INDEX
EMPLOYEE
Benefits Summary
DEPENDENTS
Medical
EMPLOYEE and DEPENDENT
Dental
Vision
BENEFIT CONTACTS & PLAN OVERVIEW
Commencement of Coverage
Accident and Life Insurance
Dental
Medical
National Early Retirement Major Medical Benefit Plan
Group Health Insurance Plan
MENTAL HEALTH AND SUBSTANCE ABUSE
PRESCRIPTION DRUGS
Dependents
VISION SERVICE PLAN
TERMINATION OF COVERAGE
COBRA
Medical Benefits provided by the Hospital Association, properly known as “Union Pacific Employee Health Systems” (UPREHS). However, the dental and vision benefits are not provided by UPREHS, nor are your dependents covered under this plan (exception: an enrolled Medicare spouse). Dues are currently $100 per month and are deducted from the first half payroll each month (i.e., the check you receive on or about the 30th of the month). The latest regulations were amended on October 1, 2002. The most updated list of providers is available on the Internet or by calling directly to the Salt Lake City office. A pharmacy drug formulary was issued in January 2001. Members have a co-pay of $15 for each office visit and plus co-pay for pharmacy in multiples of $5 per 30 day’s prescription (i.e., $5 generic, $10 name brand). If an out-of-network healthcare provider is used, even on a referral basis, UPREHS will only pay 80% of the reasonable and customary charge after the co-pay; benefits are greatly reduced if members to seek healthcare outside the network (see chart on next two pages).
The address is 795 North 400 West, Salt Lake City UT 84103-1452.
The toll-free number is 800-547-0421
The fax number is 801-595-4399
The Internet address is http://www.uphealth.com/
The pharmacy address is PO Box 3228, Ogden, UT 84409
The pharmacy number is 800-331-6353
The pre-approval number is 800-572-5508.
This number must be called at least 3 days prior to any and all inpatient hospital admissions and certain outpatient procedures or benefits are reduced by 40 percent. Emergency services performed without pre-approval must be reported within 24 hours to avoid the 40 percent reduction.
UPREHS also offers an optional plan of secondary insurance, referred to as CHC Supplemental, for an additional $60 per month (deducted from same check as your normal dues). This plan provides coverage for your dependents over and above what the National Health & Welfare Plan provides, i.e., the remaining 15 percent plus the deductible. It does not provide coverage for anything that has been denied by the primary insurance carrier.
BENEFITS SUMMARY FOR CHALLENGER HEALTH PLAN
(IN AND OUT-OF-NETWORK SERVICES)
FOR DETAILS REFER TO YOUR PLAN DOCUMENT
EFFECTIVE July 1, 2002
IMPORTANT: All services must be medically necessary and be covered benefits. Payments for out-of-network services are a percentage of the Plan Allowable Amount, NOT the billed charges.
| BENEFIT | IN NETWORK | OUT-OF-NETWORK |
|---|---|---|
|
Physician Visit – $15 Co-Pay Annual Routine Physical Exam |
100% 100%1 |
Annual Deductible Not A Benefit |
|
Emergency Ambulance Emergency Services After $50 Co-Pay2 3 |
100% 100% |
100% 100% |
| Formulary Prescription Drugs |
No Limit4
Use of Mail-Order Pharmacy Required for Maintenance Medication |
40% After 24 Hours
Emergency Only – Co-Pay Required |
|
Inpatient Hospital5 – Maximum Days Outpatient Hospital Ambulatory Surgery Center |
100% Unlimited 100% 100% |
40% Unlimited 40% 40% |
|
Chiropractic Services – Annual Limit |
80% $600 |
80% $600 |
|
Physical Therapy (56 Modalities) – 56+ Modalities6 |
100% | 40% |
|
Annual Routine Eye Exam – $15 Co-Pay – Prescription Eyewear |
National Vision Plan (NVP) NVP |
National Vision Plan (NVP) NVP |
| Preventive Healthcare | Limited | Limited |
|
Organ Transplants6 – Lifetime Maximum |
100% $100,000 |
40% $100,000 |
| Artificial & Surgical Appliances | 100% | 40% |
|
Skilled Nursing Facility6 – Maximum Days |
100% Unlimited |
40% Unlimited |
| Nursing Home Care (Domicile)6 | Not A Benefit | Not A Benefit |
| Home Health Care6 | 100% | 40% |
|
Mental Health Services8 Inpatient Outpatient Annual Deductible Annual Maximum |
80% 80% $100 45 Treatments |
Not A Benefit Not A Benefit Not A Benefit Not A Benefit |
|
Alcohol / Drug Rehabilitation7 Inpatient Outpatient Annual Deductible Annual Maximum Lifetime Maximum Maximum per Outpatient Visit |
80% $100 $100 30 Days Yes $50 |
Not A Benefit Not A Benefit Not A Benefit Not A Benefit Not A Benefit Not A Benefit |
|
Dialysis Outpatient Care First 30 Months (33 in some cases) 31+ Months (Secondary to Medicare) |
100% 100% Medicare Supplemental |
40% 40% Medicare Supplemental |
Medical Benefits
Coverage for dependents of UTU Members is provided by the “National Railway Carriers and United Transportation Union (NRC/UTU) Health and Welfare Plan.” For dependents of those employees eligible for coverage under it, the “NRC/UTU Plan” replaces coverage provided under the traditional “Railroad Employees National Health and Welfare Plan” (Original Plan).
