Plan #3100


Supplemental to Managed Care Medical Program (MMCP)

Aetna US Healthcare, Highmark Blue Cross/Blue Shield, United Healthcare GA23000 and United Healthcare 0690100

Claims must be submitted as soon as possible and received by CARE

NO LATER than one (1) year from the date your Primary and/or Secondary Carrier processed the claim.

Incomplete information or an incorrect mailing address WILL result in the delay of payment.

Actively working Railway eligible employees and dependents whose primary plan is through one of the above plans or other Railroad-sponsored plans that are eligible to enroll in this supplemental plan.

As information, this plan is for supplemental coverage only. The participant(s) should follow the guidelines of the primary health carrier regarding eligibility, benefits, limitations, exclusions and other details of the primary plan.

Plan #3100 will reimburse up to $200 (individual); $400 (family) of the deductible in full for covered services. CARE will reimburse you for the difference between the Amount Allowed* and the Amount Paid by your primary carrier, NOT TO EXCEED 20% and will reimburse you for any copayments charged by the Primary carrier. In addition, CARE will also reimburse up to $1,000 (individual); $2,000 (family) of the annual out-of-pocket maximum on allowed charges that are covered by the primary plan. The annual limit for this plan is $1,200 for individual and $2,400 for family (including the deductible).

* The Amount Allowed must have been considered for payment by the Primary carrier in order for CARE to consider for supplemental payment. For Precertification and Utilization Review, members in this Plan MUST follow the criteria established by the Primary Carrier.