Some of our members have expressed difficulties getting their company-funded deductibles reimbursed this year. For the record, this is how its supposed to work…
Employees with the low or mid-deductible plans pay a certain amount and then their company-funded deductible kicks in. In the case of the low-deductible plan, the employee pays the first $350 ($700 per family). The company-deductible then comes into play and reimburses the next $750 ($1500 for family). After that it’s a 90/10 (in-network) split. That plan has a maximum out-of-pocket of $1500 per person ($3000 per family) – which does not include your deductible.
In the case of the mid-deductible, the first $1000 is paid by the employee ($2,000 per family) and then the company-funded $750 kicks in ($1500 for family) and, like the low-deductible plan, you get reimbursed with a check in the mail. After that it’s an 80/20 (in-network) split. That plan has an maximum out-of-pocket of $2000 per person and $4000 per family – which does not include your deductible.
Again, the high deductible ($2500 deductible per person, $3500 per family) has no company-funded deductible and it is an 80/20 (in-network) split with a maximum out-of-pocket maximum of $1000 per person and $3000 per family – which does not include your rather high deductible.
The system is designed to flow from your doctors office to United Health Care. United Health Care is a third party administer (TPA) as Lee Enterprises is actually self-insured. Then, if the claim concerns a flexible spending account or a company-funded deductible, it moves on to Tristar and that’s where the glitch has developed – between UHC and Tristar.
No one actually knows what is causing the glitch but it seems that the money has not been put into the Tristar account. No one can say why and the company has made repeated assurances that the company has the money but, for some reason, it’s just not going through.
This problem is not just confined to Guild members but seems to be affecting union and non-union alike. If you have any questions about your plan or are having difficulty getting your company-funded deductible reimbursed, please call Bruce Benson of PD Human Resources at 314-340-8065. Bruce has been working with several of our members on this and has been quite helpful in getting their issues resolved – as he has in the past.
We will keep you apprised of developments as they occur.