply can't sustain the current level of benefits - fewer employers paying into the plan, significant increases in the cost of health care and investments yielding lower returns have all contributed to our economic situation. We have been forced to make some changes now to maintain the financial health of the Trust.

Please review this newsletter to learn about the changes to the benefits effective September 1, 2003 and keep it with your plan booklet for future reference.

WHAT'S IN THIS PACKET

1. This newsletter, with information about open enrollment and changes effective September 1, 2003:
   Medicare and Non-Medicare
   • New prescription drug plan vendor
   • Self-pay rates for 2003 - 2004
     
     Non-Medicare
   • Changes to the Non-Medicare Indemnity Medical Plan
2. Plan comparison grids for open enrollment options (if available) effective September 1, 2003
3. List of Medco Health major pharmacy chains

CHANGES FOR MEDICARE AND NON-MEDICARE RETIREES

NEW VENDOR FOR INDEMNITY PLAN PRESCRIPTION DRUG PROGRAM
We have a new outpatient prescription drug plan vendor for participants covered under the Trust Indemnity Plan (does not apply to participants covered under Trust offered HMO options). Medco Health has administered our prescription drug mail-order program for some time now and effective September 1, 2003, they'll administer the retail pharmacy portion as well. Here's how this change will affect you:

• Pay only the copay – No more paying up front for your prescriptions. Simply show your Medco Health card at the pharmacy and all you'll pay is your copay when you pick up your prescription.
• New ID card – You'll receive your prescription drug ID card from Medco Health at the end of August. After September 1, simply present your new ID card at your pharmacy to receive benefits. The first time you use your card you’ll need to give the pharmacist your ID number (your Social Security Number).
• You must use Medco Health pharmacies – To receive Plan benefits, you must use Medco Health network pharmacies. Benefits will not be provided for services rendered at a non-network pharmacy. It's likely the pharmacy you use now already participates in the Medco Health network. A list of the major participating chain pharmacies is included in this packet. Beginning September 1, you can find a participating pharmacy at www.medcohealth.com or by calling 1-800-711-0927.
• 34-day supply limit at a retail pharmacy – The maximum for each refill is a 34-day supply. If you use a maintenance drug (one you use on an ongoing basis), use the mail order service. Not only can you get a larger supply through the mail but you'll save money.
• New prescription drug benefit – Effective September 1, 2003, prescription contraceptive drugs and devices will be covered by the Plan.

Prescription drug benefits will continue be paid as follows:

 

PLAN FEATURES	MEDCO HEALTH PHARMACY	NON - MEDCO HEALTH PHARMACY
Medco Health Retail Pharmacy You must use Medco Health network pharmacies. Limited to 34-day supply. Prescription drugs are not subject to the deductible and out-of-pocket maximum.
Generic Brand	Plan pays 100% after $8 copay. Plan pays 60%	Not covered. Not Covered
Medco Health Mail Order Limited to 100-day supply.
Generic Brand	Plan pays 100% after $15 copay. Plan pays 100% after $30 copay.	Not covered. Not Covered

PAY ONLY THE COPAY - No more paying up front for your prescriptions. Simply show your Medco Health card at the pharmacy and all you'll pay is your copay when you pick up your prescription.

CHECK OUT MEDCOHEALTH.COM
Medcohealth.com gives you access to your pharmacy benefit when it’s convenient for you. After a one-time registration, you can:

• Find information about WTWT’s prescription drug plan (available after September 1)
• Compare medication prices – generic vs. brand
• Find a participating pharmacy (available after September 1)
• Order refills and view your recent prescription history (available after September 1)
• Learn about health and wellness through access to thousands of articles and resources – personalized to match your interests.

SAVE TIME AND MONEY WITH MAIL - ORDER PRESCRIPTIONS
You can pick up only a 34-day supply when you refill prescriptions at a retail pharmacy. Through mail order, you can receive up to a 100-day supply each time - and you'll pay less than retail for about 3 times the supply. You can conveniently order refills by phone, mail or online at medcohealth.com

Ask your doctor for a prescription for up to a 100-day supply plus refills. When you receive a new prescription, try it for a month before ordering a 100-day supply. Ask your doctor to write 2 prescriptions - one for the small supply right away and another for the mail-order service once you're sure the prescription is right for you.

You'll receive a mail-order form and instructions with your new ID card at the end of August.

