SHBP Introduces Innovative Benefits

 

May 2013

 

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Eligible Seafarers and their dependents have access to new benefits, according to a recent communication from the Seafarers Health and Benefits Plan (SHBP).

 

An early April letter from Seafarers Plans Administrator Maggie Bowen to SHBP participants described “new rehabilitation benefits for Seafarers and their dependents at the Core and Core-Plus benefit levels. The benefits will provide coverage for inpatient and outpatient rehabilitation services for Seafarers and their dependents who are recovering from a catastrophic illness or injury. The Trustees have approved this benefit as a one-year pilot program, retroactive to January 1, 2013. At the end of the year, the Trustees will evaluate the benefits, and make a determination about rehabilitation benefits for 2014 and any subsequent years.”

 

In addition to the regular mailing, a PDF copy of the letter is posted in the SHBP section of the SIU website located HERE.

 

The letter specifies that in order to be eligible, the member or his or her dependent “must be recovering from a catastrophic illness or injury, which the Plan defines as: the acute onset of a medical condition resulting from an illness or injury, which will require extensive rehabilitation services. Some examples of a catastrophic illness or injury are: a stroke, a severe accident, or a heart attack. In order to be eligible for this benefit, the patient must be expected to improve to a certain level of recovery and must require rehabilitative therapy or skilled nursing care on a daily basis. The Plan still does not provide benefits for custodial care.”

 

During the pilot program, the SHBP will pay for inpatient rehabilitation for eligible Seafarers for up to 180 days or $1 million per inpatient stay, or until the member “reaches maximum medical improvement … when the Seafarer is confined at a skilled nursing facility or acute rehabilitation facility.” Coverage amounts vary depending on whether facilities are in or out of network. Also, the benefit covers charges for physical, occupational, speech, pulmonary and cognitive therapy while the employee is an inpatient.

 

Outpatient rehabilitation services for members following a catastrophic illness or injury also are covered. This is separate from the physical therapy benefit that members already receive for non-catastrophic illness or injury.

 

For eligible dependents of members at the Core or Core- Plus levels, the SHBP also will pay for inpatient rehab for up to 180 days or $1 million per inpatient stay, or until the dependent “reaches maximum medical improvement … when a dependent is confined at a skilled nursing facility or acute rehabilitation facility.” Here again, coverage amounts differ based on network status, and the benefit covers charges for physical, occupational, speech, pulmonary and cognitive therapy while the dependent is an inpatient.

 

Detailed information about other components of the new coverage is available in the letter. This includes outpatient rehab services for dependents, cardiac rehabilitation, and rental or purchase of durable medical equipment that is required in rehab.

 

“These new benefits are subject to the same limitations on the payments of benefits, as well as the deductible amounts, copayments and co-insurance that apply to other Plan benefits,” Bowen noted in the letter.

 

Questions may be directed to the SHBP at (800) 252-4674.

 

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