The NRC/UTU Plan gives eligible members their choice of two different healthcare plan administrators to provide their benefits. The plan administrator for coverage under the original plan is only United HealthCare (which was originally The Travelers, then MetraHealth). The NRC/UTU Plan offers, in addition to that provided by United HealthCare, coverage provided by Highmark Blue Cross Blue Shield of Pittsburg, PA effective January 1, 2005, replacing the Regence BCBS plan that has been in effect for several years.
Healthcare plans available under the NRC/UTU Plan include a Comprehensive Health Care Benefit (CHCB); a Mental Health and Substance Abuse Care Benefit (MHSA); a Managed Pharmacy Services Benefit (MPSB); and a Managed Medical Care Program (MMCP), i.e., HMO. A new benefit, Basic Healthcare Benefit (BHCB), is also offered for those whose healthcare needs are minimal. These Benefits are not insured; they are payable directly by the NRC/UTU Plan.
Both United HealthCare and Highmark provide coverage under the CHCB and/or MMCP. Employees living in Colorado can choose to be covered by a MMCP if they desire; otherwise they (and the majority of Local 446 members living in Wyoming and Nebraska) are covered by a CHCB. In either case, the eligible employee may choose whether United HealthCare or Highmark Blue Cross Blue Shield shall be the plan administrator. When the NRC/UTU Plan was negotiated, the benefits offered by both United HealthCare and Regence (now Highmark) were made equal; neither plan administrator can offer greater benefits in an effort to entice business away from the other. The main competition between these plan administrators is found in the service that they provide (e.g., speed of resolving claims, or hassle-free claim handling), and the competitive rate paid by the nation’s rail carriers in order to provide the contractual coverage, which is a major factor in negotiating our national contract.
Your benefits under the Mental Health and Substance Abuse Care Benefit (MHSA) are administered by ValueOptions, Inc. Formerly some of you were covered by Magellan, but they are no longer part of the team.
The Managed Pharmacy Services Benefit (MPSB) is administered by Merck-Medco Rx Services, regardless of whether United HealthCare or Blue Cross is chosen.
You should have a booklet explaining the NRC/UTU Plan; it has a light blue cover and was made effective January 1, 2000. There is an open enrollment period each October to afford employees the opportunity to change plan administrators for the coming year. The opportunity to change between MMCP and CHCB is also given during the enrollment period. Toll-free telephone numbers are provided in the summaries below.
Dental
Employee and dependents Dental Benefits are provided under the Railroad Employees’ National Dental Plan administered by Aetna Insurance Company. Eligibility is based upon completing one (1) year of service with the same railroad and commences on the first day of the calendar month following that requirement. Employee must also meet the previous-month-seven-day requirement.
Vision
Employee and dependents Vision Benefits are provided under the Vision Service Plan. Eligibility is based upon completing one (1) year of service with the same railroad and commences on the first day of the calendar month following that requirement. Employee must also meet the previous-month-seven-day requirement.
Commencement of Coverage
IMPORTANT NOTE: Commencement of coverage was changed by the following language in the 2003 National Agreement:
“Plan coverage for an “Eligible Employee” and his/her “Eligible Dependents” will commence on the first day of the fourth calendar month after such employee first renders the “Requisite Amount of Compensated Service.”
Coverage for employee and dependent health benefits commences on the first day of the month following the month in which the employee renders compensated service, or receives vacation pay, for an aggregate of at least seven (7) calendar days. This is deemed the “qualifying month” and coverage continues in each succeeding month so long as the seven (7) day service requirement is met in the preceding month. Days spent protecting assignments, but not used through no fault of the employee, count toward meeting the seven (7) day requirement. This requirement applies to all Plans, and is known as the “Requisite Amount of Compensated Service” and “Requisite Amount of Vacation Pay.” The specific language of Side Letter #9 of the 1996 Agreement (a.k.a. Arbitration Board No. 559) reads, “…it was not the intent of the parties to affect employees by this change (to the seven-day requirement) where such employees have made themselves available for work and would have satisfied the seven-day rule but for an Act of God, an assignment of work which did not permit satisfaction of the seven-day rule, or because monthly mileage limitations and/or maximum monthly trip provisions prevented an employee from satisfying that rule. Also, where employees return to work from furlough, suspension, dismissal, or disability (including pregnancy), or commence work as new hires, at a time during the month when there is not opportunity to render compensated service on at least seven calendar days during that month, such employees will be deemed to have satisfied the seven-day rule, provided that they are available or actually work every available work opportunity.” All references to meeting requirements contained in this publication refer to this “Requisite Amount” even though such might not be specifically mentioned.