CHANGES TO THE NON-MEDICARE INDEMNITY PLAN FOR 2003 - 2004
The following changes are being made to the Non-Medicare Indemnity Medical Plan effective September 1, 2003, to keep the plan in line with the active plan. Please review this section carefully to be sure you understand how much the Plan will pay and what your responsibility will be beginning in September.

Higher coinsurance – Effective with services received September 1, the Plan will pay 80% of the PPO allowed amount for most PPO expenses. If you use non-PPO providers, the Plan will pay 60% of usual, customary and reasonable rates.

New calendar-year out-of-pocket maximum – The out-of-pocket maximum is new for PPO expenses and higher for non-PPO expenses effective Septerber 1. The out-of-pocket maximum is the maximum amount you'll pay each calendar year in coinsurance. (Coinsurance is the 20% you pay for most PPO expenses or the 40% you pay for most non-PPO expenses.) After you reach the limit, the Plan pays eligible expenses at 100% for the remainder of the calendar year. You'll continue to be responsible for prescription drug copays even after you've reached the out-of-pocket limit. Effective September 1, 2003, the calendar-year out-of-pocket maximum is $2,000 per person ($6,000 per family) for PPO expenses and $5,000 per person ($15,000 per family) for non-PPO expenses.

You'll receive credit toward the higher 2003 out-of-pocket maximum for amounts you've paid January through August. If you've already satisfied your 2003 out-of-pocket maximum, you'll have to meet the additional $500 per person for PPO expenses ($2,500 for non-PPO expenses) before the Plan will continue to pay eligible expenses at 100%.

$100 emergency room copay – Whether you use a PPO emergency room or a non-PPO facility, effective September 1, you'll pay a $100 copay for each visit to the emergency room. This copay is waived if you’re admitted to the hospital.

New limits on certain services – To make these benefits easier to understand, the Plan will pay medically necessary services starting with calendar year 2004 to these new limits:

• Spinal manipulations – 24 visits per calendar year
• Massage therapy – 10 visits per calendar year
• Acupuncture – 10 visits per calendar year
• Physical therapy – 24 visits per calendar year
• Occupational therapy – 24 visits per calendar year.

Services recieved during the remainder of 2003 in the above noted categories will be subject to medical necessity review and current Plan limits.

SAVE MONEY BY USING PPO PROVIDERS
A Preferred Provider Organization, or PPO, is a network of doctors, hospitals and other providers who have contracted with Beech Street to provide services at a discount. This means using PPO providers saves both you and the Trust money.

When you use PPO providers, you benefit from lower out-of-pocket costs. Most covered benefits for services received from a PPO provider are paid at 80% of the PPO allowed amount after the deductible (while non-PPO services are generally paid at 60% of usual, customary and reasonable charges (UCR) after the deductible).

If you live in an area that has no PPO providers, your benefits will be paid at the PPO level – based on UCR charges. Out-of-area means covered expenses incurred for services provided by a provider or facility that is over 30 miles from the nearest network provider or network facility. Except for emergencies that would be considered life-threatening, you must live over 30 miles from the nearest network provider or network facility in order to be eligible for out-of-area benefits that would be paid at 80% of UCR. And charges in excess of UCR allowances will be your responsibility subject to the out-of-pocket maximum.

Anytime you use non-PPO providers (even if you live outside the PPO service area), you may have to pay more than the stated coinsurance. This is because non-PPO providers do not have the same contractual obligations as PPO providers. Non-PPO providers are not limited to the PPO allowed amount and can charge any amount for their services. The Plan pays non-PPO providers up to the UCR amount – you must pay any amount charged by your doctor that is greater than UCR.

WHAT IS UCR?
UCR or the usual, customary and reasonable charge is the fee typically charged for a particular service in the same geographic area by the same type of provider.

CALL MHN FOR MENTAL HEALTH OR CHEMICAL DEPENDENCY CARE
If you are an Indemnity Plan participant who needs a mental health or chemical dependency treatment professional, be sure to call Managed Health Network (MHN) at 1-800-989-8008 – not Beech Street.

Cost Savings When You Use PPO Providers
The following chart is an exxample of the possible cost savings when you use a PPO provider rather than a non-PPO provider.

AFTER YOU'VE SATISFIED YOUR DEDUCTIBLE . . .

