Health Insurance
 

Most railroad employees are covered by health insurance through The Railroad Employees National Health and Welfare Plan or The National Railway Carriers and United Transportation Union Health and Welfare Plan (the Plan).1 Employees may choose one of the following health insurance benefits programs:

  • Comprehensive Health Care Benefit (CHCB)
  • Managed Medical Care Program (MMCP)
  • Basic Health Care Benefit (BHCB)

Also available through the Plan are the Mental Health and Substance Abuse Care Benefit (MHSA) and the Managed Pharmacy Services Benefit (MPSB).

 

 
CHCB
 

 

The Comprehensive Health Care Benefit program is administered separately by both United Healthcare and Highmark Blue Cross Blue Shield. The employee may choose which insurance company he or she wishes to administer the program.

Mail claims to:

United Healthcare
P. O. Box 30985
Salt Lake City, UT 84130-0985

OR

Highmark
Railroad Dedicated Unit
P. O. Box 890381
Camp Hill, PA 17089-0381
Toll free service is available at:
United Healthcare 1-888-445-4379
Highmark: 1-866-267-3320
For BMWED employees, toll free service is available at:
United Healthcare: 1-800-842-9905
Aetna, Inc.: 1-800-842-4044

 

 
MMCP
 

 

The Managed Medical Care Program may be administered by United Healthcare, Aetna or Highmark, depending upon the area where the employee lives. In areas where the MMCP administered by United Healthcare is available, the employee may choose an MMCP administered by either United Healthcare or by Highmark. In areas where the MMCP administered by Aetna is available, the employee may choose an MMCP administered either by Aetna or by Highmark.

Mail claims to:
United Healthcare
P. O. Box 30985
Salt Lake City, UT
84130-0985

OR

Highmark
Railroad Dedicated Unit
P. O. Box 890381
Camp Hill, PA
17089-0381

OR

Aetna
P. O. Box 981106
El Paso, TX 79998-1106
Toll free service is available at:
United Healthcare 1-888-445-4379
Highmark: 1-866-267-3320
Aetna: 1-888-332-8742
For BMWED employees, toll free service is available at:
United Healthcare: 1-800-842-9905
Aetna, Inc.: 1-800-842-4044

 

 
BHCB
 

 

As with the CHCB, the Basic Health Care Benefit program is administered separately by both United Healthcare and Highmark Blue Cross Blue Shield. The employee may choose which insurance company he or she wishes to administer the program.

Mail claims to:
United Healthcare
P. O. Box 30985
Salt Lake City, UT 84130-0985

OR

Highmark
Railroad Dedicated Unit
P. O. Box 890381
Camp Hill, PA 17089-0381
Toll free service is available at:
United Healthcare 1-888-445-4379
Highmark: 1-866-267-3320

 

 
MHSA
 

 

The Mental Health and Substance Abuse Care Benefit for United Transportation Union members is administered by ValueOptions, Inc.

Mail claims to:
ValueOptions
Railroad Claims Unit
P. O. Box 850
Latham, NY 12110
Toll free service is available at:
ValueOptions 1-800-934-7245
The Mental Health and Substance Abuse Care Benefit for Brotherhood of Maintenance of Way Employes Division members is administered by United Behavioral Health.

Mail claims to:
United Behavioral Health
Railroad Claims Unit
P. O. Box 30760
Salt Lake City, UT 84130-0760
Toll free service is available at:
United Behavioral Health 1-866-850-6212

 

 
MPSB
 

 

The Managed Pharmacy Services Benefit is administered by Medco Health Solutions, Inc. You do not need to file a claim form if you fill your prescription at an in-network pharmacy. If you fill your prescription at an out-of-network pharmacy, you must file a claim with Medco. Claim forms may be obtained on the Web site at www.medco.com or by calling the toll free number below. Claims must be submitted to the address printed on the claim form

Toll free service is available at:
Medco 1-800-842-0070

 

 
FAQ
 

 

NOTE: The questions and answers below are generic in nature and may not apply to all situations. For information that is unique to you and your particular situation, consult The Railroad Employees National Health and Welfare Plan or The National Railway Carriers and United Transportation Union Health and Welfare Plan booklet.

