Summary of Material Modifications (SMM)
Comprehensive Plan Only
The following Plan Modifications are an additional reference to your existing Summary Plan Description (SPD).
Effective January 1, 2011
Lifetime/Annual Maximums
Effective January 1, 2011, the lifetime maximum of $1,000,000 has been eliminated. Effective January 1, 2011, this benefit has been increased to an annual aggregate maximum of $750,000 for all essential benefits. All other terms of the Summary Plan Description (SPD) still apply.
Prescription Drug Benefit
Please be aware that not all of the following drug plans may pertain to you. It is important for you to refer to your enrollment documents (e.g. Summary Plan Description) for more information on your specific drug plan or you may contact the NOITU Insurance Trust Fund's Member Services Department at 718-291-3434, option 3.
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Prior to January 1, 2011
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Effective January 1, 2011
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$7.50/$20 copay plan
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$1,500/$3,000 annual maximum
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Generic Drugs: No annual maximum
Brand Drugs:
$7.50/$20 copay to $1,500/$3,000
100% copay $1,501/$3,001- $10,000/$10,000
$7.50/$20 copay after $10,000/$10,000
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$10/$30 copay plan
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$3,000/$6,000 annual maximum
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Generic Drugs: No annual maximum
Brand Drugs:
$10/$30 copay to $3,000/$6,000
100% copay $3,001/$6,001 - $10,000/$10,000
$10/$30 copay after $10,000/$10,000
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$10/$30 copay plan
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$6,000/$6,000 annual maximum
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Generic Drugs: No annual maximum
Brand Drugs:
$10/$30 copay to $6,000/$6,000
100% copay $6,001/$6,001 - $10,000/$10,000
$10/$30 copay after $10,000/$10,000
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Injectables
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Maximum of $15,000 per person, per Calendar Year.
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No copay to $20,000
100% copay $20,001 - $40,000
No copay after $40,000
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Outpatient Infusion
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Maximum of $30,000 per person, per Calendar Year
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No copay to $30,000
100% copay $30,001 - $60,000
No copay after $60,000
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Alcohol/Substance Abuse Detox
Effective January 1, 2011 the lifetime maximum of 5 days inpatient detox per person has been eliminated. This benefit has been increased to 5 days inpatient detox per person per calendar year.
Cardiac Rehabilitation
Effective January 1, 2011 Out-Patient Cardiac Rehabilitation has been increased from an annual maximum of $1,500 per person per calendar year to 30 visits per person per calendar year.
Psychotherapy, including Alcohol & Substance Abuse
Effective January 1, 2011 Out-patient Psychotherapy, including Alcohol & Substance Abuse has been increased from an annual maximum of $2,500 per person per calendar year to 30 visits per person per calendar year.
Transplants
Effective January 1, 2011 the $300,000 lifetime Transplant Benefit maximum has been eliminated. This benefit has been increased as follows: Copays, in accordance with Plan provisions, for related costs up to $300,000. 100% copay for costs between $300,000 and $600,000. Copays, in accordance with Plan provisions, for costs in excess of $600,000.
Congenital Anomalies
Effective January 1, 2011 the $300,000 lifetime Congenital Anomalies Benefit maximum has been eliminated. This benefit has been increased as follows: Copays, in accordance with Plan provisions, for related costs up to $300,000. 100% copay for costs between $300,000 and $600,000. Copays, in accordance with Plan provisions, for costs in excess of $600,000.
Motor Vehicle Accident Injury
Effective January 1, 2011 the $100,000 lifetime Motor Vehicle Accident Injury Benefit maximum has been eliminated. This benefit has been increased as follows: Copays, in accordance with Plan provisions, for related costs up to $100,000. 100% copay for costs between $100,000 and $200,000. Copays, in accordance with Plan provisions, for costs in excess of $200,000.
Please always remember to refer to your Summary Plan Description to determine what Health Benefits to which you are entitled. Details of the above, improved benefits will be included in the next issue of the Summary Plan Description.
SI USTED NO HABLA INGLES, Si tiene dificultad de entender cualquier parte de este documento, llame a la oficina de 9:00a.m. a 5:00p.m., de lunes a viernes, (718) 291-3434, seleccione el numero #3, para ayudarle.
