Note: PEF disagrees with UHC’s use of AWP as the R&C Charge and has filed a Step 3 class action grievance asserting management is violating Article 9 of the 1999-2003 PEF/NYS contract. It’s the union’s position that the AWP reimbursement level is not consistent with the definition of R&C Charge found in the Empire Plan Certificate. This grievance is currently being scheduled for arbitration.

 

Hospital Outpatient Dept.

Physician and  Hospital Extension Clinic

Pharmacy

Chemotherapy Administration 

No copay

Par

No copay

Not Covered

Non-Par

2002 Deductible: $271

Coinsurance: 20% of total charge or R&C Charge, whichever is lower. 100% of any amount exceeding R&C Charge.

Chemotherapy drugs/agents

No copay

Par

No copay

Generic: $5 copay for up to 90 day supply

Brand: $15 copay for up to 90 day supply

Non-Par

2002 Deductible: $271

Coinsurance: 20% of total charge or R&C Charge (AWP), whichever is lower. 100% of any amount exceeding R&C Charge.