Article V – Health And Welfare Benefits

The benefits now provided under The Railroad Employees National Health and Welfare Plan, modified as provided below, will be continued subject to the provisions of the Railway Labor Act, as amended. Contributions to the Plan will be offset by the expeditious use of such amounts as may at any time be in Special Account A or in one or more special accounts or funds maintained by the insurer in connection with Group Policy Contract GA-23000, and by the use of funds held in trust that are not otherwise needed to pay claims, premiums or administrative expenses which are payable from trust. Detailed contract language effectuating all changes in the Plan called for by this Agreement will be worked out by the Joint Policyholder Committee with the insurer.

Section 2. Benefit Changes

The following benefit changes will be made effective on the first day of the month after the month in which this Agreement becomes effective:

  1. Life Insurance – The maximum life insurance benefit for active employees will be increased from $6,000 to $10,000.
  2. Accidental Death, Dismemberment and Loss of Sight – The maximum accidental death, dismemberment and loss of sight benefit, called the “Principal Sum” in Group Policy Contract GA-23000, will be increased from $4,000 to $8,000. Those benefits payable at one-half the Principal Sum will be increased from $2,000 to $4,000.
  3. Hospital Miscellaneous Benefits – The provision for reimbursement for hospital charges for medical care and treatment (other than room and board, nurses’, and physicians’ and surgeons’ fees), and excess intensive care charges, will be increased from “not more than $2,000 plus 80% of the excess over $2,000” to “not more than $2,500 plus 80% of the excess over $2,500.”
  4. Surgical Expense Benefit

    1. The maximum surgical benefit for all surgical procedures due to the same or related causes, and the maximum basic benefit for any one surgical procedure, will be increased from $1,000 to $1,500, and the $1,000 E Surgical Schedule will be replaced by a $1,500 E Surgical Schedule.
    2. No surgical expense benefits described in Part E of Article VII of Group Policy Contract GA-23000 will be payable for the following non-emergency surgical procedures unless opinions of two surgeons regarding medical necessity are obtained and at least one recommends the procedure. Major medical expense benefits described in Part J will remain payable regardless of a second opinion.

      1. Breast Surgery
      2. Bunion Surgery
      3. Cataract Surgery
      4. Hemorrhoid Operations
      5. Hernia Repairs
      6. Hysterectomy
      7. Gall Bladder Operations
      8. Knee Surgery
      9. Prostate Operations
      10. Rhinoplasty
      11. Tonsillectomy & Adenoidectomy
      12. Varicose Vein Operations
  5. Radiation Therapy Expense Benefits – Radiation therapy benefits will be broadened to include chemotherapy treatments. The combined maximum radiation therapy and chemotherapy benefit per person per calendar year and per accident or sickness will be increased from $400 to $600.
  6. X-Ray or Laboratory Examinations – The maximum medical expense benefit for x-ray and laboratory examinations per person per calendar year will be increased from $150 to $250.
  7. Physician’s Fee Benefit

    1. The maximum payable for physician visits during hospital confinement will be increased from $10.00 to $12.00 per day, with the maximum per confinement increased from $3,650 to $4,380.
    2. The maximum payable for physician office visits will be increased from $10.00 to $12.00 per visit, and home visits from $12.00 to $15.00 per visit, limited to one visit per day and a maximum of 180 visits in a 12-month period, with no benefit payable for the first visit for injury or first three visits for sickness.
  8. Major Medical Expense Benefits – The lifetime maximum aggregate major medical expense benefit will be increased from $250,000 to $500,000.
  9. Hospital Emergency Room – To the extent not otherwise covered, benefits will be payable for emergency room expenses exceeding $50. Any portion of the first $50 not covered will apply toward the $100 cash deductible under the major medical expense provisions.

Section 3. Eligibility

The provision under which a new employee becomes a Qualifying Employee, and may become covered and eligible for benefits, on the first day of the first calendar month starting after such employee has completed 60 continuous days during which he has maintained an employment relationship, will be changed to provide that a new employee (employed on or after the first day of the calendar month following the month in which this agreement is executed) will become a Qualifying Employee on the first day of the first calendar month starting after the day on which such employee first performs compensated service; provided, however, that no employee or dependent health benefits described in Article VII of Group Policy Contract GA-23000, other than the major medical benefits described in Part J thereof, will be payable to or on behalf of an employee until the expiration of twelve months after the month during which he first performs compensated service.

Section 4. Coverage for Dependents Health Benefits

If an employee is covered immediately prior to his death with respect to an eligible dependent’s health benefits described in Article VII of Group Policy Contract GA-23000, such coverage will continue with respect to those benefits until the end of the fourth month following the month in which the employee’s death occurred.

Section 5. Suspended and Dismissed Employees

An employee who is suspended or dismissed from service and is thereafter awarded full back pay for all time lost as a result of such suspension or dismissal will be covered under the Plan as if he or she had not been suspended or dismissed in the first place.- 13 –