Health plan issues settled in precontract talks Essay

Uniroyal, Inc. and the United Rubber Workers negotiated a plandesigned to contain rising health care costs, rather than shift thesecosts to employees. The plan, which will be incorporated into the laborcontract the parties will negotiate in 1985, contains a number ofcost-control features: * The attending physician will be required to complete a”Precertification form” prior to each nonemergency admissionto a hospital. The form will be reviewed by the plan’s staff. Anyquestions on admission, care, or proposed length of stay will bereferred to a reviewing physician, who will discuss a possiblemodification of treatment with the attending physician. If they areunable to agree, the attending physician’s opinion will prevail.

* Employees and retirees will have to obtain company-paid secondopinions prior to specified nonemergency surgical procedures. Employeeswill be paid for up to 4 hours worktime lost while obtaining the secondopinion. * Before nonemergency surgery, workers and retirees will have toobtain from the surgeon a form indicating the diagnosis, operatingprocedures, and amount to be charged. If the proposed charge is higherthan the allowable amount, the plan administrator will attempt toresolve the difference. If this cannot be accomplished, the worker orretiree will not have to pay the difference. * Preadmission tests prior to nonemergency surgery will beperformed on an outpatient basis, with participants becoming immediatelyeligible for sickness and accident benefits, rather t han after awaiting period.

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As before, participants receive a $50 bonus for certainsurgical procedures if they are performed on an outpatient basis. * Plan participants must generally obtain all prescription drugs through the plan’s mail order film, either by mailing in ortelephoning in the prescription. The drugs, which are free to theparticipant, will be mailed by the plan in postage free envelopes. Themail order firm also offers toothpaste, shampoo, and similar items atreduced prices. * Claims administration will be improved to cut costs.

* Health maintenance organizations that provide better benefits atcompetitive costs will continue to be reviewed.


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