INSURANCE
N.A.B.E.R. INC.
NATIONAL ALLIANCE OF "BROWN" EMPLOYEES AND RETIREES INC.
Medical Plan Investigation
N.A.B.E.R. INC. is  comparing the Summary of Benefits for locals covered  by the UPS R4(503) plan. To find out if you are involved CLICK HERE.
Contraceptive Coverage
Add Delaware to the list of states where UPS no longer covers contraceptives as part of its Prescription Drug Coverage. Coverage lapsed on May 1. Participants were not even given written notification of the change. A Summary of Material Modification (SMM) to the Summary of Plan Document (SPD) is required by law when a major change is to be implimented to a Health Plan.  At least one UPSer's spouse was taken by surprise when she went to pick up her prescription.
Make no mistake, UPS (not the drug plan provider) calls the shots as to what is covered and what is not. UPS is self-insured. The company has been cutting healthcare coverage for woman for years. Prescription coverage for contraceptives was affirmed by the EEOC on 12/14/2000.  If UPS insurance  denied prescription benefit for contraceptives after that date, you may be eligible for reimbursement. You will need documentation of your purchase of  the prescription contraceptives
According to an EEOC website http://www.eeoc.gov/litigation/02annrpt.html
"In a cutting-edge case dealing with insurance coverage of oral contraceptives, EEOC contended that UPS's Flexible Benefits Plan discriminated against women unlawfully. EEOC v. United Parcel Service. Under the Plan, female employees and the spouses of male employees were denied coverage for oral contraceptives prescribed to treat female hormonal disorders. The Plan did not exclude any prescription treatments for male hormonal disorders."
UPS has also allegedly been denying coverage for perscriptions under the premise that the level of benefits is not a contractual issue. UPS's Summary Plan Document that spells out that healthcare is a contractual agreement.
"As a bargaining unit employee of UPS, you're eligible to participate in the UPS Health and Welfare Package per the terms of your collectively bargained agreement. Please see your insert for specific details of your group's eligibility for coverage." (UPS SPD 2004)
"Your Prescription Drug Benefit Plan" distributed by Medco Health for UPS  states that "Some medications are covered by your plan only for certain uses or in certain quantities. Your plan sets all coverage parameters." (MEDCOHealth.com)
UPS seems to be dropping this prescription benefit, region by region or district by district instead of nationwide. Could it be that they would attract too much attention and the EEOC would again take them to court? Eight years after the original court decision this practice is still going on.  UPS has used the same tactic to deny woman insurance coverage to PAP Smears and Mammograms. When will some agency, some woman's group, or even UPSers themselves take up the fight to this seeming obvious injustice?

What's Happened To 
Women's Healthcare?

According to UPSers in Colorado, Nebraska, and Kentucky, UPS's insurance is no longer paying for mammograms and PAP smears. Other areas surveyed are still receiving this benefit. 

The American Cancer Society recommends yearly mammograms (screening test for breast cancer) to women over 40. Most doctors recommend yearly PAP smears (screening test for cervical cancer) to women over 18. Breast cancer and cervical cancer are the two most common cancers in women.

In the areas where UPS has dropped coverage for these diagnostic tests, it is reported that UPS used to cover these tests. Yet, UPS still covers cancer screening tests for prostate cancer and colon cancer. ADDED 6/19/05

UPS Has Significantly Changed Some Healthcare Coverage But Is NOT Notifying UPSers

Your healthcare may have changed, but you would never know it from the Summary of Material Modification (SMM). Some Chicago-area UPSers have received copies of a new 2004 Summary of Plan Document (SPD). 

There were substantial changes in the dental plan compared to the 2002 SPD.  Many services that were considered Basic Services are now Major Services. Major Services are paid at a lower rate than Basic Services. This is particularly significant if you use an out-of network provider.

