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November 7 , 1991
AGREED UPON IMPLEMENTATION OF
PUBLIC LAW 102-29
The attached document reflects the joint efforts of the Brotherhood of
Locomotive Engineers and the National Carriers' Conference Committee to reduce
to contract terms the report and recommendations of Presidential Emergency Board
No. 219 dated January 15, 1991, as clarified and modified by Special Board No.
102-29.
This understanding is based upon the provisions of Public Law 102-29, signed by
the President on April 18, 1991, which declares that the report and
recommendations of Presidential Emergency Board No. 219, as clarified and
modified by Special Board 102-29, shall be binding effective July 29, 1991, on
the participating carriers listed in Exhibit A, attached hereto and made a part
hereof, and represented by the National Carriers' Conference Committee of the
National Railway Labor Conference and certain of their employees represented by
the Brotherhood of Locomotive Engineers and shall have the same effect as though
arrived at by agreement of the parties in accordance with the Railway Labor Act.
R.P. McLaughlin Charles I. Hopkins, Jr.
President BLE Chairman NCCC
July 29, 1991
ARTICLE I - WAGES
Section 1 - Lump Sum Payment
Each employee subject to this Implementing Document who rendered compensated
service on a sufficient number of days during the calendar year 1990 to qualify
for an annual vacation in the calendar year 1991 will be paid $2,000 within 60
days of the date of this Implementing Document. Those employees who rendered
compensated service on an insufficient number of days during the calendar year
1990 to qualify for an annual vacation in the calendar year 1991 will be paid a
proportional share of that amount. This Section shall be applicable solely to
those employees subject to this Implementing Document who have an employment
relationship as of the date of this Implementing Document or who have retired or
died subsequent to January 1, 1990. There shall be no duplication of lump sum
payments by virtue of employment under an agreement with another organization.
Section 2 - First General Wage Increase
(a) Effective July 1, 1991, all standard basic daily rates of pay of employees
represented by the Brotherhood of Locomotive Engineers in effect June 30, 1991
shall be increased by three (3) percent.
(b) In computing the increase under paragraph (a) above, three (3) percent shall
be applied to the standard basic daily rates of pay applicable in the following
weight-on-drivers brackets, and the amounts so produced shall be added to each
standard basic daily rate of pay:
Passenger - 600,000 and less than 650,000 pounds
Freight - 950,000 and less than 1,000,000 pounds
(through freight rates)
Yard Engineers - Less than 500,000 pounds
Yard Firemen - Less than 500,000 pounds
(separate computation covering five day rates and other than five
day rates)
Section 3 - Second General Wage Increase
Effective July 1, 1993, all standard basic daily rates of pay of employees
represented by the Brotherhood of Locomotive Engineers in effect on June 30,
1993 shall be increased by three (3) percent, computed and applied in the same
manner prescribed in Section 2 above.
Section 4 - Third General Wage Increase
Effective July 1, 1994, all standard basic daily rates of pay of employees
represented by the Brotherhood of Locomotive Engineers in effect on June 30,
1994 shall be increased by four (4) percent, computed and applied in the same
manner prescribed in Section 2 above.
Section 5 - Standard Rates
The standard basic daily rates of pay produced by application of the increases
provided for in this Article are set forth in Appendix 1, which is a part of this Implementing Document.
Section 6 - Application of Wage Increases
(a) Duplicate time payments, including arbitraries and special allowances that
are expressed in time, miles or fixed amounts of money, and mileage rates of pay
for miles run in excess of the number of miles comprising a basic day, will not
be subject to the adjustments provided for in this Article.
(b) Miscellaneous rates based upon hourly or daily rates of pay, as provided in
the schedules or wage agreements, shall be adjusted under this Implementing
Document in the same manner as heretofore increased under previous wage
agreements.
(c) In determining new hourly rates, fractions of a cent will be disposed of by
applying the next higher quarter of a cent.
(d) Daily earnings minima shall be changed by the amount of the respective daily
adjustments.
(e) Existing money differentials above existing standard daily rates shall be
maintained.
(f) In local freight service, the same differential in excess of through freight
rates shall be maintained.
(g) Where applicable, the differential of $4.00 and/or S6.00 per basic day in
freight, passenger and yard service, and 4 cents and/or 6 cents per mile for
miles in excess of the number of miles encompassed in the basic day in freight
and passenger service, will be maintained for engineers working without firemen
on locomotives on which under the former National Diesel Agreement of 1950
firemen would have been required. Such differential will continue to be applied
in the same manner as the local freight differential.
(h) In computing the first increase in rates of pay effective July 1, 1 991,
under Section 2 for firemen employed in local freight service, or on road
switchers, roustabout runs, mine runs, or in other miscellaneous service, on
runs of miles equal to or less than the number comprising a basic day, which are
therefore paid on a daily basis without a mileage component, whose rates had
been increased by "an additional $.40" effective July 1, 1968, the three (3)
percent increase shall be applied to daily rates in effect June 30, 1991,
exclusive of local freight differentials and any other money differential above
existing standard daily rates. For firemen, the rates applicable in the
weight-on drivers bracket 950,000 and less than 1,000,000 pounds shall be
utilized in computing the amount of increase. The same procedure shall be
followed in computing the increases effective July l, 1993 and July 1, 1994. The
rates produced by application of the standard local freight differentials and
the above referred-to special increase of "an additional $.40" to standard basic
through freight rates of pay are set forth in Appendix 1 which is a part of this
Implementing Document.
