Recent discussions with NYARM revealed a need to offer its members quality health care at affordable rates. The plan described in the two most recent issues of the NYARM newspaper offered coverage through the Combined Welfare Fund (CWF) of the United Construction Trades and Industrial Employees Union. A "Quality Point of Service" (QPOS) program, providing coverage both in, and out of network, would be provided through Aetna/US Healthcare. As it turned out, it was just too affordable!
Over the past two years, with other health insurance provider's rates climbing drastically, the CWF's low premiums attracted so many new members, the group size almost doubled. It is now one of the three largest groups insured by Aetna. Providing low-cost, quality health care to such a large group resulted in AetnaÕs placing a moratorium on new additions to the CWF. Aetna has agreed that in six months it will reassess the possibility of reopening its doors to new members.
GHI BENEFITS
Aetna's moratorium came as a surprise to the Union. It was one result of the annual negotiation (the contract year is March 1 to February 28) which this year, was unusually prolonged. Aetna's decision allowed the Union very little time in which to secure alternative coverage in the form of an agreement with another insurer, which was as beneficial as the one it negotiated with Aetna. To the Union's credit, however, a six-month contract was signed with GHI, providing coverage that is almost identical to the Aetna policy. This coverage is now available to all new CWF members which includes NYARM members.
What's more, the rates are almost identical. Individual coverage can be obtained at a cost of $249.60 per month, and family coverage at $570.82.These rates will be in effect until May, 2000. The current GHI Benefits Summary is available through the NYARM office (call 212.505.8770).The Union also provides a $2000 Life Insurance Benefit and an extensive Dental Plan at no additional cost!
GET FAMILIAR WITH YOUR BENEFITS
Health insurance is something none of us can afford to be without. Whichever coverage you purchase, maximize your benefits and protect yourself by making sure you take the proper preliminary steps. To avoid paying medical bills unnecessarily, learn to use "the system" and be prepared!
If you need special medical care and you have the advantage of not being caught in an emergency situation, the best way to prevent unexpected medical bills is to consult with your physician's office manager or benefits manager. His or her job is to make sure the doctor gets paid for his services, and will work with you to this end. Very often, your doctor's staff will be familiar with procedures that may be unfamiliar to you or your family member. Take the time to call and discuss the best way to receive quality care that is made available under your existing coverage.
Do not take anything for granted. Call the insurance company and ask "what if" questions about special situations BEFORE you incur the expenses. Take a minute to go to the GHI website (www.GHI.com) where you will find lots of helpful information under Member Services. Then browse the website for a doctor you know or one who is convenient to you.
BE CAREFUL
One word of caution: sometimes attractive healthcare plans are offered through a union that "self-insures". That means the union pays the claims out of the collected premiums. This type of insurance is generally low cost, but if too many expensive claims are made in a short period of time, the union may be unprepared to meet the expenses and could declare bankruptcy. If this happens, your coverage is cancelled and you have little or no recourse. Be sure you are paying your premiums to an organization that has secured coverage through a major insurer.
Health insurance, like any other kind of insurance, is a bet against the odds. I hope the odds always remain in your favor and you never need to make a claim. But, just in case, do your homework. To steal a line from Sy Syms, an educated consumer is our best customer!