Health plan issues settled in precontract talks Essay

Uniroyal, Inc. and the United Rubber Workers negotiated a plan
designed to contain rising health care costs, rather than shift these
costs to employees. The plan, which will be incorporated into the labor
contract the parties will negotiate in 1985, contains a number of
cost-control features:



* The attending physician will be required to complete a
“Precertification form” prior to each nonemergency admission
to a hospital. The form will be reviewed by the plan’s staff. Any
questions on admission, care, or proposed length of stay will be
referred to a reviewing physician, who will discuss a possible
modification of treatment with the attending physician. If they are
unable to agree, the attending physician’s opinion will prevail.

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* Employees and retirees will have to obtain company-paid second
opinions prior to specified nonemergency surgical procedures. Employees
will be paid for up to 4 hours worktime lost while obtaining the second
opinion.



* Before nonemergency surgery, workers and retirees will have to
obtain from the surgeon a form indicating the diagnosis, operating
procedures, and amount to be charged. If the proposed charge is higher
than the allowable amount, the plan administrator will attempt to
resolve the difference. If this cannot be accomplished, the worker or
retiree will not have to pay the difference.



* Preadmission tests prior to nonemergency surgery will be
performed on an outpatient basis, with participants becoming immediately
eligible for sickness and accident benefits, rather t han after a
waiting period. As before, participants receive a $50 bonus for certain
surgical 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 or
telephoning in the prescription. The drugs, which are free to the
participant, will be mailed by the plan in postage free envelopes. The
mail order firm also offers toothpaste, shampoo, and similar items at
reduced prices.



* Claims administration will be improved to cut costs.



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

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