Metropolitan Life Insurance Company – Railroad Employees National Health and Welfare Plan (Original Plan)
(GP-1023000-G) Life Insurance and Accidental Death and Dismemberment (AD&D) Benefit
Dues: None.
Plan Overview: This is a paid-up life insurance plan provided by the National Plan. Group Life in the amount of $10,000, reduces to $2,000 paid-up life at retirement. $8,000 is maximum benefit for accidental death and dismemberment. NOT TO BE CONFUSED WITH METLIFE OPTIONAL COVERAGES PLAN DESCRIBED BELOW.
Crafts Covered: All crafts including Hospital Association members. (Dependents are not covered).
Telephone Contact & Claim Address:
Metropolitan Life Insurance Company 800-310-7770
MetSource Life Recordkeeping Center, P.O. Box 6122, Utica, NY 13504-6122
Metropolitan Life Insurance Company – OPTIONAL Contributory Group Life & AD&D Insurance (Formerly Equitable)
Dues: Premiums vary with age of employee and the amount of insurance purchased.
Plan Overview: Employees can purchase either Optional Group Term Life Insurance and/or Voluntary Accidental Death & Dismemberment Insurance for themselves and dependents.
Crafts Covered: All crafts. (Employees must sign up within first year of employment).
Telephone Contact & Claim Address:
Metropolitan Life Insurance Company 800-357-4482
MetSource Life Recordkeeping Center, P.O. Box 6129, Utica, NY 13504-6129
The Aetna Life Insurance Company / Aetna U.S. Healthcare – Railroad Employees National Dental Plan
(GP-12000) Plan Booklet amended through January 1, 1999.
Dues: None – But must meet “Requisite Amount” of service.
Plan Overview: Provides benefits to cover dental expenses incurred by a covered employee and eligible dependents.
Crafts Covered: All crafts
Telephone Contact: 877-277-3368 (877-2RR-DENT) or 616-942-6400
Internet Address: www.aetna.com
Union Pacific Employee Health Systems (UPREHS) – Challenger Health Plan
Plan Booklet amended through October 2000.
Dues: $100 per month, deducted from first pay period in month (the check you receive on the 30th).
Plan Overview: Provides medical, surgical, hospital, prescription drugs, mental health and substance abuse for the employee.
Provides optional CHC Supplemental Family Plan for dependents to pick up the deductible and the remaining 15% that is not paid by the healthcare plan for dependents (Note: will not pay on what is not covered by such dependents’ plan). Cost: $60 per month additional.
Crafts Covered: All crafts.
Telephone Contact: 800-547-0421 Fax: 801-595-4399
Mental Health / Substance Abuse 888-484-3568
The pre-approval number is 800-572-5508. This number must be called at least 3 days prior to any and all inpatient hospital admissions and certain outpatient procedures or benefits are reduced by 40 percent. Emergency services performed without pre-approval must be reported within 24 hours to avoid the 40 percent reduction.
The address is 795 North 400 West, Salt Lake City, UT 84103-1452.
The Internet address is http://www.uphealth.com/
National Railway Carriers and United Transportation Union Health and Welfare Plan – (NRC/UTU Plan)
Group # 690100 for dependents of employees; one has choice of administrators (two separate packages) from year to year via open enrollment each October. Plan Booklet amended through January 1, 2000.
Dues: None – But must meet “Requisite Amount” of service.
Plan Overview: Provides medical, surgical, hospital (under CHCB, BHCB or MMCP where available), prescription drugs (MPSB), mental health and substance abuse for the dependents (MHSA).
Crafts Covered: All Crafts.
Telephone Contact & Claim Addresses for the Choices of Healthcare Package Options Available:
1) United HealthCare: CHCB, MMCP or BHCB plans, 800-691-0013 or 888-445-4379
Send claims to P. O. Box 30985, Salt Lake City, UT 84130-0985
For mandatory prior approval for certain tests and procedures 800-842-4555
To Report Suspicious Billing and Fraud 800-414-2013
Internet Address: http://www.myuhc.com/
ValueOptions: MHSA (800-934-7245)
Merck-Medco: MPSB (800-842-0070)
OR
2) Highmark BlueCross BlueShield: CHCB, MMCP or BHCB
Railroad Dedicated Service Unit, P.O. Box 890381, Camp Hill, PA 17089-0381
Telephone 866-267-3320
For mandatory prior approval for certain tests and procedures 800-452-8507
Internet Address: http.//www.highmark.com
3) ValueOptions: MHSA 800-934-7245
4) Merck-Medco: MPSB 800-842-0070
Note: CHCB = Comprehensive Health Care Benefit
MMCP = Managed Medical Care Program (not available in Wyoming)
BHCB = Basic Healthcare Benefit
MHSA = Mental Health & Substance Abuse Care Benefit
MPSB = Managed Pharmacy Service Benefit
Railroad Employees National Early Retirement Major Medical Benefit Plan
Group GA-46000: United HealthCare.