(i) Other than standard rates:
(i) Existing basic daily rates of pay other than standard shall be changed,
effective as of the dates specified in Sections 2, 3 and 4 hereof, by the same
respective percentages as set forth therein, computed and applied in the same
manner as the standard rates were determined.
(ii) Where applicable, the differential of $4.00 and/or $6.00 per basic day in
freight, passenger and yard service, and 4 cents and/or 6 cents per mile for
miles in excess of the number encompassed in the basic day in freight and
passenger service, will be maintained for engineers working without firemen on
locomotives on which under the former National Diesel Agreement of 1950 firemen
would have been required. Such differential will continue to to be applied in
the same manner as the local freight differential.
(iii) Daily rates of pay, other than standard, of firemen employed in local
freight service, or on road switchers, roustabout runs, mine runs, or in other
miscellaneous service, on runs of miles equal to or less than the number
encompassed in the basic day, which are therefore paid on a daily basis without
a mileage component, shall be increased as of the effective dates specified in
Sections 2, 3 and 4 hereof, by the same respective percentages as set forth
therein, computed and applied in the same manner as provided in paragraph
(i)(i) above.
ARTICLE II - COST- OF-LIVING PAYMENTS
PART A - Cost-of-Living Lump Sum Payments Through January 1, 1995
Section 1 - First Lump Sum Cost-of-Living Payment
Subject to Sections 6 and 7, employees with 2,000 or more straight time hours
paid for (not including any such hours reported to the Interstate Commerce
Commission as constructive allowances except vacations, holidays and guarantees
in protective agreements or arrangements) during the period April 1, 1991
through March 31, 1992, will receive a lump sum payment on July 1, 1992 of
$1,455.00
Section 2 - Second Lump Sum Cost-of Living Payment
Subject to Sections 6 and 7, employees with 1,000 or more straight time hours
paid for (not including any such hours reported to the ICC as constructive
allowances except vacations, holidays and guarantees in protective agreements or
arrangements) during the period April 1, 1992 through September 30, 1992, will
receive a lump sum payment on January 1, 1993 equal to the difference between
(i) $1,444.00, and (ii) the lesser of $720.00 and one quarter of the amount, if
any, by which the carriers' 1993 payment rate for foreign-to-occupation health
benefits under the Railroad Employees National Health and Welfare Plan (the
"Plan") exceeds the sum of (a) the amount of such payment rate for 1992 and (b)
the amount per covered employee that will be taken during 1993 from that certain
special account maintained at The Travelers Insurance Company known as the
"Special Account Held in Connection with the Amount for the Close-Out Period
(the ("Special Account") to pay or provide for Plan foreign-to-occupation health
benefits.
Section 3 - Third Lump Sum Cost-of Living Payment
Subject to Sections 6 and 7, employees with 2,000 or more straight time hours
paid for (not including any such hours reported to the ICC as constructive
allowances except vacations, holidays and guarantees in protective agreements or
arrangements) during the period October 1, 1992 through September 30, 1993, will
receive a lump sum payment on January 1, 1994 equal to the difference between
(i) $1,467.00, and (ii) the lesser of $733.50 and one quarter of the amount, if
any, by which the carriers' 1994 payment rate for foreign-to-occupation health
benefits under the Plan exceeds the sum of (a) the amount of such payment rate
for 1993 and (b) the amount per covered employee that will be taken during 1994
from the Special Account to pay or provide for Plan foreign-to-occupation health
benefits.
Section 4 - Fourth Lump Sum Cost-of Living Payment
Subject to Sections 6 and 7, employees with 2,000 or more straight time hours
paid for (not including any such hours reported to the ICC as constructive
allowances except vacations, holidays and guarantees in protective agreements or
arrangements) during the period October 1, 1993 through September 30, 1994, will
receive a lump sum payment on January 1, 1995 equal to the differences between
(i) $1,006.00, and (ii) the lesser of $503.00 and one quarter of the amount, if
any, by which the carriers' 1995 payment rate for foreign-to-occupation health
benefits under the Plan exceeds the amount of such payment rate for 1994.
Section 5 - Definition of Payment Rate for Foreign to Occupation Health Benefits
The carrier's payment rate for any year for foreign-to-occupation health
benefits under the Plan shall mean twelve times the payment made by the carriers
to the Plan per month (in such year) per employee who is fully covered for
employee health benefits under the Plan. Carrier payments to the Plan for these
purposes shall not include the amounts per such employee per month (in such
year) taken from the Special Account, or from any other special account, fund or
trust maintained in connection with the Plan, to pay or provide for current Plan
benefits, or any amounts paid by remaining carriers to make up the unpaid
contributions of terminating carriers pursuant to Article III, Part A, Section 1
hereof.
Section 6 - Employees Working Less Than Full Time
For employees who have fewer straight time hours (as defined) paid for in any of
the respective periods described in Sections 1 through 4 than the minimum number
set forth therein, the dollar amounts specified in clause (i) thereof shall be
adjusted by multiplying such amounts by the number of straight time hours
(including vacations, holidays and guarantees in protective agreements or
arrangements) for which the employee was paid during the applicable measurement
period divided by the defined minimum hours. For any such employee, the dollar
amounts described in clause (ii) of such Sections shall not exceed one-half of
the dollar amounts specified in clause (i) thereof, as adjusted pursuant to this
Section.
