Loading...
HomeMy WebLinkAboutSEGAL WESTERN COST MANAGEMENT TRUST - CONTRACT - RFP - P902 BENEFITSThe City of Fort Collins (Plan Letterhead) To: All Plan Participants From: The Human Resources Department The City of Fort Collins JUN hL*.w,jv Assoural June 1997 Re: Western Cost Management Trust - Organ and Bone Marrow Transplant Benefits (O/BMT) We are pleased to inform you that, effective June 1, 1997, a preferred provider organ and bone marrow transplant benefit through the BCS Financial Western Cost Management Trust (WCMT), which includes a centers of excellence network, is available to you and your eligible dependents. Under the WCMT, a human organ and tissue transplant benefit will be provided as follows: A. Persons Covered - the program will cover each eligible employee, retiree and dependents. B. Covered Transplant Procedures -covered transplant procedures are limited to the following human to human organ or tissue transplants: bone marrow (self and other donated); heart; heart/lung; liver; lung; pancreas; pancreas/kidney; and small intestine. (Note: kidney and cornea transplants are still covered by the City of Fort Collins Group Health Plan). C. Covered Services - covered services include the following: 1. Organ and tissue procurement. 2. Transportation, lodging and meal costs for the recipient and a companion or two companions if the recipient is a minor. 3. Hospital, room and board, and medical supplies. 4. Diagnosis, treatment, and surgical procedures performed by a doctor. 5. Private nursing care by an RN or LPN. 6. Rental of wheelchair, hospital -type beds, and respiratory therapy equipment. 7. Local ambulance services. 8. Medications. Y 9. X-rays and other diagnostic services, laboratory tests, and oxygen. 10. Rehabilitative therapeutic therapy, including speech therapy, audio therapy, visual therapy, occupational therapy, and physiotherapy. 11. Surgical dressings and supplies. Services Not Covered - benefits will not be payable if the service is for an injury or sickness or for a related condition that existed within three months prior to the date the recipient becomes insured. This limitation does not apply to expenses for these charges incurred after the first of the following dates: The date after the person becomes insured when no charges were incurred or advice or treatment received for the injury or sickness for three consecutive months; 2. In the case of an employee, the date at the end of six consecutive months in which the employee was continuously insured under the WCMT or the policy it replaces and was actively at work. 3. At the end of twelve consecutive months during which the person was continuously insured under the Program. Subject to approval by BCS Life Insurance Company, similar coverage under a prior plan will be applied toward this pre-existing condition limitation period. E. Benefit Period - the benefit period begins five days (30 days before for bone marrow) before the date of the organ or tissue transplant and ends eighteen months after the transplant procedure. Multiple transplant procedures will be covered under the same or separate benefit periods as follows: 1. If they are due to related causes, they will be covered in the same benefit period. 2. If the transplants are due to unrelated causes, they will be covered under separate benefit periods. 3. If they are due to related causes, they are covered under separate benefit periods if an employee returns to active work before the second transplant, or if a dependent's transplants are separated by at least three consecutive months. F. Benefit Amounts Provided - the following benefit amounts are provided for covered services: Organ or tissue procurement: $25,000 for each transplant procedure. 2. Transportation costs and lodging and meals: $10,000 for each transplant procedure (Lodging and meals expenses are covered to a maximum of $200 per day.) 3. Private nursing care: $10,000 for each transplant procedure. 4. All other services: 100% of charges. 5. Maximum: the maximum benefit that will be paid during the lifetime of a recipient for all organ or tissue transplant services is the amount of $2,000,000. Transplant Network The WCMT utilizes LifeTrac, a national network, for organ and bone marrow transplant services. LifeTrac contracts with transplant facilities across the United States for favorable reimbursement fees. It is a patient's choice whether or not to use a LifeTrac contracted facility; however, reimbursement for a non-LifeTrac facility will be limited to what the LifeTrac facility would have been paid. Please contact the Administrative Office for a listing of the current LifeTrac facilities. LifeTrac, the transplant network contracted by BCS Insurance Company, is managed by a group of professionals who have a great deal of experience in working with the facilities that provide these types of surgeries. Please note that you do not have to use the LifeTrac facilities for a transplant, but if you use other facilities, your benefits may be limited.