C and O Employees' Hospital Association

 

 

 

2018

Summary of Benefits and Coverage for plans below:

2018 SBC Plans One & Thirteen.doc
2018 SBC for Plans Two and Nine.doc
2018 SBC Plans Three and Eleven.doc
2018 SBC Plan Four.doc
2018 SBC for Plan Five.doc
2018 SBC for Plan Twelve.doc
sbc-uniform-glossary-of-coverage-and-medical-terms-final.pdf
_____________________________________________________________________________________________________________________

ATTENTION C AND O EMPLOYEES’ HOSPITAL ASSOCIATION MEMBERS

Please find enclosed the following documents:

"Summary of Benefits and Coverage"
"Glossary of Health Coverage and Medical Terms"
"Claims and Appeals Procedures"

"Summary of Benefits and Coverage" – the purpose of this document is to provide you with a summary of your health care coverage. If you want more detail about your coverage and costs, please refer to C and O Employees’ Hospital Association Rules & Regulations and Master Plan Document.

"Glossary of Health Coverage and Medical Terms" – this Glossary defines many commonly used terms, but it is not a full list. These Glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your Plan. The underlined text in your "Summary of Benefits and Coverage" indicates a term defined in this Glossary.

"Claims and Appeals Procedures" – this document outlines a new portion of our appeals procedures, which is your right to an external review process.

We have listed below the changes to your 2017 Rules & Regulations and Master Plan Document. Please keep this document with your 2017 Booklet.

Page 4, under Director:

Keith Kerley replaced Matt Thornton as General Chairman for the Brotherhood of Locomotive Engineers.

Page 17, under Plan Four:

Annual Deductible is $1200 effective January 1, 2018

Annual Out-of-Pocket is $1000 effective January 1, 2018

Durable Medical Equipment and Prosthetic Devices are covered at 75% of our fee schedule after the annual deductible has been met

Page 19, under Plan Twelve:

Annual Deductible is $3000 effective January 1, 2018

Annual Out-of-Pocket is $1000 effective January 1, 2018

Pages 22 & 23 under Diabetic Testing Supplies:

Liberty Medical, LLC is now Edgepark Medical Supplies (i.e. RGH Enterprises, Inc., doing business as Edgepark Medical Supplies). Their phone number is 1-800-321-0591.

Pages 23 & 24, under Durable Medical Equipment:

For Plan Four, these type of expenses are covered at 75% of our fee schedule after the annual deductible has been met

Page 27, at the top of the page:

For Plan Two, outpatient therapy is paid at 75% of our fee schedule after annual deductible has been met

Page 29, under Prosthetic Devices:

For Plan Four, these type of expenses are covered at 75% of our fee schedule after the annual deductible has been met

Page 29, under Skilled Nursing Facility Care:

After the yearly deductible has been satisfied, COEHA will cover the facility charge at the appropriate percentage for your Plan. Coverage is limited to 100 days.

Pages 39-41, Claims and Appeals Procedure:

Please refer to enclosed document titled: "Claims and Appeals Procedures", which replaces pages 39-41.

Effective March 1, 2017, we are no longer providing coverage for charges incident to CSX On-Duty-Injuries. You should let the provider know that these type of claims should be filed to the following address with a copy of the treatment notes:

Chief Medical Officer

ATTN: Johnny Delk, RN

CSX Transportation, Inc.

500 Water Street, J290

Jacksonville, FL 32202

If you have any questions, please do not hesitate to give us a call at 1-800-679-9135 or locally at 862-5728.