Director's Message

Director's Message

Your 2020 health benefit changes

Below you will find a summary of the 2020 benefit changes. Please keep in mind that at the time this article was submitted for print, we did not have approval to release the 2020 premium rates. As a result, please refer to the official 2020 Health Benefit Plan brochure or check our website at nalchbp.org.

Changes to this Plan:

Changes to our High Option only:
  • We now cover the charges for a non-PPO assistant surgeon at the PPO benefit level when services are performed at a PPO hospital or ambulatory surgical center, and the primary surgeon is PPO.
  • We increased the Plan payment for hearing aids and related examination to $1,000 per ear. Previously, we paid $500 per ear. 
  • We increased the Plan payment for one pair of custom functional foot orthotics to $500 with replacement every 2 years. Previously, we paid $400 with replacement every 5 years. 
  • You will now pay a $350 copayment per admission to or observation stay in a PPO hospital. 
  • You will now pay a $450 copayment and 35% coinsurance, plus the difference between our allowance and the billed amount, per admission to a non-PPO facility. Previously, you paid $350 and 30%. 
  • We decreased the copayment for telemental/virtual visits to $10. Previously, you paid $20. 
  • We now cover up to four (4) visits to treat postpartum depression at 100% when you use an In-network mental health provider. 
  • You will now pay 50% of the Plan allowance for prescriptions purchased at a non-network retail pharmacy. Previously, you paid 45%. 
  • You will now pay 50% of the cost for non-formulary brand drugs purchased at a retail pharmacy if NALC is primary. Medicare prime members will now pay 40% of the cost. Previously, you paid 45% and 30%, respectively. 
  • You will now pay the following copayments for mail order prescriptions: 60-day supply for NALC prime members, $10 generic, $60 formulary brand, $84 non-formulary brand; 90-day supply for NALC prime members, $15 generic, $90 formulary, $125 non-formulary. Medicare prime members, 60-day supply: $7 generic, $50 formulary brand, $75 non- formulary brand. 90-day supply: $10 generic, $75 formulary brand, $110 non-formulary brand. 
  • You will now pay $200 for a 30-day supply of a specialty medication, $300 for a 60-day supply and $400 for a 90-day supply. Previously, you paid $150, $250, and $350, respectively. 
  • We now offer the Real Appeal® weight loss program. Previously, we offered Weight Talk. 

Changes to our Value Option only:

Changes to our Consumer Driven Health Plan Option only:

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Note: The information located in this article is only a summary of some of the NALC Health Benefit Plan benefits.  Detailed information can be found in the NALC Health Benefit Plan's official 2019 brochure (RI 71-009).  All benefits are subject to the definitions, limitations, and exclusions set forth in the official brochure.