Section 7 - Lump Sum Proration
In the case of any employee subject to wage progression or entry rates, the
dollar amounts specified in clause (i) of Sections 1 through 4 shall be adjusted
by multiplying such amounts by the weighted average entry rate percentage
applicable to wages earned during the specified determination period. For any
such employee, the dollar amounts described in clause (ii)of such Sections shall
not exceed one-half of the dollar amounts specified in clause (i) thereof, as
adjusted pursuant to this Section.
Section 8 - Eligibility for Receipt of Lump Sum Payments
The lump sum cost-of-living payments provided for in this Article will be
payable to each employee subject to this Implementing Document who has an
employment relationship as of the dates such payments are made or has retired or
died subsequent to the beginning of the applicable base period used to determine
the amount of such payments. There shall be no duplication of lump sum payments
by virtue of employment under an agreement with another organization.
PART B - Cost of-Living Allowance and Adjustments Thereto After January 1, 1995
Section 1 - Cost-of-Living Allowance and Effective Dates of Adjustments Thereto
(a) A cost of living allowance will be payable in the manner set forth in and
subject to the provisions of this Part, on the basis of the "Consumer Price
Index for Urban Wage Earners and Clerical Workers (Revised Series) (CPI-W)"
(1967=100), U.S. Index, all items - unadjusted, as published by the Bureau of
Labor Statistics, U.S. Department of Labor, and hereinafter referred to as the
BLS CPI. The first such cost-of-living allowance shall be payable effective July
1, 1995 based, subject to paragraph (d), on the BLS CPI for September 1994 as
compared with the BLS CPI for March 1995. Such allowance, and further
cost-of-living adjustments thereto which will become effective as described
below, will be based on the change in the BLS CPI during the respective
measurement periods shown in the following table, subject to the exception
provided in paragraph (d)(iii), according to the formula set forth in paragraph
(e).
Measurement Periods Effective Date
Of Adjustment
Base Month Measurement Month
September 1994 March 1995 July 1, 1995
March 1995 September 1995 January 1, 1996
Measurement Periods and Effective Dates conforming to the above schedule shall
be applicable to periods subsequent to those specified above during which this
Article is in effect.
(b) While a cost-of-living allowance is in effect, such -cost-of-living
allowance will apply to straight time, overtime, vacations, holidays and to
special allowances in the same manner as basic wage adjustments have been
applied in the past, except that such allowance shall not apply to duplicate
time payments, including arbitraries and special allowances that are expressed
in time, miles or fixed amounts of money or to mileage rates of pay for miles
run in excess of the number of miles comprising a basic day.
(c) The amount of the cost-of-living allowance, if any, that will be effective
from one adjustment date to the next may be equal to, or greater or less than,
the cost-of-living allowance in effect in the preceding adjustment period.
(d) (i) Cap. In calculations under paragraph (e), the maximum increase in the
BLS CPI that will be taken into account will be as follows:
Effective Date Maximum CPI Increase That
of Adjustment May Be Taken Into Account
July 1, 1995 3% of September 1994 CPI
January 1, 1996 6% of September 1994 CPI,
less the increase from
September 1994 to March
1995
Effective Dates of Adjustment and Maximum CPI Increases conforming to the above
schedule shall be applicable to periods subsequent to those specified above
during which this Article is in effect.
(ii) Limitation. In calculations under paragraph (e), only fifty (50) percent of
the increase in the BLS CPI in any measurement period shall be considered.
(iii)If the increase in the BLS CPI from the base month of September 1994 to
the measurement month of March 1995 exceeds 3% of the September base index, the
measurement period that will be used for determining the cost-of-living
adjustment to be effective the following January will be the 12-month period
from such base month of September; the increase in the index that will be taken
into account will be limited to that portion of the increase that is in excess of
3% of such September base index; and the maximum increase in that portion of the
index that may be taken into account will be 6% of such September base index less
the 3% mentioned in the preceding clause, to which will be added any residual
tenths of points which had been dropped under paragraph (e) below in calculation of
the cost-of living adjustment which will have become effective July 1, 1995 during
such measurement period.
(iv) Any increase in the BLS CPI from the base month of September 1994 to the
measurement month of September 1995 in excess of 6% of the September 1994 base
index will not be taken into account in the determination of subsequent
cost-of-living adjustments.
(v) The procedure specified in subparagraphs (iii) and (iv) will be applicable
to all subsequent periods during which this Article is in effect.
(e) Formula. The number of points change in the BLS CPI during a measurement
period, as limited by paragraph (d), will be converted into cents on the basis
of one cent equals 0.3 full points. (By "0.3 full points" it is intended that
any remainder of 0.1 point or 0.2 point of change after the conversion will not
be counted.) The cost-of-living allowance in effect on December 31, 1995 will be
adjusted (increased or decreased) effective January 1, 1996 by the whole number
of cents produced by dividing by 0.3 the number of points (including tenths of
points) change, as limited by paragraph (d), in the BLS CPI during the
applicable measurement period. Any residual tenths of a point resulting from
such division will be dropped. The result of such division will be added to the
amount of the cost-of-living allowance in effect on December 31, 1995 if the BLS
CPI will have been higher at the end than at the beginning of the measurement
period, and subtracted therefrom only if the index will have been lower at the
end than at the beginning of the measurement period and then, only, to the
extent that the allowance remains at zero or above. The same procedure will be
followed in applying subsequent adjustments.