OFFICE VISIT	PPO PROVIDER	NON - PPO PROVIDER
Physician's Charge	$115	$115
Negotiated PPO Discount	$25	None
PPO Allowed Amount	$90	Not applicable
Non-PPO UCR Charge	Not applicable	$115
Benefit Coverage	80% of PPO allowed amount	60% of $115 UCR amount
The Plan Pays	$72	$69
You Pay	$18	$46

HOW DO YOU FIND A PPO PROVIDER?
To locate a PPO provider in your area, call Beech Street toll-free at 1-877-891-7983. You may also visit their web site at www.beechstreet.com to find out about a specific provider or to print a personalized directory.

INDEMNITY MEDICAL PLAN HIGHLIGHTS FOR RETIREES NOT ELIGBLE FOR MEDICARE
Highlights of the non-Medicare medical benefits effective September 1, 2003 are shown below. The percentages in the chart show how much the Plan pays toward your covered medical care.

 

PLAN FEATURES	PPO PROVIDER*	NON - PPO PROVIDER
Calendar Year Deductible	$300 per person, per calendar year. $900 per family, per calendar year.
Calendar Year Out-of-Pocket Maximum** (Excluding the Deductible)	$2,000 per person, per calendar year. $6,000 per family, per calendar year.	$5,000 per person, per calendar year. $15,000 per family, per calendar year.
Hospital Services (Pre-certification Required for Inpatient Admission)	Plan pays 80% of PPO allowed amount after deductible.	Plan pays 60% of UCR charges after deductible.
Physician Services Inpatient Visits Outpatient Visits Surgeon's Fees	Plan pays 80% of PPO allowed amount after deductible.	Plan pays 60% of UCR charges after deductible.
Preventive Care Physical Exams Immunizations Well Child Care	Plan pays 80% of PPO allowed amount after deductible, to a maximum of $500 per person, per calendar year.	Plan pays 60% of UCR charges to a maximum of $500 per person, per calendar year, after the deductible.
Diagnostic X-Ray and Lab	Plan pays 80% of PPO allowed amount after deductible.	Plan pays 60% of UCR charges after deductible.
Spinal Manipulations Massage Therapy Acupuncture	Plan pays 80% of PPO allowed amount after deductible.	Plan pays 60% of UCR charges after deductible.
	Limited to 24 spinal manipulations, 10 massage therapy visits and 10 acupuncture visits per calendar year.
Physical and Occupational Therapy	Plan pays 80% of PPO allowed amount after deductible.	Plan pays 60% of UCR charges after deductible.
	Limited to 24 physical therapy and 24 occupational therapy visits per calendar year.

^* Those who reside outside the PPO service area will receive PPO-level benefits, but coverage will be limited to the usual, customary and reasonable charge. Out-of-area means covered expenses incurred for services provided by a provider or facility that is over 30 miles from the nearest network provider or network facility. Except for emergencies that would be considered life threatening, you must live over 30 miles from the nearest network provider or network facility in order to be eligible for out-of-area benefits that would be paid at 80% of UCR. Any charges in excess of usual, customary and reasonable allowances will be your responsibility, subject to out-of-pocket maximums.

^** Eligible out-of-pocket expenses do not include deductibles, copays or amounts in excess of UCR.

NOTE: This summary is provided as a brief overview of benefits only and does not include all covered and excluded benefits. For a more detailed description of your plans and their exclusions, refer to your Benefit Booklet or log onto the WTWT web site at www.westernteamsters.com.

^* The Cimarron Health Plan HMO option in New Mexico only provides an early Retiree coverage option (Non-Medicare). Medicare Retirees do not have Cimarron as an HMO option.

ABOUT YOUR HMO OPTIONS
Depending on your location, you may have the option to enroll in a Health Maintenance Organization or HMO. HMO service areas are determined by zip code. This is a good time to take a close look at all of your options and decide which type of plan is best for you. If an HMO is an option in your location, see the enclosed plan comparison grid for specific information on how the plan pays benefits. If you are eligible to participate and would like to enroll in an HMO, request a packet from your Area Administrative Office.

HOW HMOs WORK
Your monthly self-payment rates are a lot lower and benefits are higher under the HMOs than under the Indemnity Medical Plan, but you have to be willing to follow the rules. Although the specifics vary from plan to plan, the following are some key points to consider as you decide whether an HMO may be a good option for you:

• To receive most benefits, you must visit or call your primary care physician (PCP) first; you may see any provider in a life-threatening emergency but a call to your HMO is usually required within 24 or 48 hours of emergency services
• Your PCP obtains preauthorization for your care, if necessary
• The HMO pays 100% after your copay for most covered services and supplies
• You generally pay a fixed copay, for example $15 for an office visit, at the time you receive care
• The HMO handles all paperwork.