Dues: None for basic GA-46000; if Plan E supplemental coverage is attached, dues are currently $130 per month per person.
Plan Overview: Provides major medical benefits and a managed pharmacy benefit to dependents of eligible retired and disabled railroad employees; however will cover these employees only if not covered by UPREHS. Eligibility for Medicare ceases coverage under this plan.
Crafts Covered: All crafts
Telephone Contact & Claim Address:
GA-46000 (incl Plan E): 800-842-5252 or 800-842-9905
P. O. Box 30985, Salt Lake City, UT 84130-0985
For mandatory prior approval for certain tests and procedures: 800-842-4555 To Report Suspicious Billing and Fraud 800-414-2013
Internet Address: http://www.myuhc.com/
Group Health Insurance Plan
Group GA-23111: United HealthCare
Dues: Plan C – $370 (employee or dependents) / $50 (student child) / $175 (incapacitated child);
Plan D – $325 Medicare Supplement;
Plan F – $140, Medicare Supplement;
all per month per person. The various plans provide different levels of coverage as options.
Plan Overview: Provides major medical benefits for furloughed, dismissed and retired railroad employees and their dependents when coverage under GA-23000, GA-46000 or GA-690100 ends. Plan D is available as a supplement to Medicare.
Crafts Covered: All crafts
Telephone Contact & Claim Address:
Plan C: 800-842-5252 or 800-842-9905
P. O. Box 30985, Salt Lake City, UT 84130-0985
Plan D or F: 800-809-0453
P. O. Box 30304, Salt Lake City, UT 84130-0304
For mandatory prior approval for certain tests and procedures: 800-842-4555
To Report Suspicious Billing and Fraud 800-414-2013
Internet Address: http://www.myuhc.com/
MHSA Benefit included in both NRC/UTU Plan and Original Plan
Dues: None – But must meet “Requisite Amount” of service.
Plan Overview: Provides mental health and substance abuse (MHSA) managed care benefits for all dependents and employees not covered by a hospital Association.
Crafts Covered: All
Telephone Contact & Claim Address:
ValueOptions (if United HealthCare or Highmark is administrator) 800-934-7245
Railroad Unit, Attn: Claims, P. O. Box 1002, Merrifield, VA 22116
EMPLOYEE: UPREHS Pharmacy Drug Formulary amended to September, 2003.
Dues: Included with basic UPREHS dues.
Plan Overview: Covers prescription drugs that are medically necessary for employee members. Emergency and one-time-only prescriptions may be obtained from a contract network pharmacy. Medications intended to be taken longer than 30 days must be ordered through UPREHS Mail-Order Pharmacy.
Co-Pay: $5 per 30-day supply (generic) or $10 per 30-day supply (name brand) through Mail-Order Pharmacy; $6 (generic) or $8 (brand name) per 30-day supply through contract network pharmacies. Tier 3 Non-Formulary drugs are $40 per 30-day supply through Mail-Order Pharmacy.
Telephone Contact: 800-331-6353 or 800-547-0421
The pharmacy address is PO Box 3228, Ogden, UT 84409
The Internet address is http://www.uphealth.com/
DEPENDENT: Merck-Medco Prescription Drug Card Program
Group #690100 – (NRC/UTU):
Group # GA46000:
Dues: None – But must meet “Requisite Amount” of service.
Plan Overview: Covers prescription drugs that are medically necessary for dependents. Use of an In-Network Pharmacy is easiest, as you will pay only the co-pay ($2 generic or $6 for brand-name). Use of an Out-of-Network Pharmacy will result in your being reimbursed for 75% of the cost for only the first 21 days, none thereafter; you must make a claim. There is a mail-order program available.
Crafts: All
Telephone Contact & claim Address:
Above named Plans: 800-842-0070 www.merckmedco.com
Plan D GA-23111 800-842-0304
PAID Prescriptions, LLC, P.O. Box 702, Parsippany, NJ 07054
Railroad Employees National Vision Plan
Administered by Mid-Atlantic Vision Service Plan, Inc. Plan booklet amended to January 1, 1999.
Dues: None – But must meet “Requisite Amount” of service.