(f) Continuance of the cost-of-living allowance and the adjustments thereto
provided herein is dependent upon the availability of the official monthly BLS
Consumer Price Index (CPI-W) calculated on the same basis as such Index, except
that, if the Bureau of Labor Statistics, U.S. Department of Labor should, during
the effective period of this Article, revise or change the methods or basic data
used in calculating such Index in such a way as to affect the direct
comparability of such revised or changed index with the CPI-W Index during a
measurement period, then that Bureau shall be requested to furnish a conversion
factor designed to adjust the newly revised index to the basis of the CPI-W
Index during such measurement period.
Section 2 - Payment of Cost-of-Living Allowances
(a) The cost-of-living allowance payable to each employee effective July 1, 1995
shall be equal to the difference between (i) the cost-of-liv ing allowance in
effect on that date pursuant to Section 1 of this Part, and (ii) the cents per
hour produced by dividing one-quarter of the increase, if any, in the carriers'
1995 payment rate for foreign-to-occupation health benefits under the Plan over
such payment rate for 1994, by the average composite straight-time equivalent
hours that are subject to wage increases for the latest year for which
statistics are available, but not more than one-half of the amount specified in
clause (i) above. For the purpose of the foregoing calculation, the amount of
any increase described in clause (ii) that has been taken into account in
determining the amount received by the employee as a lump sum payment on January
1, 1995 shall not be taken into account.
(b) The cost-of-living allowance payable to each employee effective January 1,
1996, shall be equal to the difference between (i) the cost-of-living allowance
in effect on that date pursuant to Section 1 of this Part, and (ii) the cents
per hour produced by dividing one-quarter of the increase, if any, in the
carriers' 1996 payment rate for foreign-to-occupaticn health benefits under the
Plan over the amount of such payment rate for 1995, by the average composite
straight-time equivalent hours that are subject to wage increases for the latest
year for which statistics are available, but not more than one-half of the
amount specified in clause (i) above.
(c) The procedure specified in paragraph (b) shall be followed with respect to
computation of the cost-of-living allowances payable in subsequent years during
which this Article is in effect.
(d) The definition of the carriers' payment rate for foreign-to-occupation
health benefits under the Plan set forth in Section 5 of Part A shall apply with
respect to any year covered by this Section.
(e) In making calculations under this Section, fractions of a cent shall be
rounded to the nearest whole cent; fractions less than one-half cent shall be
dropped and fractions of one-half cent or more shall be increased to the nearest
full cent.
Section 3 - Application of Cost-of- Living Allowances
The cost-of-living allowance provided for in this Part will not become part of
basic rates of pay. In application of such allowance, each one cent per hour of
cost-of-living allowance that is payable will be treated as an increase of 8
cents in the basic daily rates of pay produced by application of Article I. The
cost-of-living allowance will otherwise be applied in keeping with the
provisions of Section 6 of Article I.
Section 4 - Continuation of Part B
The arrangements set forth in Part B of this Article shall remain in effect
according to the terms thereof until revised by the parties pursuant to the
Railway Labor Act.
ARTICLE III - HEALTH AND WELFARE PLAN AND EARLY RETIREMENT MAJOR MEDICAL BENEFIT
PLAN
Part A - Health and Welfare Plan
Section 1 - Continuation of Plan
The Railroad Employees National Health and Welfare Plan (the "Plan"), modified
as provided in this Part, will be continued subject to the provisions of the
Railway Labor Act, as amended. Contributions to the Plan will be offset by the
expeditious use of such amounts as may at any time be in Special Account A or in
one or more special accounts or funds maintained by any insurer, third party
administrator or other entity in connection with the Plan and by the use of
funds held in trust that are not otherwise needed to pay claims, premiums, or
administrative expenses that are payable from funds held in trust; provided,
however, that such amounts as may at any time be in that certain special account
maintained at The Travelers Insurance Company, known as the 'Special Account
Held in Connection with the Amount for the Close-Out Period,' relating to the
obligations of the Plan to pay, among other things, benefits incurred but not
paid at the time of termination of the Plan in the event such termination should
occur, shall be used to pay or provide for Plan benefits as follows: one-third
of the balance in such special account as of January 1, 1992, shall be used to
pay or provide for benefits that become due and payable during 1992. One-half of
the balance in such special account as of January 1, 1993, shall be used to pay
or provide for benefits that become due and payable during 1993. All of the
balance in such special account in excess of $25 million as of January 1, 1994,
shall be used to pay or provide for benefits that become due and payable during
1994. The $25 million referred to in the preceding sentence shall be maintained
by the Plan as a cash reserve to protect against adverse claims experience from
year to year.
In the event that a carrier participating in the Plan defaults for any reason,
including but not limited to bankruptcy, on its obligation to contribute to the
Plan, and the carrier's participation in the Plan terminates, the carriers
remaining in the Plan shall be liable for any Plan contribution that was
required of the terminating carrier prior to the effective date of its
termination, but not paid by it. The remaining carriers shall be obligated to
make up in a timely fashion such unpaid contribution of the terminating carrier
in pro rated amounts based upon their shares of Plan contributions for the month
immediately prior to such default.
Section 2 - Change to Self-Insurance
Except for life insurance, accidental death and dismemberment insurance, and all
benefits for residents of Canada, the Plan will be wholly self-insured
and administered, under an administrative services only arrangement, by an
insurance company or third party administrator.