 

 
 
 
A. When Does Coverage Start?
 
 
 
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A.
Railroad employees hired on or after March 1, 2004 become covered on the first day of the fourth calendar month beginning after the month in which you first rendered the requisite amount of compensated service (7 calendar days in a calendar month).

Example 1: You began working for a railroad on June 5, 2005, and worked at least 7 calendar days during the month of June, as well as 7 calendar days in the months of July, August and September 2005. You will be eligible for insurance coverage starting October 1, 2005.

 
 
 
Q.
 
 
A.
Coverage will start for your eligible dependents on the same day your coverage starts. Eligible dependents include:
  • Your spouse.
  • Your unmarried children under the age of 19.
  • Your unmarried children between the ages of 19 and 25 who are full-time students and who are dependent mainly upon you for care and support and who have their legal residence with you.
  • Your unmarried children 19 or over who are dependent upon you for support and have a permanent physical or mental condition that began prior to age 19 and who are unable to engage in any regular employment and have their legal residence with you.
 
 
 
Q.
 
 
A.
The three programs and the benefits payable are outlined in The Railroad Employees National Health and Welfare Plan or The National Railway Carriers and United Transportation Union Health and Welfare Plan booklet. If you do not have this booklet, it may be obtained from your employer, your labor organization or from United Healthcare.
 
 
 
 
B. When Does Coverage End?
 
 
 
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Q.
 
 
A.
The effective date of your resignation.
 
 
 
Q.
 
 
A.
Assuming you have met the requirements to be an eligible employee, you will be covered for employee and dependent benefits until the end of the fourth month following the month in which you last rendered compensated service.

Example 2: You are furloughed effective January 5, 2006. You and your dependents will be covered through the remainder of January, as well as February, March, April and May 2006. Coverage will end on May 31, 2006.

There are certain conditions that could extend these benefits, such as receipt of vacation pay or becoming disabled. Please consult The Railroad Employees National Health and Welfare Plan or The National Railway Carriers and United Transportation Union Health and Welfare Plan booklet.
 
 
 
Q.
 
 
A.
Again, assuming you are an eligible employee and you have had an employment relationship for at least six months, and you have rendered compensated service for three months as an eligible employee, you will be covered during your suspension or after your dismissal until the end of the fourth month following the month in which you last rendered compensated service. If you are awarded full back pay for all time lost as a result of your suspension or dismissal, your coverage will be provided as if you had not been suspended or dismissed in the first place.

Example: See Example 2 above.

There are certain conditions that could extend these benefits, such as receipt of vacation pay or becoming disabled. Please consult The Railroad Employees National Health and Welfare Plan or The National Railway Carriers and United Transportation Union Health and Welfare Plan booklet.
 
 
 
Q.
 
 
A.
If you cease to render compensated service solely as a result of disability or if you become disabled by reason of pregnancy or if you become disabled before your coverage as a furloughed, suspended or dismissed employee ends, and if you remain continuously disabled, you (the employee) will be covered for health insurance until the end of the second calendar year next following the year in which you last rendered compensated service.

Example 3: You become disabled from your regular occupation effective January 5, 2006. You will be covered by health insurance with waiver of premium--as long as you remain continuously disabled--through the remainder of 2006, all of 2007 and all of 2008. Your coverage will end on December 31, 2008. You will need to periodically provide proof of continued disability by way of a form completed by your attending physician. This form may be accessed and downloaded here.

There are certain conditions that could extend these benefits, such as receipt of vacation pay that is paid in a year subsequent to the year in which you could no longer work. Please consult The Railroad Employees National Health and Welfare Plan or The National Railway Carriers and United Transportation Union Health and Welfare Plan booklet.
 
 
 
Q.
 
 
A.
Your dependents will be covered for health insurance until the end of the first calendar year next following the year in which you last rendered compensated service.

Example 4: You become disabled from your regular occupation effective January 5, 2006. Your dependents will be covered by health insurance--as long as you remain continuously disabled--through the remainder of 2006 and all of 2007. Your dependent coverage will end on December 31, 2007.
 
 
 
Q.
 
 
A.
Coverage will end for both you and your dependents at the end of the month following the month in which you last rendered compensated service.