Plan Overview: Provides benefits for employees and dependents for eye examinations and benefits toward vision care expenses including glasses or contact lenses. Eligibility established after one year of service.
Telephone Contact & Claim Address (not necessary if using VSP Doctor):
Vision Service Plan 888-877-4782
Attn: Non-VSP Provider Claims, P.O. Box 997100, Sacramento, CA 95899-7100
(OTHER THAN CONTINUATION UNDER COBRA
OR FAMILY AND MEDICAL LEAVE ACT)
| The Date Coverage Terminates (See Note 1) | |
|---|---|
| Reason for Ceasing to Render Compensated Service | Coverage for Employee and Dependents – Healthcare Benefits |
| Furlough |
End of third month (UPREHS for employee) or fourth month (NRC/UTU Plan for dependents) following the month in which you last rendered compensated service or received Vacation Pay (See Notes 2 & 5) |
| Suspension or Dismissal |
End of fourth month following the month in which you last rendered compensated service or received Vacation Pay (See Notes 2 & 5) |
| Leave of Absence |
End of month following the month in which you last rendered the Requisite Amount of Compensated Service or received Vacation Pay |
| Employment Relationship Terminates other than for Retirement or by Dismissal |
Date of termination of employment relationship (See Note 3) |
| Employment Relationship Terminates for Retirement |
End of month following the month in which you last rendered compensated service or received Vacation Pay (See Note 4) |
| Disability – Inability to Perform Work in your Regular Occupation |
Date your disability ends, but in any event when you have failed to render compensated service or receive vacation pay in a calendar year (2 calendar years for Employee Health Care Benefits) |
| Pregnancy |
End of fifth month following the month in which you last rendered compensated service |
Notes:
1. For complete information concerning termination of coverage, including modifications of the provisions outlined above, see the section of NRC/UTU booklet entitled “Eligibility and Coverage” beginning on page 10 (page 8 in the National Vision Plan booklet). Under certain circumstances and provided the Plan is continued, benefits may be payable after coverage terminates. Information in this regard is also contained in the Eligibility for Benefits section on pages 25 through 29.
2. For a Furloughed Employee, Vacation Pay must be received prior to furlough. However a Furloughed Employee must have rendered compensated service or received Vacation Pay during a total of three months prior to the date of furlough or he will be covered only until the end of the month following the month in which he last rendered compensated service. For a Dismissed Employee, Vacation Pay must be received prior to severance of the employment relationship. An Eligible Employee who becomes disabled while covered under 690100 or GA-23000 as a furloughed, suspended or dismissed employee will be covered as described in the above chart in the section entitled “Disability.”
3. In the event an Eligible Employee dies while covered, coverage for Dependents Health Care Benefits continues to the end of the fourth month following the month in which the Eligible Employee died.
4. For a Retired Employee, Vacation Pay must be received prior to the relinquishment of employment rights for retirement.
5. For a Furloughed Employee, healthcare through UPREHS is only for three months, not four; for him to continue coverage, said Furloughed Employee must pay his own premium ($100/month), due by the 5th day of the month.
6. For any reason listed above, or any other reason, where the paycheck stops (i.e., no payroll deduction), employees having the CHC Supplemental Coverage with UPREHS must arrange to make payments directly to continue coverage.
UPREHS (COBRA) or United HealthCare (COBRA)
Dues: Yes (premiums)
Plan Overview: All employees and their dependents not entitled to Medicare whose medical coverage ends as a result of a termination of employment, reduction in hours, dissolved marriage, failure to meet dependent eligibility status, etc., may continue health coverage at their own expense.
Telephone contacts:
UPREHS 800-877-0618
United HealthCare 800-842-5252
Trustmark – Supplemental Sickness: 800-669-5066
Provident – Supplemental Sickness: 800-542-4231
COBRA refers to a Federal Law, known as the Consolidated Omnibus Budget Reconciliation Act of 1985, which requires that coverage be provided to those no longer eligible, if they desire, at their own expense; written to avoid non-insurability that some persons encounter.
This pamphlet is issued for the purpose of general information. Certain limitations, exceptions, and special cases are not covered.
The Railroad Unemployment Insurance Act provides two kinds of benefits for railroad employees: unemployment benefits, when you are not working but are ready, willing and able to work; and sickness benefits, when you are unable to work because of illness or injury. Sickness benefits are also payable to female employees unable to work because of pregnancy, miscarriage, or childbirth.
Benefit payments are based on biweekly claims filed with the Railroad Retirement Board, the Federal agency responsible for administering the Railroad Unemployment Insurance Act.
The funds to pay unemployment and sickness benefits are provided by payroll taxes on railroad employers only. Employees do not pay unemployment insurance taxes.
The following describes the requirements for railroad unemployment and sickness benefits, the amounts payable, and how to claim them.