Section 3 - Joint Plan Committee
The Joint Policyholder Committee shall be renamed the Joint Plan Committee. This
change in name shall not in any way change the functions and responsibilities of
the Committee.
A neutral shall be retained by and at the expense of the Plan for the duration
of this Implementing Document to consider and vote on any matter brought before
the Joint Plan Committee (formerly the Joint Policyholder Committee), arising
out of the interpretation, application or administration (including investment
policy) of the Plan, but only if the Committee is deadlocked with respect to the
matter. A deadlock shall occur whenever the carrier members of the Committee,
who shall have a total of one vote regardless of their number, and the
organization members of the Committee, who shall also have a total of one vote
regardless of their number, do not resolve a matter by a vote of two to nil and
either side declares a deadlock.
If the members of the Joint Plan Committee cannot agree upon a neutral within 30
days of the date this Implementing Document becomes effective, either side may
request the National Mediation Board to provide a list of seven persons from
which the neutral shall be selected by the procedure of alternate striking.
Joint Plan Committee members and the neutral shall, to the extent required by
ERISA, be bonded at the expense of the Plan. The Joint Plan Committee shall have
the power to create such subcommittees as it deems appropriate and to choose a
neutral chairman for such subcommittees, if desired.
Section 4 - Managed Care
Managed care networks that meet standards developed by the Joint Plan Committee,
or a subcommittee thereof, concerning quality of care, access to health care
providers, and cost-effectiveness, shall be established wherever feasible as
soon as practicable. Until a managed care network is established in a given
geographical area, individuals in that area who are covered by the Plan will
have the comprehensive health care benefit coverage described in Section 5 of
this Part A. Each employee in a given geographical area who is a Plan
participant at the time a managed care network is established in that area will
be enrolled in the network (along with his or her covered dependents) unless the
employee provides timely written notice to his or her employer of an election to
have (along with his or her covered dependents) the comprehensive health care
benefit coverage rather than to be enrolled in the network. Any such employee
who provides such timely written notice shall have an annual opportunity to
revoke his or her election by providing a written notice of revocation to his or
her employer at least sixty days prior to January 1 of the calendar year for
which such revocation shall first become effective. Similarly, each employee in
a given geographical area who is a Plan participant at the time a managed care
network is established in that area and is thereafter enrolled in the network
(along with his or her covered dependents) shall have an annual opportunity to
elect to have (along with his or her covered dependents) the comprehensive
health care benefit coverage rather than continue to be enrolled in the network.
This election may be made by such an employee by providing written notice thereof to
his or her employer at least sixty days prior to January 1 of the calendar year
for which the election shall first become effective. Each employee hired after a
managed care network is established in his or her geographic area (and his or
her covered dependents) will be enrolled in the network and may not thereafter
elect to be covered by the comprehensive benefits until the January 1 which
falls on or after the first anniversary of his or her initial date of
eligibility for Plan coverage. Employees who return to eligibility for Plan
coverage within 24 months of loss of eligibility for Plan coverage and whose
employment relationship has not terminated at any time prior to such return will
be enrolled in the program of Plan benefits in which they were enrolled when
their eligibility for Plan coverage was lost, and shall thereafter have the same
rights of election as other employees whose eligibility for Plan coverage was
not lost.
Covered individuals enrolled in a managed care network will have a point of
service option allowing them to choose an out-of-network provider to perform any
covered health care service that they need. The benefits provided by the Plan
when a service is performed by an in-network provider and the benefits provided
by the Plan when the service is performed by an out-of-network provider will be
as described in the table below:
PLAN FEATURE IN-NETWORK OUT-OF-NETWORK+
Primary Care Physician yes No
Required
Annual Deductible
Individual None $100
Family None $300
Deductible applies
to all covered
expenses
Plan/Employee Coinsurance 100%/0% 75%/25%
Annual Out-of-Pocket
Maximum (exclusive of
deductible)
Individual None $1.500
Family None $3,000
Maximum Lifetime Benefit None $1,000,000 ($5,000)
annual restoration)
Special Maximum Lifetime None $100,000 lifetime
Benefit for Mental Health ($500 annual restoration)
Hospital Charges (inpatient 100% 75%*
and outpatient)
Ambulatory Surgery 100% 75%*
Emergency Room 100% after $15 75%
employee copayment
Inpatient Mental Health &
Substance Abuse
Benefit
Hospital 100% 75%#
Alternative Care - 100% 75%#
Residential Treatment
Center Inpatient or
Partial Hospitalization/
Day Treatment
Outpatient Mental Health & 100% after $15 75%#
Substance Abuse employee copayment
per visit
Physician Services
Surgery/Anesthesia 100% 75%*
Hospital Visits 100% 75%*
Office Visits 100% after $15 75%**
employee copayment
Diagnostic Tests 100% 75%*
Routine Physical 100% after $15 Not Covered
employee copayment
Well Baby Care 100% after $15 Not Covered
employee copayment
Skilled Nursing Facility 100% 75%*
Care
Hospices Care 100% 75%*
Home Health Care 100% 75%*
Temporomandibular Joint 100% 75%*
Syndrome
Birth Center 100% 75%*
Prescription Drugs 100% after $5 75%**
(other than by employee copayment
mail order) for brand name
($3 for generic)
Mail Order Prescription 100% after $5 100% (not subject to
Drugs (60-90 day supply employee copayment regular deductible)
of maintenance drugs after $5 employee co-
only) payment (not counted
toward regular de-
ductible)**
Claim System Paperless Forms Required
Approved by Utilization Physician-initiated Required. If approval
Review/Large Case included in network not given, benefits
Management management reduced by 20% (except
for mental health and
substance abuse care
where benefits reduced by
50%) both before and
after annual out-of-
pocket maximum is
reached, and amount of
reduction is not counted
toward that maximum.
