Alternative health care option

Q

I would like to ask Human Resources if they have looked into adding an
alternative medicine program to the list of our existing health plans. Also
I would like to see an alternative medical rider offered to our existing
plans to cover chiropractic, acupuncture, and naturopathic services.

Answered on October 27, 1997

A

There are two separate questions here.

The first asks if Human Resources has looked into adding an
additional option to the medical plan that would cover alternative
medicine. We have not. Group plans covering alternative medicine are not
common but do exist. We have not been approached by any provider of
alternative medicine plans, and are not aware of any provider in the area.
In the past two years, we have had no employee ask for such separate
coverage. If there were sufficient employee interest, and if the costs were
comparable to our newer medical plans, we would certainly investigate the
possibility of adding such an option. Since this would add to our
administrative costs, there would need to be significant employee
participation to justify the additional option.

The second question is more common and concerns provision of our
current plans. UCAR currently offers three basic plans. Two of them, Kaiser
and PacificCare EPO, are HMOs, and the provisions of the plans are
generally established by the providers. These plans are designed to be
cost-efficient and include standard medical preventative care. Both plans
have some restrictions on treatments and providers. Adding alternative
medicine options to these plans is inconsistent with the intent of the
plans and would increase the cost to UCAR and all participants.

The third UCAR plan is the PacifiCare PPO plan. This plan allows
employees more flexibility in providers and treatment plans, as long as the
treatment is medically necessary. This plan allows for certain treatments
by practitioners of acupuncture or chiropractic medicine. Chiropractic care
is covered only when medically necessary because of injury or illness
incurred under this plan. Maintenance care is not covered.

Acupuncture is covered for the relief of pain. As mentioned in the
summary plan description: "Eligible diagnoses include but are not limited
to: a) pain from surgical procedures; or b) pain from injuries that involve
strains or sprains of muscles, ligaments, or tendons of any body part.
Ineligible diagnoses include but are not limited to: a) hepatitis, b) flu,
c) allergies, d) weight loss, e) smoking cessation, f) internal pain, or g)
other general illness.

Chiropractic and acupuncture treatments are subject to review for
medical necessity and may have additional limits on the number of sessions
allowed. UCAR relies on PacifiCare to determine medical necessity and
eligibility of all claims.

Other alternative medical practices, including naturopathic services,
are not covered at this time. There is no plan to add new alternative
medical practices to the plan in 1998. While we are not aware of any
personal plans that may cover alternative medicine, you may check with
local practitioners to see if they know of plans that provide supplemental
coverage.

--Bob Roesch, Manager, Human Resources