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Retired Members Plan (RMP) |
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Retiree Summary of Benefits as of June
1, 2007 |
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Comprehensive
Medical Benefit |
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| Calendar
Year Deductible |
$500 per
person |
Lifetime
Maximum
Chiropractic/Spinal Care
Substance Abuse Treatment
Inpatient Treatment
Infertility Treatment |
$500,000 per
person
$5,000 per person
$25,000 per person
One 21-day course of
treatment per person
$10,000 |
Calendar
Year Maximums
Chiropractic/Spinal Care
Substance Abuse Treatment
Mental Health Treatment
Inpatient Maximum
Outpatient Maximum
Speech Therapy (to restore
normal speech) |
$1,000 per person
$10,000 per person
15 days per person with up
to 15 physician visits
30 visits per person
30 visits per person |
Specific
Benefit Maximums
Hospital Daily Room And
Board
Hospital Intensive Care |
Semi-private room rate
Three times semi-private
room rate |
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Type of Service
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PPO Provider |
Non-PPO Provider |
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Outpatient Pre-Admission
Tests |
Plan pays 100%; no
deductible |
Plan pays 100%; no
deductible |
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Hospital Benefits |
Plan pays 80% |
Plan pays 70% |
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Mammograms |
Plan pays 100%; no
deductible |
Plan pays 100%; no
deductible |
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Colon Cancer Screenings |
Plan pays 100%; no
deductible |
Plan pays 100%; no
deductible |
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Chiropractic/Spinal Care |
Plan pays 70% |
Plan pays 70% |
Substance Abuse Treatment4
Inpatient Treatment5
Outpatient Treatment
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Plan pays 80%
Plan pays 80% of first
$5,000 in a year;
50% thereafter |
Plan pays 70%6
Plan pays 50%
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Mental Health Treatment
Inpatient Treatment
Outpatient Treatment |
Plan pays 80%
Plan pays 50% |
Plan pays 50%
Plan pays 50% |
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For All Other Covered
Medical Expenses |
Plan pays 70% |
Plan pays 70% |
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Prescription Drug
Benefits |
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| Calendar
Year Deductible |
$250 |
| Coinsurance
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You pay 25%
for each prescription, up to
a maximum of $100 per 30-day
supply |
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1 Does not apply if you are age
65 or older or Medicare-eligible,
in which case benefits generally
will be paid at 70%.
2 Benefit payable will be equal to
the maximum allowed under the
normal and customary charge
guidelines in effect for the
geographic area in
which the procedure is performed.
3 Chiropractic/spinal care
includes all services and supplies
for care of the back, neck, spine,
and vertebrae.
4 Amounts paid by the Plan at the
50% level for substance abuse
treatment do not apply to the
out-of-pocket maximum.
5 Inpatient treatment is covered
if it is provided by a hospital or
approved treatment facility and
treatment is based on completion
of a course of
treatment and the discharge is
certified by a physician.
6 Inpatient treatment provided by
a non-PPO provider is subject to
the $500 per person non-PPO
deductible for each non-emergency
admission,
in addition to the calendar year
deductible
This is a plan description. Not a
guarantee of benefits.
Benefits depend on eligibility, date
of service and Fund Plan
limitations.
In the event of a conflict between
the Summary Plan Description,
this web site and the Plan's legal
documents, the legal documents will
govern.
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