+ The medically necessary health care services for which out-of-network benefits
will be paid are those listed in subparagraphs 1 through 7 of Part A, Section 5,
of this Implementing Document.
* Benefits reduced by 20% if care is not approved by utilization review program.
# Benefits reduced by 50% if care is not approved by utilization review program.
**Benefits not generally subject to utilization review program but may be
reviewable in specific circumstances with advance notice to the employee; in
such cases, benefits reduced by 20% if care not approved by utilization review
program.
At any time after the expiration of two years from the effective date of
implementation of the first managed care network, either the carriers or the
organizations may bring before the Joint Plan Committee for consideration a
proposal to change the Plan's in-network or out-of-network benefits for the
purpose of promoting an increase in the use of in-network providers by Plan
participants.
Section 5 - Comprehensive Health Care Benefits
The comprehensive health care benefits provided under the Plan in geographical
areas where managed care networks are not available to Plan participants and
their dependents, and in cases where a Plan participant has elected to be
covered, along with his or her dependents, by such comprehensive benefits rather
than to be enrolled in a managed care network, shall be as described below.
Terms used in such description shall have the same meaning as they have in the
Plan.
After satisfaction of an annual deductible of $100 per covered individual or
$300 per family unit of three or more, the Plan will pay 85%, and the covered
individual 15%, of certain health care expenses, up to an annual out-of- Pocket
maximum which shall not include the deductible) of $1,500 per covered individual
or $3,000 per family. The expenses counted toward the $3,000 annual family
out-of-pocket maximum will include those, which are otherwise eligible, incurred
on behalf of a covered employee and each of his or her covered dependents
regardless of whether the employee or dependent has reached the $1,500
individual annual out-of-pocket maximum. Once the applicable annual
out-of-pocket maximum has been reached, the Plan will pay 100% of such
reasonable charges up to an overall lifetime maximum of $1 million per covered
individual, restorable at a rate of $5,000 per year; provided, however, that
there shall be a separate lifetime maximum of $100,000 per covered individual,
restorable at a rate of $500 per year, for Plan benefits for the treatment of
mental and/or nervous conditions and substance abuse. (Benefits counted for
purposes of determining whether or not a lifetime maximum has been reached are
all benefits paid under the Plan as amended by this Implementing Document and
all Major Medical Expense Benefits paid under the Plan prior to such
amendments.) The Plan will pay 85% of the reasonable charges for medically
necessary health care services as follows:
1. All expenses that are "Covered Expenses" (as defined in the Plan) at any time
under the current major medical expense benefits provisions of the Plan, and not
within any exclusions from and limitation upon them, except that the exclusion for
the treatment of polio will be removed.
2. Expenses for mammograms described in American Cancer Society guidelines,
childhood disease immunization, pap smears and colorectal cancer screening.
3. Donor expense benefits as now defined.
4. Jaw joint disorder benefits as now defined, and subject to the current
exclusions from and limitation on them, except that the $50 separate lifetime
cash deductible will be removed.
5. Home health care expense benefits as now defined, subject to the current
exclusions from and limitation on them, except that the exclusion that governs
if polio benefits are payable will be removed.
6. Treatment center expense benefits, subject to the current exclusions from and
limitation on them, except that
a. the separate $100 cash deductible per confinement will be removed in
connection with benefits for transportation to a treatment center, and
b. the separate $100 cash deductible per benefit period and the S40 maximum
limitation on benefits per episode of treatment - all with regard to outpatient
benefits - will be removed.
7. Expenses for the services of psychologists if benefits would be paid for such
services had they been rendered by a physician.
The Plan will provide the same benefits to all employees eligible for Plan coverage, including those in their first year of such eligibility and those eligible for extended Plan coverage because of disability.
The Plan's comprehensive health care benefits will include, where permissible under applicable law, a mail order prescription drug benefit that will reimburse a covered individual, after he or she pays $5.00 per prescription, 100% of the cost of prescriptions covering a 60-to-90 day supply of maintenance drugs for such individual. This benefit will not be subject to, and the covered individual's $5.00 copayment will not be counted against, the Plan's regular $100/$300 deductible and will be included only upon execution of appropriate contracts with vendors.
Section 6 - Strengthened Utilization Review and Case Management
The Plan's current utilization review/case management contractor, and any
successor, shall henceforth require that its prior approval be secured for the
following services to the extent that benefits with respect to them are payable
under the Plan: (a) all non-emergency confinements, and all lengths of stay, in
any facility, (b) all hc Jme health care, and (c) all inpatient and outpatient
procedures and treatment, except for any care where, pursuant to standards
developed by the Joint Plan Committee, prior approval is not feasible or would
not be cost-efficient. Approval may be withheld if the utilization review/case
management contractor determines that a less intensive or more appropriate
diagnostic or treatment alternative could be used.
