New Medical Plan Improvements at Amtrak

New Medical Plan Improvements at Amtrak

1-6-05 – AmPlan, the negotiated medical plan covering unionized workers at Amtrak, will add contraceptive care as a covered benefit effective February 1, 2005.

All forms of contraception that are recognized as safe and effective will be covered, including IUDs, pills, injectables, implants and diaphragms. For oral contraceptives, members or their dependents may obtain their first prescription for any new contraceptive drug at a retail pharmacy or through the mail order program. After the initial prescription, however, refills are covered only when obtained through the mail order program.

AmPlan has also added certain preventive care benefits for members and their dependents who are enrolled in the Managed Medical Care Program (MMCP) but who obtain services out-of-network. Effective January 1, 2005 expenses for the following services became covered under the out-of-network portion of MMCP:

  • routine childhood (age 6 and under) immunizations for diphtheria, pertussis or tetanus (DPT), measles, mumps, rubella & polio
  • one routine pap smear each year
  • one baseline mammogram for women age 35 through 39
  • one mammogram for women age 40 through 49 every two years, or more frequently if recommended by a physician
  • one annual mammogram for women age 50 and over
  • one annual digital rectal exam age 40 or over
  • one proctosignoidoscopy every three years after age 49
  • prostate specific antigen (PSA) tests for men age 50 and over

Benefits for these and other services are greater when a participant utilizes an in-network provider. After a $15 co-pay to an in-network physician, services are generally covered at 100 percent, including an annual physical examination and preventive care testing. However, if a participant chooses to utilize an out-of-network provider, there is now coverage for the benefits listed above, which will generally be covered at 75% of reasonable and customary charges, after annual deductibles have been satisfied. Previously, there were no out-of-network preventive care benefits.

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