You must always use providers who belong to the HMO's network – there's no benefit for non-network care except in life-threatening emergencies. Some HMOs, such as Kaiser and Group Health Cooperative, have an exclusive network of providers who care for that HMO's participants only. Others, such as PacifiCare/Secure Horizons, contract with providers in the community who may have contracts with multiple plans.

For details about the HMO option in your location, if any, see the enclosed plan comparison grid or ask your Area Administrative Office for a packet.

2003 - 2004 RETIREE PLAN SELF-PAY RATES
Even with the benefit changes described in this newsletter, self-pay rates are rising for 2003-2004.

Effective September 1, 2003, the monthly self-payment rates per individual are:

 

TYPE OF COVERAGE	STANDARD PLAN	OPTIONAL PLAN/RETIREES OF WITHDRAWN EMPLOYERS
Medicare Retirees	Per Individual
Trust Indemnity Medical Plan Only	$85	$85
Trust Indemnity Prescription Drug Plan Only	$135	$135
Trust Indemnity Medical and Prescription Drug	$220	$220
HMO Coverage	$190	$190
Non-Medicare Retirees	Per Individual
Trust Indemnity Medical Plan With Access to HMOs	$385	$900
Trust Indemnity Medical Plan - No Access to HMOs	$330	$900
HMO Coverage	$260	$425

The new Retiree Pre-Funding Program will provide a $300 per month benefit for eligible non-Medicare retirees who are not retired from withdrawn employers. This will be used to offset these monthly self-payment rates. Also, the earning limitation has changed. If you earn more than $25,000 a year, you’ll pay the full plan cost (the Optional Plan rates shown above) and the pre-funding benefit will not apply. Please see the letter sent from the Trust in early July 2003 that explains the “WTWT Enhanced Retiree Pre-Funding Program” for the details.

EXAMPLES:
If you’re eligible for Medicare and your spouse is not and you live in an HMO service area, you’ll pay $605 a month for Indemnity Plan Medical and prescription drug coverage ($220 + $385).

If you’re retired from a withdrawn employer and both you and your spouse are not yet eligible for Medicare, you’ll pay $1,800 a month for Indemnity Plan Coverage but only $850 for an HMO.

REMINDER:
You or your spouse may be able to suspend or postpone your Retirees Plan coverage if you have other employmentrelated health coverage. If you wish to suspend your Retirees Plan coverage, contact your Area Administrative Office for the necessary form. If you qualify, no self-payments will be required, and no benefits will be provided by the Retirees Plan, while you have other group health coverage.

When you lose your other coverage, you must contact your AAO within 30 days to resume your Retirees Plan coverage. Your AAO will require documentation that your other group health coverage has been continuous and is now terminated, and they will advise you of your self-payment amount. When the necessary documentation and selfpayment is received, your Retirees Plan coverage will resume in the month following the month your other coverage terminates. In order to resume coverage, there cannot be a break in coverage.

This provision is offered for retirees who have other group health insurance and want to preserve their ability to participate in the WTWT Retirees Plan.

QUESTIONS?
If you have additional questions, call your Area Administrative Office for details.

 

AREA SERVED	AREA ADMINISTRATIVE OFFICE (AAO)*	LOCATION OF AAO	AREA SERVED
Northern California Idaho Northern Nevada Oregon Utah Washington	Northwest Administrators	Seattle, WA	206-726-3235 or 1-800-872-5439
Arizona Southern California Southern Nevada New Mexico	Southwest Administrators	Alhambra, CA	626-284-4792 or 1-877-350-4792
Change of Operations Participants	Southwest Administrators	Alhambra, CA	1-800-472-5340
Colorado Wyoming	Robert F. May Company	Denver, CO	303-629-0931
Montana	William C. Earhart Company, Inc.	Portland, OR	503-282-5581
Principal Trust Office	Northwest Administrators	Seattle, WA	206-726-3235

OPEN ENROLLMENT ENDS AUGUST 25
Now through August 25 is open enrollment. During this time you may switch between the Indemnity Medical Plan and a Health Maintenance Organization (HMO) if one is offered in your location. Follow these steps:

1. Read about the upcoming plan changes and review your options. HMO options are only available if you reside in an HMO service area. A plan companison grid is enclosed if you reside in an HMO service area.
2. Determine if you want to change your medical coverage. If you do, notify your Area Administrative Office by August 25.
3. If you don't want to change your plan election, don't do a thing. If you don't notify your Area Administrative Office by August 25, your current elections will continue.