The SMM that is being sent to these same individuals has no reference to any changes in the dental plan.  The SMM is a legal obligation of the company to explain changes in the healthcare coverage. For a more detailed look at the changes go to ups-spd.info ADDED 10/12/04
Please inform NABER of changes in your SPD.

Contraceptive Coverage
Prescription coverage for contraceptives was affirmed by the EEOC on 12/14/2000.  If UPS insurance  denied prescription benefit for contraceptives after that date, you may be eligible for reimbursement. You will need documentation of your purchase of  the prescription contraceptives  

According to an EEOC website http://www.eeoc.gov/litigation/02annrpt.html
"In a cutting-edge case dealing with insurance coverage of oral contraceptives, EEOC contended that UPS's Flexible Benefits Plan discriminated against women unlawfully. EEOC v. United Parcel Service. Under the Plan, female employees and the spouses of male employees were denied coverage for oral contraceptives prescribed to treat female hormonal disorders. The Plan did not exclude any prescription treatments for male hormonal disorders." 

To resolve the suit, UPS agreed to change the Plan to provide coverage for oral contraceptives prescribed for birth control or for other medical reasons on the same terms as other prescription drugs. The company also agreed to pay the cost of oral contraceptives for three years to 36 employees affected by the policy"
NABER has developed forms for reimbursement. 
CLICK HERE    UPDATED 7/23/04

Presciptions
UPS has been allegedly been denying coverage for perscriptions under the premise that the level of benefits is not a contractual issue. UPS has a brand new Summary Plan Document that spells out that healthcare is a contractual agreement.

"As a bargaining unit employee of UPS, you're eligible to participate in the UPS Health and Welfare Package per the terms of your collectively bargained agreement. Please see your insert for specific details of your group's eligibility for coverage."

"Your Prescription Drug Benefit Plan" distributed by Medco Health for UPS  states that "Some medications are covered by your plan only for certain uses or in certain quantities. Your plan sets all coverage parameters." www.Medcohealth.com

N.A.B.E.R. INC. would like to hear about cases of denyed prescription coverage that are on the "approved" list
HIPAA Privacy Rules
These new laws have real teeth. For knowingly obtaining or disclosing identifiable health information relating to an individual criminal penalties can be:
-Up to $50,000 & 1 year imprisionment.
-Up to $100,000 & 5 years imprisionment if done under false pretenses
-Up to $250,000 & 10 years if intent to sell, transfer, or use for commercial advantage, personal gain or malicious harm.

UPS has refused to discuss with union officials coverage issues that would not disclose health information without a specific authorization that meets certain requirements.  N.A.B.E.R. INC. has provided you with the necessary form. HERE

Health Care Law Changes*
  • Certificates of Creditable Coverage can shorten the exclusion period of preexisting conditions.
  • New spouses and new dependents may have special enrollment rights after a marriage, birth, adoption or placement for adoption.
  • When an employee or dependent of an employee loses eligibility for other health coverage, a specially enrollment opportunity may be triggered. Enrollment must be requested within 30 days after the oher coverage ends.
  • The Newborns' Act requires that group health plans that offer maternity coverage pay for at least a 48-hour hospital stay following childbirth (96-hour stay in the case of Cesarean section).
  • The Mental Health Parity Act (MHPA) provides for parity in lifetime and annual dollar limits on mental health benefits with dollar limits on medical/surgical benefits.
  • The Women's Health and Cancer Rights Act (WHCRA) includes protections for individuals who elect breast reconstruction in connection with a mastectomy
Even though some of these laws have been of the books for years, many people do not know their rights under them.  For more information CLICK HERE Or call (202) 693-8335 Updated 7/29/04


Benefit Appeals

UPS Contacts

All UPS Benefits

UPS Benefits Service Center
100 Half Day Road
Lincolnshire, IL 60069-9971
(800) 353-9877
or
UPS Benefits (EHR)
(800) UPS 1508
(800) 877 1508

ATLANTA CORPORATE CONTACT

B.J. Dorfman
UPS Corporate Benefits
55 Glenlake Pkwy, NE
Atlanta, GA 30328
(800) 643-4442

APPEALS

Contact the provider first by phone and explain why you are appealing the non-payment of a particular claim. The phone number should be on the EOB (Explanation of Benefits) and on your SPD (Summary Plan Description).