If an individual covered by the Plan incurs expenses without the requisite
approval of the Plan's utilization review/case management contractor, such
benefits as the Plan would otherwise pay will be reduced by one-fifth; provided,
however, that if such unapproved expenses are incurred for the treatment of
mental or nervous conditions or substance abuse, such benefits as the Plan would
otherwise pay will be reduced by one-half. These reductions will continue to
apply after the out-of-pocket maximum is reached, i.e., the l00% benefit will
become 80 % (or 50%, as the case may be) if approval by the utilization
review/case management contractor is not obtained.
When there is disagreement between an attending physician and the utilization
review/case management contractor, the patient and/or attending physician, after
all opportunities for appeal have been exhausted within the utilization
review/case management contractor's organization, shall be afforded an
opportunity to obtain a review (including if necessary, an examination) by an
independent specialist physician. This independent physician, who shall be
conveniently located and board certified in the appropriate specialty, shall be
designated by a physician appointed for this purpose by the Joint Plan
Committee. Neither physician may be an employee of or under contract to the
utilization review/case management contractor. In the event of an appeal to a specialist described above, the utilization review/case management contractor shall bear the burden of convincing the specialist that the utilization review/case
management contractor's determination was correct.
Section 7 - Coordination of Benefits
The Plan's coordination of benefit rules shall be changed so that the Plan will
pay no benefit to any covered individual that would cause the sum of the
benefits paid by the Plan and by any other plan with which the Plan coordinates
benefits to exceed (a) the maximum benefit available under the more generous of
the Plan and such other plan, or (b) with respect only to spouses who are both
covered as employees under the Plan (and the Dependents of such spouses), and to
spouses one of whom is covered as an employee under the Plan and the other as a
retired railroad employee under the Railroad Employees National Early Retirement
Major Medical Benefit Plan (and the Dependents of such spouses), 100% of the
reasonable charges for services the expense of which is covered by the Plan.
Section 8 - Medicare Part B Premiums
Active employees currently covered by Medicare Part B and those who elect to
enroll in Medicare Part B when they become eligible shall not be reimbursed for
premiums they pay for such Part B Medicare participation unless Medicare is
their primary payor of medical benefits.
Section 9 - Solicitation of Bids
As promptly as practicable, the Joint Plan Committee will solicit bids from
qualified entities for the performance of (a) all managed care functions under
the Plan, including without limitation the establishing and/or arranging for the
use by individuals covered by the Plan of managed networks of health care
providers in those geographical areas where it is feasible to do so, and (b) all
utilization review/case management functions under the Plan, including
specialized utilization review/case management functions for mental health and
substance abuse to assure expert determination of medical necessity and
appropriateness of treatment and provider. The Committee will select one or more
contractors, from among those that the Committee determines are likely to
provide high-quality, cost-effective services, to perform such functions on
behalf of the Plan. In the meantime, the Plan's current utilization review/case
management contractor will continue to perform those functions. Hospital
associations shall be incorporated into the managed care networks wherever
appropriate.
Upon the expiration of three years from the effective date of this Implementing
Document, the Joint Plan Committee will solicit bids for all of the services
involved in the administration of the Plan, including the utilization
review/case management and/or managed care functions, unless the Committee
unanimously determines not to seek bids for any one or more of the services
involved in the administration of the Plan.
Part B - Early Retirement Major Medical Benefit Plan
Section 1 - Continuation of Plan
The Railroad Employees Early Retirement Major Medical Benefit Plan ("ERMA"),
modified as provided in this Part, will be continued subject to the provisions
of the Railway Labor Act, as amended. Contributions to ERMA will be offset by
the expeditious use of such amounts as may at any time be in one or more special
accounts or funds maintained by any insurer, third party administrator or other
entity in connection with ERMA and by the use of funds held in trust that are
not otherwise needed to pay claims, premiums, or administrative expenses that
are payable from funds held in trust; provided, however, that such amounts as
may at any time be in the special account maintained at The Travelers Insurance
Company in connection with the obligations of ERMA to pay benefits incurred but
not paid at the time of termination of ERMA, in the event such termination
should occur, shall be used to pay or provide for Plan benefits as follows:
one-third of the balance in such special account as of January 1, 1992, shall be
used to pay or provide for benefits that become due and payable during 1992.
One-half of the balance in such special account as of January 1, 1993, shall be
used to pay or provide for benefits that become due and payable during 1993. All
of the balance in such special account in excess of $1 million as of January 1,
1994, shall be used to pay or provide for benefits that become due and payable
during 1994. The $1 million referred to in the preceding sentence shall be
maintained by the Plan as a cash reserve to protect against adverse claims
experience from year to year.
Section 2 - Change to Self-Insurance
EMRA will be wholly self-insured. It will be administered, under an
administrative services only arrangement, by an insurance company or third party
administrator.
Section 3 - Coordination of Benefits
ERMA's coordination of benefit rules shall be changed so that ERMA will pay no
benefit to any covered individual that would cause the sum of the benefits paid
by ERMA and by any other plan with which ERMA coordinates benefits to exceed (a)
the maximum benefit available under the more generous of ERMA and such other
plan, or (b) with respect only to spouses who are both covered as retired
railroad employees under ERMA (and the Dependents of such spouses), and to
spouses one of whom is covered as a retired railroad employee under ERMA and the
other as an employee under the Railroad Employees National Health and Welfare
Plan (and the Dependents of such spouses), 100% of the reasonable charges for
services the expense of which is covered by ERMA.
