EMERGENCY ROOM PROCEDURES: PROTECT YOURSELF
EMERGENCY ROOM PROCEDURES: PROTECT YOURSELF
Panic often lays waste to the most carefully laid plans. But it only takes a couple of plans to ensure that a medical emergency doesn't end up costing you anxiety when it comes time to make a claim.
If it's not . . .
What's An Emergency
An emergency is . . .
Emergency rooms are not "first come - first served." You will usually have to sit for hours in an emergency room while patients with more serious conditions are treated first.
A hospital is an expensive place for medical care for you and the Trust Fund.
If your doctor's office is closed and your situation is urgent but not an emergency, consider an Urgent Care clinic. Urgent Care Clinics have extended hours of service are less expensive than hospital emergency rooms. If you experience problems accessing your urgent care facility, please contact your health plan's member services.
Continuity of care is also an important factor in improving overall health. In an emergency room you have no choice about the doctor you see.
Your regular doctor knows you - and your health history. Save time and money by only using the emergency room when necessary.
If you receive non-authorized services in a situation that your health plan determines was not an emergency, your claim could be denied.
In order for you to receive help with health claims from your Union rep, friend or anyone else, you must name that specific person on a special Authorization Form.
You can get that form from your Union Representative, your company's Human Resources Department or from PacFed by calling 1-800-753-0222.
Most of the changes required by HIPAA won't even be apparent to you. For example, PacFed and your Health Plan have taken steps to assure that your health information is stored in secure locations and cannot be accidentally disclosed or transmitted.
New electronic standards have been established for how information is exchanged. In addition, PacFed and your Health Plan have signed contracts with each other assuring that your health information is kept confidential.
These new regulations, mandated by federal law, will make things different, but after a brief period of time, everyone will adjust to the changes and new rules. Remember, they are in effect for your benefit.
For assistance on these or other matters, please contact PacFed Member Services.
Bilingual representatives are standing by to make this transition as smooth as possible for you.
SUMMARY ANNUAL REPORT FOR PUBLIC EMPLOYEES BENEFIT TRUST
This is a summary of the annual report of the Public Employees Benefit Trust, E.I.N. 95-4845974, Plan No. 501, for the year ended August 31, 2002. The annual report has been filed with the Pension and Welfare Benefits Administration, Retirement Income Security Act of 1974 (ERISA).
Insurance Information
The value of plan assets, after subtracting liabilities of the plan, was $30, 719 as of August 31, 2002, compared to $9,767 as of September 1, 2001. During the plan year the plan experienced an increase in its net assets of $20,952. During the plan year the plan had total income of $1,732,646 including employer contributions of $1,724,557 and participant contributions of $8,089.
Plan expenses were $1,711,694. These expenses including $203,046 in administrative expenses and $1,508.648 in benefits paid to or for participants and beneficiaries.
Your Rights To Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request. The following items are included in that report:
You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both. If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report. The charge to cover coping costs given above does not include a charge for the copying of these portions of the report because these portions are furnished without charge.
You also have the legally protected right to examine the annual report at the main office of the plan (1000 North Central Avenue, Suite 400, Glendale, CA, 91202-9905) and at the U.S. Department of Labor in Washington, D.C., or to obtain a copy from the U.S. Department should be addressed to: Public Disclosure Room, Room N1513, Pension and Welfare Benefits Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C. 20210.
RECONSTRUCTIVE SURGERY FULLY COVERED AFTER MASTECTOMY
Millions of Americans, whether they're HMO members or not, mistakenly believe that HMOs never cover procedures often referred to as "plastic surgery." That is simply incorrect.
Some procedures are, of course, classified as cosmetic and, therefore, not covered.
But women who undergo a mastectomy are entitled to reconstructive surgery as part of your health plan's comprehensive benefits package. The Women's Health and Cancer Rights Act of 1998 has further clarified the policy, which often varied from carrier to carrier.
In the case of a participating or beneficiary benefits under he plan in connection with a mastectomy and elects reconstruction, federal law requires coverage in a manner determined in consultation with the attending physician and the patient, for:
this coverage is subject to the plan's annual deductible and coinsurance provisions.