Also file a written appeal and send it via certified mail-return receipt to the provider, within 30 days of your receipt of the EOB. The provider has 30 days to respond to your appeal.

If the appeal is denied or is not responded to, contact the UPS Appeal Committee in Atlanta, within 30 days of receipt of the denial or lack of response to your first appeal.

Corporate Benefits Appeal Committee
Attn: Mr. Brian M. Brum
UPS Corporate Benefits
55 Glenlake Pkwy, NE
Atlanta, GA 30328

If you are still not satisfied with their decision (or the Appeal Committee does not respond in a timely manner)  Or, if you feel that you are not being treated fairly or have other ERISA complaints, contact the DOL/EBSA in Atlanta.  

You may also wish to request in your call or letter that the Benefits Advisor assigned to your case should NOT BE Mr. Jack Joyner. Over the years it has become apparent and our opinion that Mr. Joyner has become a little too familiar in sharing information that should not be shared concerning specific complainants activities, with Mr. Bryan M. Brum the UPS Attorney, Trustee, Fiduciary, Employee/Stockholder handling Health & Welfare complaints.

Mrs./Ms. Rebecca Marshall
Regional Director
Atlanta Office DOL/EBSA
U.S. Department of Labor
61 Forsyth Street, SW, Suite 7B54
Atlanta GA 30303
Tel 404.302.3900
Fax 404.302.3975


Any changes made to your healthcare coverage (Plan) or SPD should be preceded by a SMM (Summary of Material Modification). If you find that coverage has changed without your receiving a SMM, contact the DOL/EBSA. ADDED 12/30/2004


  
For Further Reading:

Consumer Guide to Handling Disputes 
with Your Employer's Health Plan 

Winning fights with your Health Plan
 
*The information on this web site does not constitute legal advice. The law is constantly changing, and we make no warranty of the accuracy of information on this site or any site to which we link.
If any information that we provide is in error, please contact us and we will correct it.
Corrections@naberinc.org


WHO PRESCRIBES
 YOUR MEDICINE?

Doctors prescribe medicine for your family based on 
what would be the most effective drug with the least 
side effects and interactions with other medications.
 Doctors use all their knowledge and experience to 
prescribe the “best” medicines available. 
Unfortunately, UPS and Medco (acting as 
administrator of the UPS prescription plan) are 
telling UPSers and their doctors what is appropriate. 
”Medco employs pharmacists to call doctors in 
cases where a medication has been prescribed 
that is not on a preferred drug list,” according to 
KaiserNetwork.org.   

In April, Medco settled a lawsuit brought by attorney 
generals in 20 states. Medco paid a $29.3 million 
dollars settlement for switching medicines and not
passing on the savings. There is a similar case in 
federal court. This settlement, however, does not 
stop Medco (acting on the behalf of UPS) from 
calling your doctor to change your prescriptions.

 In an unrelated case, a UPSer filed suit against 
UPS for being fired for taking a legally prescribed 
drug for depression and anxiety. A recovering 
alcoholic was prescribed Xanax. UPS felt the 
medication was inappropriate and fired the UPSer.
The suit is seeking class action status for 
discrimination of individuals in recovery. 
CLASS ACTION SUIT ADDED 8/16/04


Prescription Drug Information

Oregon Research Project to study effectiveness of certain classes of drugs (i.e. statin, calcium channel blockers, NSAIDS, etc.).

Consumer Reports rated drugs on cost effectiveness.

AARP's "Choosing the Right Prescription Drug".

Visit  worstpills.org, a searchable, online drug database that provides comprehensive information about 538 prescription drugs and warns of 181 drugs that are unsafe or ineffective. 
Google
Web pupsinc.homestead.com