A new benefit year for unemployment and sickness benefits begins every July 1. To qualify in the benefit year beginning July 1, 2004, you must have base year earnings of $2,800 in calendar year 2003, not counting earnings of more than $1,120 per month. To qualify in the benefit year beginning July 1, 2005, you must have base year earnings of $2,825 in calendar year 2004, not counting earnings of more than $1,130 per month. If the base year was your first year of railroad service, you must also have worked in five months of that year.
If you do not meet these requirements but have at least 10 years of service, you might still be able to qualify under the conditions for extended and accelerated benefits.
The maximum daily benefit payable in benefit year 2004-05 is $56 and, for biweekly claims, maximum benefits can total $560. While the daily benefit rate will remain at $56 in July 2005, it may increase at the beginning of each future benefit year depending on the growth in average national wages.
While a benefit year waiting period cannot count toward a strike waiting period, the 14-day strike waiting period may count as the benefit year waiting period if you subsequently become unemployed for reasons other than a strike later in the benefit year.
To be eligible for unemployment benefits, you must be ready, willing and able to work and be available for work. A “day of unemployment” is a day on which you meet these conditions and do not receive any pay, are not disqualified, and have properly registered for unemployment benefits. If you are in train and engine service, any calendar day on which you do not work solely because of a mileage limitation or work-restriction agreement or solely because you are between regularly assigned trips or tours of duty, or because you missed a turn in pool service, is not considered a day of unemployment.
To be eligible for sickness benefits, you must be unable to work because of illness or injury. A “day of sickness” is a day on which you meet this condition and for which you do not receive any pay and have filed a “statement of sickness” signed by your doctor or other authorized individual. This statement provides evidence of your medical condition and its expected duration.
You may not receive benefits for any day for which you receive pay. This includes railroad and non-railroad wages, salary, pay for time lost, pay while sick, dismissal allowances, most wage guaranty payments, vacation pay, holiday pay, military reservist pay, earnings from self-employment, or remuneration other than subsidiary remuneration.
However, payments received under an approved nongovernmental supplemental unemployment or sickness insurance plan, your own health or accident insurance policy or a group insurance policy will not affect entitlement to unemployment or sickness benefits and should not be reported on your claims.
Also, an earnings test is applied to unemployment claims. If a claimant’s earnings for days worked, and/or days of vacation or paid leave, in a 14-day registration period are more than a certain indexed amount, no benefits are payable for any days of unemployment in that period. Earnings include pay from self-employment and railroad, non-railroad, and part-time work. Earnings also include pay that you would have earned except for your failure to mark up or report for duty on time, or because you missed a turn in pool service or were otherwise not ready or willing to work.
For the benefit year beginning July 2004, the earnings test is $1,120; and for the benefit year that begins July 2005 the test will be $1,130. These amounts correspond to the base year monthly compensation amounts used in determining eligibility for benefits in each year. But, even if an earnings test applies on the first claim in a benefit year, this will not prevent the first claim from satisfying the waiting period in that benefit year.
On the other hand, earnings of not more than $15 a day from work which is substantially less than full-time and not inconsistent with the holding of normal full-time employment may be considered subsidiary remuneration and may not prevent payment of any days in a claim. However, be sure to report all full and part-time work on your claims, regardless of the amount of your earnings, so the Board can determine whether it affects your benefits.
Unemployment —In order to receive unemployment benefits, you must file an application for benefits by mail or through the Board’s Web site (www.rrb.gov). If you choose to file by mail, you must obtain an application from your employer, labor organization, local Railroad Retirement Board office or the Board’s Web site. The completed application should be mailed to the local Board office as soon as possible and, in any case, must be filed within 30 days of the date on which you became unemployed or the first day for which you wish to claim benefits. Benefits may be lost if the application is filed late.
In order to file for unemployment benefits through the Board’s Web site, or to conduct other business over the Internet, you must first establish an RRB Internet Services account. Employees are encouraged to establish online accounts while still employed so the account is ready if they ever need to apply for these benefits or use other Internet services. Once you establish an online account, you do not need to do so again. Directions for establishing an online account are available by clicking the link “Main Line Services” on the Board’s Web site at www.rrb.gov.
In either case, the local Board office reviews the completed unemployment application and notifies your base-year railroad employer, and your current employer if different. Your employer has the right to provide information about your benefit application. Biweekly claim forms are then mailed to you as long as you remain unemployed and eligible for benefits.
The Board must notify your base-year employer each time you file a claim for unemployment benefits and give that employer an opportunity to submit information relevant to the claim before the Board makes an initial determination on it. Any current employer is also notified. The Board also notifies your base-year employer each time benefits are paid to you. While the base-year employer may protest the decision to pay benefits, such a protest does not prevent the timely payment of benefits. However, you may be required to repay benefits if the protest is successful.
