Benefit changes retroactive to Jan. 1, 2021, for UAW Retiree Medical Benefits Trust members

Earlier this year, the UAW Retiree Medical Benefits Trust requested Blue Cross Blue Shield of Michigan make the benefit changes outlined below for its members in the Enhanced Care Plan, or ECP, and the Traditional Care Network, or TCN. All current benefits identified below are effective retroactive to Jan. 1, 2021, for these members.

• Ambulatory infusion centers:
• Previously, medical drugs and related services administered at an ambulatory infusion center weren’t covered.
• Medical drugs and related services administered at an ambulatory infusion center will be a covered benefit.  
• This benefit will now align with the Blue Cross standard payment and reimbursement policy.
• Member cost share will apply.

• Occupational therapy and speech therapy services:
• Previously, OT and ST services applied in‑network cost share.
• In‑network OT and ST services will be covered at 100%.

• Outpatient behavioral health and substance use disorder:
• The 35‑visit limit for outpatient visits will be removed. This change allows for unlimited outpatient behavioral health and substance use disorder visits but doesn’t apply to partial hospitalization services.
• Behavioral health services rendered by a physician assistant will also be covered. 
• No change to current member cost share.

• Medical injections:
• Previously, the Trust had group-specific coverage for medical injections and was limited to specific types (considered surgical in nature or related to a malignancy). 
• All medical injection types will be covered provided the medical drug itself is a covered benefit.  
• No change to current member cost share.
• This benefit will now align with the Blue Cross standard payment and reimbursement policy.

• Medical emergency criteria:
• Previously, the Trust had group-specific medical emergency qualification criteria.
• The Trust will align with Blue Cross’ standard medical emergency diagnoses and qualification standards for professional and facility services.
• The “72-hour rule” is no longer applicable for emergency room claims. This will eliminate the claims rejecting for treatment not being sought within 72 hours from the onset of symptoms.

• Tobacco cessation:
• Trust members are no longer required to participate in any tobacco cessation program as a pre‑requisite to receive prescription tobacco cessation medications.
• Questions about these claims should be directed to Express Scripts.

Claims for members with the affected services will be reprocessed and restored starting at the end of September to pay correctly to the health care provider.

About 30 days after the claims are restored, members will receive letters letting them know that their claims have been reprocessed and if they paid their health care provider for one of the services, then they could be entitled to a refund or a credit to the members’ account. We’re instructing members to contact their health care providers about these services.

The benefit information will be updated on web-DENIS, so be sure to check there for member benefit and eligibility information.