Yes. The new contract maintains your right to choose the high quality health plan you want for yourself and your family.

Yes. The biggest difference is UHC replaces Aetna as the plan administrator.

Same school bus, different driver.

What is covered by the PPO under Aetna's policies will be covered by UHC.

Insurance companies negotiate discounts with a wide array of doctors, clinics, hospitals, and other medical providers. The purpose is to encourage participants to use these Preferred Providers as their first Option for medical care.

Our PPO will use the "UnitedHealthcare Choice Plus" network.

You can find out if you doctor is in the UHC Choice Plus network.  You may also call 1-866-873-3903.

You are able to keep your doctor for as long as you want. However, you will pay higher out-of-pocket payments.

Yes.  There is a 90-day grace period.

You must be "under an active course of treatment" by a doctor in Aetna's network, on the date UHC starts to process claims. You must apply within 30 days of UHC's start date.

If you meet both conditions, your ongoing treatment within 90 days of UHC's start date will be paid as if your doctor were in-network.

Example: Suppose the doctor who is treating you charges $90 for each office visit.

For each visit within 90 days of UHC's start date, you would continue to pay $10 - the in-network co-pay.

After the 90-day grace period, you would pay $27 for the out-of-network 30% co-pay.

No sooner than April 1, 2011.

Yes. The contract requires the district to notify our union at least 60 days prior to the start date.

Our teacher team has concerns about a new PPO plan administrator, based on transition issues in the past and research on the practices of for profit companies including Aetna and UHC.

We want the committee to start in January to jointly and proactively work out as many implementation/transition issues before UHC starts to process claims.

The Board's team wants the committee to discuss cost issues - especially for retirees - along with service quality and other health insurance topics.

Yes. In fact, our negotiators strongly preferred the WEA Trust. The Trust is non-profit and teacher managed.

Yes. It came down to money.

 UHC had substantially higher savings than the bids from other carriers.

Yes. If you are in either the HMO or the PPO, a premium contribution will be deducted from your base earnings.

Base earnings include only the amount you receive for your regular workdays during your normal work year - not any extra earnings.

Base salary earnings are noted as "Contract Pay (T)," on your paycheck.

There will be no premium deductions on extra earnings:

• summer school
• inservices
• lunch duty
• class coverage
• coaching
• etc.

Your contributions will automatically be run through the MPS pre-tax 125 plan. Handling premium contributions on a pre-tax basis will provide you with more money to spend than if it were taxable income.

Basing contributions on the premium cost of the plan chosen by each teacher would result in losing the higher quality PPO plan.

As health care costs skyrocketed locally and nationally, a team of our union's leaders, staff, bargaining team members, along with our insurance actuary, spent months researching and developing innovative, long-term strategies to sustain the PPO option for our members.

One of the conclusions from that study dealt directly with how to deal with employee premium contributions, if and when necessary.

The consensus: The best strategy for maintaining the PPO would be to bargain premium contributions based on salary.

Employee contributions based on the premium cost of their choice of plan would cause adverse selection.

Example:

Suppose the premium share for family coverage is $100/month for the PPO and $40/month for the HMO. Healthier teachers would choose the HMO.

A higher percentage of teachers with multiple and/or serious health issues would choose the PPO - creating adverse selection.

Each year, the trend would drive up the cost of the PPO until only seriously ill members would choose it. The cost of the PPO to the district and the employee's premium share would make the PPO unsustainable. The PPO would be eliminated, and all teachers would be in the lower cost HMO.

Employees who complete voluntary programs in the Goodhealth plan prior to Decemer 15, 2010 will receive a $350 contribution into their health reimbursement account (HRA) by February 28, 2011. The increase from $250 to $350 will apply in future Goodhealth program years.

If you are in the HMO and use an out-of-network provider, you will pay the entire bill.

When both members of a 2-person family each reach the $75 single deductible, the family’s total deductible amount ($150) will be met.

For a family of 3 or more, the $225 total will be met when 3 members each reach the $75 deductible.

Example for a family of 5. When 3 different family members - say you, your spouse and one of your 3 sons - each meet the $75 deductible amount, the $225 family amount will be met.

In this example, you would pay no deductible for your other 2 sons.

If the $326 deductible (single) is paid by 1 family member, any combination of $174 in payments for the rest of the family will meet family deductible ($500).

Example: suppose your spouse reaches the $326 single amount. When out-of-network payments for other family members add up to $174 - for instance - $60 for you, $34 for your son, and $80 for your daughter - your family deductible will be met.

Example for single coverage:

If you had a $45,000 surgery at the Mayo Clinic, the 30% coinsurance would be $13,500. You would only pay $1,100, your out-of-pocket maximum for care from out-of-network providers.

Note: Details on how the out-of-network family coinsurance maximum will work are not available at this time. The information will be posted here when it is available.

Medco will administer the 3-tier program for the PPO and HMO.

Examples:

Tier 1 - Fexofenadine is a drug used to treat allergies.

Tier 2 - Medco gets a better discount on one of the brand name allergy treatment drugs - Clarinex. Such drugs are in Medco's Preferred Tier.

Tier 3 - Medco does not have a good discount on Allegra, also a brand name drug used to treat allergies. The most expensive drugs in Medco Tier 3 are called Non-Preferred.

No. This change merely eliminates UHC as a middle man at a cost savings to MPS.

Yes, just 1. Retirees in the HMO will no longer have vision coverage. The change will occur on the date UHC starts to administer the PPO.

Our team wanted to establish a strong incentive for UHC to provide quality service for PPO participants - as it has in the HMO locally for several years.

The new language allows our union to require the Board to rebid the PPO. If we raise demonstrable and substantive deficiencies in claims processing and/or other performance areas, UHC would not be considered.

An annual audit was added to the rebid provision. This is another proactive step to maintain quality service, minimize claims processing problems, and reduce costs.

This provision will protect PPO participants from unexpected payments to RAPS providers.

RAPS is the abbreviation for radiology, anesthesiology, and pathology (RAPS) services.

Its not uncommon for a patient at an in-network hospital, with an in-network attending physician, to receive RAPS services out-of-network without the patient's knowledge.

Under the 2007-09 contract, if you are improperly denied benefits, you can appeal to the PPO administrator (Aetna). If Aetna does not grant your appeal, you would have to file a grievance. Your appeal would finally be decided by a labor arbitrator, not a medical professional.

We bargained a new appeal process in which a panel of independent medical professionals will make the final decision.

This change will be a deterent against improper denials.

With rare exceptions, other school districts do not have a lower-cost HMO option.

• Of the 10 largest districts in Wisconsin, only Milwaukee and Madison have HMO options.
• Elmbrook is the only neighboring district that has an HMO option.
• No district in the state offers only an HMO.
• The vast majority of districts have only one health plan - a PPO, commonly through the WEA Trust.
• The PPO in other districts is very comparable to our district's negotiated PPO. Both PPOs provide comprehensive coverage and benefits, along with the freedom to choose your doctor.
• Teachers in most districts have paid a portion of their health insurance cost for many years.
• The most common method for teacher contributions is a percentage of the premium cost - 5% or more.
• On average, the dollar amount teachers in other districts pay is the same amount MPS teachers will pay as a percentage of salary.

Our team considered the health insurance and other comparables and determined their current status did not support going to arbitration.