You should contact a Board office if you do not receive a claim or notice of ineligibility within 15 days of submitting an application or claim.
Claim forms should be signed and mailed only on or after the last day of the claim. The completed claim must be received by a Board office within 15 days of the end of the claim or the date the claim was mailed to you, whichever is later. While you can file applications online, employees cannot yet file their biweekly claims over the Internet, but the Board is planning to add this service in the future.
Only one application need be filed during a benefit year even if you become unemployed more than once. In that case, you must request a new claim form from a Board office within 30 days of the first day for which you want to claim benefits.
Sickness —An application for sickness benefits can be obtained from railroad employers, railroad labor organizations, any Board office or printed off the Board’s Web site (www.rrb.gov). An application and a doctor’s statement of sickness are required at the beginning of each “period of continuing sickness” for which benefits are claimed. The Board suggests that you keep an application form on hand for use in claiming sickness benefits, and that your family knows where the form is kept and how to use it.
Attached to each application is a statement of sickness which must be completed by your doctor. If you become unable to work because of sickness or injury, complete your application and take or send it to your doctor for completion of the statement of sickness.
If you are too sick to complete the application, someone else may do it for you. In such cases, a member of your family should also complete the “Statement of Authority to Act for Employee,” which accompanies the statement of sickness.
After completion, the forms should be mailed to the Board’s headquarters in Chicago by the seventh day of illness or injury for which benefits are claimed. (Employees cannot file for sickness benefits through the Board’s Web site.) After the Board receives your application and statement of sickness and determines eligibility, biweekly claim forms are mailed to you for completion and return to a Board field office for processing.
The claim forms must be received at the Board within 30 days of the last day of the claim period, or within 30 days of the date the claim form was mailed to you, whichever is later. Benefits may be lost if an application or claim is filed late. If an unemployment or sickness application or claim is filed late, you should include a signed statement explaining the reason for the late filing.
As with claims for unemployment benefits, the Board must notify your base-year employer each time a claim for sickness benefits is filed. That employer has the right to submit information relevant to the claim before the Board makes its initial determination. If your current employer is not your base-year employer, your current employer is also notified. In addition, the base-year employer is notified each time benefits are paid to you. While the base-year employer may appeal the decision to pay benefits, the appeal does not prevent the timely payment of benefits. However, you may be required to repay benefits if the appeal is successful.
Payments —If you file an application for benefits you may expect to receive a claim form, or a decision on your application, within 15 days of the date you filed your application. When you file your biweekly claims, you may expect to receive a payment, or a decision on your claim, within 15 days of the date a Board office receives your claim form.
However, some claims for benefits may take longer to handle than others if they are more complex, or if a Board office has to get information from other people or organizations. If this happens, you may expect an explanation and an estimate of the time required to make a decision.
The normal method of payment for railroad unemployment and sickness benefits is by Direct Deposit. With Direct Deposit, payments are issued directly to a claimant’s bank, savings and loan, credit union or other financial institution. Applicants for unemployment and sickness benefits are asked to provide information needed for Direct Deposit enrollment.
The Railroad Unemployment Insurance Act authorizes the Board to operate a free placement service. The primary purpose of the placement service is to secure new employment for experienced railroad workers who have lost their jobs.
When you apply for unemployment benefits you also apply for employment service. You will probably be interviewed by a Board representative who will try to help you secure employment if you do not have good prospects of returning to your former job. You may be referred by the representative to a suitable railroad job; otherwise, an effort will be made to place you in a non-railroad job for which you appear qualified. As part of its placement service, the Board maintains a list of job openings reported by railroads to its field offices. The list is available for review at all offices of the Board and on the Board’s Web site (www.rrb.gov).
If you have been paid a separation allowance by your employer, you cannot receive unemployment or sickness benefits for roughly the period of time it would have taken to earn the amount of the allowance.
If you leave either your railroad or non-railroad job voluntarily without good cause, you will be disqualified for railroad unemployment benefits until you have returned to railroad work and earned wages sufficient to qualify for benefits again.
If you leave work voluntarily with good cause, you will be disqualified for unemployment benefits for periods in which you could receive unemployment benefits under another law. If you are not qualified for other unemployment benefits, you may receive railroad unemployment benefits.
If you refuse to accept suitable work, or fail to follow instructions to apply for work or to report to a State unemployment office or a Board office for an interview, you may be disqualified for unemployment benefits for 30 days.
You will be disqualified for unemployment benefits for any day on which you take part in a strike which began in violation of the Railway Labor Act or in violation of the established rules and practices of your labor organization.
You may be disqualified for sickness benefits if you fail to take a medical examination when required by the Board.
