Workers and retirees who don't get pre-clearance from their health plans for non-emergency hospitalization next year will be hit with a $500 penalty.
Pre-clearance, which has been standard practice for years in many private health plans, is one of the new 1991 cost-containment features in the federal employee health benefits program. The federal program covers about half of the insured people in the Washington area.
Most federal health maintenance organizations have had the pre-clearance rule all along. But it is new for most of the traditional fee-for-service plans. That is important since 75 percent of the people in the federal program are in fee-for-service plans such as Blue Cross, GEHA or popular union-backed plans such as the Mailhandlers or the American Postal Workers Union plan.
Emergency hospitalizations are exempt from the pre-clearance requirement. But for other conditions such as elective surgery, you or your doctor must notify your health plan and get its approval before you go to the hospital. Just telling them you are going in won't do it. Otherwise, expect the $500 penalty.
In another cost-control measure, most fee-for-service plans also will base limits on what they will pay on "reasonable and customary" charges made by local doctors. Some will set ranges based on communities; some will go by the zip code of the physician in determining what is reasonable and customary for that area. This can be a tricky feature in a big metropolitan area such as Washington that has lots of doctors and many different rates. It would help if your doctor would check over the brochures of the plans you are considering to see if his fees fit within the ranges they will pay.
The Wheaton chapter of the National Association of Retired Federal Employees will have its regular 1 p.m. meeting today at the Wheaton Community Recreation Center.
About 40,000 members of the National Association of Retired Federal Employees sent telegrams to Congress protesting the plan to freeze and then reduce retiree cost-of-living adjustments. The association set up a phone service so members could, for a fee, send pre-written telegrams. Congress dropped the pension freeze plan. Result: Federal-military and Social Security retirees will get a 5.4 percent increase in January.
Foreign Service Spouses
George Mason University and the State Department has set up a new program to prepare spouses of Foreign Service officers for teaching jobs in schools overseas. The program is called "Fast Train" and leads to a state certification in elementary or secondary education, which in turn could lead to a job overseas. For details, call Michele Braithwaite at 703-764-7804.
Retired Adm. William J. Crowe Jr. will speak at the Nov. 28 noontime meeting of the National Military Family Association. The session will be at the Army-Navy Country Club. For details, call 703-823-NMFA.