Example 5: You retire effective November 15, 2006. Coverage for both you and your dependents will be in effect the remainder of November 2006 and all of December 2006. It will expire on December 31, 2006.

Receipt of vacation pay could extend this coverage. In addition, retired employees may be eligible for benefits under The Railroad Employees National Early Retirement Major Medical Benefit Plan. Please consult The Railroad Employees National Health and Welfare Plan or The National Railway Carriers and United Transportation Union Health and Welfare Plan booklet.
 
 
 
Q.
 
 
A.
At the end of the fourth month following the month of your death.

Example 6: You die on January 5, 2006. You and your dependents will be covered through the remainder of January, as well as February, March, April and May 2006. Dependent coverage will end on May 31, 2006.
 
 
 
Q.
 
 
A.
As an employee, you will be eligible for COBRA if you lose your coverage due to either one of the following qualifying events:
  • Your hours of employment are reduced
  • Your employment ends for any reason other than your gross misconduct.
If you are the spouse of an employee, you will become eligible for COBRA if you lose your coverage under the Plan because of any of the following qualifying events:
  • The spouse-employee dies.
  • The spouse-employee's hours of employment are reduced.
  • The spouse-employee's employment ends for any reason other than his or her gross misconduct.
  • The spouse-employee becomes entitled to Medicare benefits (under Part A, Part B or both).
  • You become divorced or legally separated from your spouse.
Your dependent children will become eligible for COBRA if they lose coverage under the Plan because of any of the following qualifying events:
  • The parent-employee dies.
  • The parent-employee's hours of employment are reduced.
  • The parent-employee's employment ends for any reason other than his or her gross misconduct.
  • The parent-employee becomes entitled to Medicare benefits (Part A, Part B or both).
  • The parents become divorced or legally separated.
  • The child stops being eligible for coverage under the4 Plan as a "dependent child."
  • In order to receive COBRA coverage, the employee and/or employer MUST notify United Healthcare of the qualifying event in a timely manner.
 
 
 
Q.
 
 
A.
COBRA is a temporary continuation of the coverage you lost as a result of the qualifying event. Generally, the coverage lasts for only up to a total of 18 months. However, there are certain factors that could extend the continued coverage.

Please consult The Railroad Employees National Health and Welfare Plan or The National Railway Carriers and United Transportation Union Health and Welfare Plan booklet.
 
 
 
NOTE: It is important to remember that when an employee is off work due to disability and is on waiver of premium for health insurance benefits, the period for waiver of premium and the period for COBRA run concurrently and NOT consecutively.
 
 
 
C. Coverage for On-Duty Injuries
 
 
 
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Q.
 
 
A.
The Railroad Employees National Health and Welfare Plan or The National Railway Carriers and United Transportation Union Health and Welfare Plan provides that when an employee requires medical treatment because of an on-duty injury for which the employee may have a right of recovery against the employing railroad, benefits will be provided under the Policy Contract. Generally, medical bills for on-duty injuries should be processed through the employee's health insurance for payment under the terms of the Plan. Any balances due should then be presented to the railroad's claims agent to be approved for payment in full under a supplemental health insurance policy.
 
 
 
 
D. Health Insurance Plan for Former Railroad Employees
 
 

Railroad employees who lose health insurance coverage due to furlough, suspension, dismissal, resignation, or another reason, but who are not eligible for coverage under Medicare or the early retirement plan, GA-46000, may apply for major medical benefits. These benefits are outlined in Plan C of a booklet entitled Group Health Insurance Plans for Former Railroad Employees and their Dependents, Group Policy Number GA-23111. If you do not have this booklet, it may be obtained from your employer, your labor organization or from United Healthcare. This plan also provides coverage for the employee's eligible dependents. Premiums for Plan C under GA-23111 may be paid on either a monthly or quarterly basis.

If you have questions concerning Group Policy No. GA-23111, Plan C, you may consult the Plan booklet, your local union organization or United Healthcare.

 
 
1Certain railroad employees are covered by hospital associations and must look to their hospital association for health care benefits. However, they may have limited benefits under the Plan.
2Railroad employees who are covered under hospital association plans have different periods of continued coverage under waiver of premium. For additional information regarding hospital association plans, consult the specific booklet for the plan.