You will be disqualified for both unemployment and sickness benefits for 75 days if you make a false or fraudulent statement or claim to obtain benefits. You may also be subject to fine or imprisonment. The Railroad Retirement Board conducts checks with Federal agencies, all 50 States (as well as the District of Columbia and Puerto Rico), and railroads to detect fraudulent benefit claims. The Board also checks with physicians to verify the accuracy of medical statements supporting sickness benefit claims.
If you receive a regular retirement or survivor benefit under the Railroad Retirement Act, Social Security Act, or any other social insurance law for days for which you are also entitled to benefits under the Railroad Unemployment Insurance Act, your unemployment or sickness benefits are payable only to the extent to which they exceed the other payments for those days. Examples of other such social insurance payments are military pensions, firefighters’ and police pensions, or certain workers’ compensation payments. Claimants should report all such other payments promptly to avoid having to refund benefits later.
There is no reduction in unemployment or sickness benefits for benefits paid under a Board-approved nongovernmental sickness insurance plan, such as a supplemental sickness benefit plan established by a railroad. Similarly, there is no reduction in benefits if you receive supplemental unemployment benefits under a Board-approved nongovernmental unemployment benefit plan. But unemployment and sickness benefits provided under the Railroad Unemployment Insurance Act are not payable to you if you also receive Federal/State unemployment or sickness benefits under other laws, including Canadian law, for the same period of time.
If you receive sickness benefits for an injury or illness for which you are paid damages, the Board is entitled to reimbursement of either the amount of the benefits paid for the injury or illness, or the net amount of the settlement (after deducting your gross medical, hospital, and legal expenses), whichever is less.
Unemployment benefits can sometimes be paid even though you are covered by a job protection plan which guarantees you a certain amount of work or wages each month. However, if you receive a protective allowance from your employer for a period for which benefits were paid, some or all of the benefits will have to be refunded. Report such allowances promptly to the Board.
Employers.–Employers may protest the payment of a claimant’s benefits, but such protests do not prevent the timely payment of benefits. However, employees may be required to repay benefits if their employers’ protests are ultimately successful.
Employees.–If you disagree with a decision made on your claim, you have 60 days from the date of the initial notice of the decision in which to file a written statement requesting reconsideration from the Board office that made the decision. This step is mandatory before a decision may be appealed to the Board’s Bureau of Hearings and Appeals. Failure to request reconsideration within 60 days will result in forfeiture of further appeal rights.
If the case involves a benefit overpayment of more than 10 times the maximum daily benefit rate, you may request a waiver of repayment. A request for waiver filed within 60 days will, in certain cases, defer recovery of the overpayment from subsequent benefit payments. If you request waiver, you may be asked to complete a financial statement on a form provided by the Board. If dissatisfied with the reconsideration or waiver decision of a Board office, you may, within 60 days, appeal to the Board’s Bureau of Hearings and Appeals.
If not satisfied with the Bureau of Hearings and Appeals’ decision, you may further appeal, within 60 days, to the three-member Board.
If not satisfied with the three-member Board’s decision, you may file a petition for a review of your claim by a U.S. Court of Appeals. A petition for review must be filed within 90 days of the notice of the Board’s decision.
Unemployment benefits paid by the Board are subject to Federal income tax, just like unemployment benefits paid under State government programs.
Sickness benefits paid by the Board, except for sickness benefits resulting from on-the-job injuries, are subject to Federal income tax under the same limitations and conditions that apply to the taxation of sick pay received by workers in other industries.
The Railroad Unemployment Insurance Act specifically provides that railroad unemployment and sickness benefits are not subject to State income taxes. In January of each year, the Board sends railroad employees Form 1099-G showing the total amount of unemployment benefits paid during the previous year and/or a Form W-2 showing the net amount of sickness benefits paid.
Claimants may also obtain information on railroad unemployment and sickness benefits by using the automated toll-free RRB Help Line, which is available 24 hours a day, 7 days a week, at 1-800-808-0772. The Board’s Web site at www.rrb.gov is another source of information on railroad unemployment and sickness benefits, and includes access to publications that may be downloaded and a new Internet service to file applications for unemployment benefits online.
Or, if you prefer, you can also contact the nearest office of the Railroad Retirement Board for information about railroad unemployment and sickness benefits. To locate the nearest Board office, you may call the RRB Help Line at
1-800-808-0772 or access the Board’s Web site at www.rrb.gov. You may also look in the telephone directory under “United States Government,” or check with your union representative, a rail employer, a local post office, or the nearest Federal Information Center. Most Board offices are open to the public from 9:00 a.m. to 3:30 p.m., Monday through Friday, except on Federal holidays.
If you have any comments or suggestions regarding the presentation of information in this publication, please let us know. You can fax us at 1-312-751-7154, e-mail us at opa@rrb.gov or write us at the following address:
Office of Public Affairs
U.S. Railroad Retirement Board
844 North Rush Street
Chicago, IL 60611-2092