Section 4 - Strengthened Utilization Review and Case Management
ERMA's current utilization review/case management contractor, and any successor,
shall henceforth require that its prior approval be secured for the following
services to the extent that benefits with respect to them are payable under
ERMA: (a) all non-emergency confinements, and all lengths of stay, in any
facility, (b) all home health care, and (c) all inpatient and outpatient
procedures and treatment, except for any care where prior approval is not
feasible or would not be cost-efficient. Approval may be withheld if the
utilization review/case management contractor determines that a less intensive
or more appropriate diagnostic or treatment alternative could be used.
If an individual covered by ERMA incurs expenses without the requisite approval of
ERMA's utilization review/case management contractor, such benefits as ERMA
would otherwise pay will be reduced by one-fifth; provided, however, that if
such unapproved expenses are incurred for the treatment of mental or nervous
conditions or substance abuse, such benefits as ERMA would otherwise pay will be
reduced by one-half.
When there is disagreement between an attending physician and the utilization
review/case management contractor, the patient and/or attending physician, after
all opportunities for appeal have been exhausted within the utilization
review/case management contractor's organization, shall be afforded an
opportunity to obtain a review (including if necessary, an examination) by an
independent specialist physician. This independent physician, who shall be
conveniently located and board certified in the appropriate specialty, shall be
designated by a physician appointed for this purpose by mutual agreement between
the Chairman of the Health and Welfare Committee, Cooperating Railway Labor
Organization and of the National Carriers' Conference Committee. Neither
physician may be an employee of or under contract to the utilization review/case
management contractor. In the event of an appeal to a specialist described
above, the utilization review/case management contractor shall bear the burden
of convincing the specialist that the utilization review/case management
contractor's determination was correct.
The standards developed by the Joint Plan Committee for determining whether or
not prior approval is feasible and cost-efficient under the Health and Welfare
Plan shall be applied by the National Carriers' Conference Committee under ERMA,
and the utilization review/case management contractor(s) selected by the Joint
Plan Committee under the Health and Welfare Plan shall be selected by the
National Carriers' Conference Committee under ERMA.
Section 5 - Mail Order Prescription Drug Benefit
The Plan's benefits will include, where permissible under applicable law, a mail
order prescription drug benefit that will reimburse a covered individual, after
he or she pays $5 per prescription, 100% of the cost of each prescription
covering a 60-90 day supply of maintenance drugs for such individual. This
benefit will not be subject to, and the covered individual's $5.00 co payment
will not be counted against, the Plan's regular $100 deductible, and will be
included only upon execution of appropriate contracts with vendors.
Section 6 - Solicitation of Bids
As promptly as practicable, the National Carriers' Conference Committee will
solicit bids from qualified entities for the performance of all utilization
review/case management functions under the Plan, including specialized
utilization review/case management functions for mental health and substance
abuse to assure expert determination of medical necessity and appropriateness of
treatment and provider. The Committee will select one or more contractors, from
among those that the Committee determines are likely to provide high-quality,
cost-effective services, to perform such functions on behalf of the Plan. In the
meantime, the Plan's current utilization review/case management contractor will
continue to perform those functions.
Upon the expiration of three years from the date of this Implementing Document,
the National Carriers' Conference Committee will solicit bids for all of the
services involved in the administration of the Plan, including the utilization
review/case management function, unless the Committee determines not to seek
bids for any one or more of the services involved in the administration of the
Plan.
ARTICLE IV - PAY RULES
Section 1 - Mileage Rates
(a) Mileage rates of pay for miles run in excess of the number of miles
comprising a basic day will not be subject to general, cost-of-living, or other
forms of wage increases.
(b) Mileage rates of pay, as defined above, applicable to interdivisional,
interseniority district, intradivisional and/or intraseniority district service
runs now existing or to be established in the future shall not exceed the
applicable rates as of June 30, 1986. Such rates shall be exempted from wage
increases as provided in Section 1(a) of this Article. Weight-on-drivers
additives will apply to mileage rates calculated in accordance with this
provision.
Section 2 - Miles in Basic Day and Overtime Divisor
(a) The miles encompassed in the basic day in through freight and through
passenger service and the divisor used to determine when overtime begins will be
changed as provided below:
Effective Date Through Freight Service Through Passenger Service
of Change
Miles in Basic 0vertime Miles in Basic 0vertime
Day Divisor Day Divisor
July 29, 1991 114 14.25 114 22.8
January 1, 1992 118 14.75 118 23.6
January 1, 1993 122 15.25 122 24.4
January 1, 1994 126 15.75 126 25.2
January 1, 1995 130 16.25 130 25.0
(b) Mileage rates will be paid only for miles run in excess of the minimum
number specified in (a) above.
(c) The number of hours that must lapse before overtime begins on a trip in
through freight or through passenger service is calculated by dividing the
miles of the trip or the number of miles encompassed in a basic day in that
class of service, whichever is greater, by the appropriate overtime divisor.
Thus, effective July 29, 1991, overtime on a trip in through freight service of
125 miles will begin after 8 hours and 46 minutes (125/14.25 = 8.77 hours). In
through freight service, overtime will not be paid prior to the completion of 8
hours of service.
Section 3 - Conversion to Local Rate
When employees in through freight service become entitled to the local rate of
pay under applicable conversion rules, the daily local freight differential (56
cents for engineers and 43 cents for firemen under national agreements) will be
added to their basic daily rate and the combined rate will be used as the basis
for calculating hour |