General Plan Overview

CREW is controlled by the elected officers and trustees of the Small Railroad Business Owners Association of America (SRBOA). Participation in CREW is contingent upon maintaining an annual membership. The Plan is subject to the Employee Retirement Income Security Act (ERISA) of 1974 as amended including such provisions for COBRA and HIPAA and all other federal benefit mandates.

Each employer may select and provide the benefit plan that fits their pocketbook and the needs of their employees and dependents. The plan can include medical, prescription drugs, dental, vision or short term disability coverage. Group life and AD&D coverage is also available through an “A” rated national group life insurance company. The healthcare rates for each participating employer group are based on the discounted cost of benefits in the geographic area where the employees and dependents reside, their actual age, sex, and family status and the general medical condition of the employer group.

CREW is not in and of itself insurance. The Plan, however, purchases insurance direct from the world insurance market under one policy. Under this insurance arrangement all eligible medical benefits are guaranteed from the first eligible dollar to the limits set forth in the Summary Plan Description by qualified “A” rated Underwriters at Lloyd’s, London. There is no need for a primary domestic insurer, a major savings in itself. While the Plan is not covered by any state GUARANTY association, the insurers are required to guarantee the full amount of all outstanding U.S. claims with security held in a trust in the United States.

Through CREW, each participating employee receives a Summary Plan Description (rather than an insurance policy) describing all the benefits provided. Each employee receives an identification card showing the selected preferred provider.

The insurance for the Plan is provided through R. J. Wilson & Associates Ltd., a reinsurance brokerage house and direct correspondent with Underwriters at Lloyd’s, London. The plan administration, payment and processing of claims is provided by Medical Benefits Administrators of MD, Inc., a well known third party administrator domiciled in Maryland using all the latest state of the art information and benefit processing systems.

Major Plan Features

Major Medical

Comprehensive Major Medical Benefits are provided up to $1,000,000 per employee and their dependents per person per year and a lifetime maximum of $2,000,000 per person for the rail industry in all states. CREW is subject to federal provisions such as "ERISA", "COBRA", and "HIPAA." Without general claims experience, medical information may be required at inception but such information is used for group rating purposes only. Additional new employees will be added subject to the rules of HIPAA.

Medical benefits are extended to cover occupational injuries or diseases of employees (only) of railroads engaged in interstate commerce.

Fully Insured

Under the insurance arrangement all benefit claims of eligible employees or dependents incurred during the Period of Insurance are directly guaranteed from the first eligible dollar to the limits of the set forth in the Summary Plan Description by certain qualified “A” rated Underwriters at Lloyd’s, London.

Interstate Railroads

Occupational medical (24 hour) insurance coverage is included for employees only up to $1,000,000 per year per person and a lifetime maximum of $2,000,000 per person.

Supplemental occupational short term disability coverage is available up to $500 per week to all full time railroad employees. This coverage is integrated with the benefits of the Railroad Unemployment Act.

Employer contributions are first applied to the cost of occupational benefits. CREW will not attempt to recover occupational medical or short term disability claims from the interstate railroad’s own liability insurer. Occupational claims are paid on behalf of the railroad employer, thereby reducing the employers obligation to the employee and making it possible to obtain a premium credit from your liability insurer.

Contributions

Preferred Providers

Before you change doctors, we´ll change networks. CREW has several National & Regional PPO networks available. To see a complete list go to our PPO map and/or PPO list.

Utilization

Each employee has access to a toll free line that they may call 24 hours per day, 7 days per week for pre-certification of inpatient, outpatient, and elective procedures, diagnostics, therapies, network guidance, and other needs. The utilization program includes concurrent, and retrospective review, as well as a second opinion program. Participation in CREW will allow for an appeals process as well as access to additional national and international networks. CREW also provides specific large claim management services with a focus to facilitate more individualized and coordinated care.

Administrators

CREW is administered exclusively by Medical Benefits Administrators of MD, Inc. [MBA], a R. J. Wilson & Associates Ltd. affiliate. MBA processes all claims, provides day to day management, as well as assumes the fiduciary duties of "plan administrator" as set forth in ERISA. All federal filings are made by MBA. MBA, is an approved benefit administrator with Underwriters at Lloyd’s London.

MBA is a full service benefit administration firm affiliated with R. J. Wilson & Associates Ltd. the reinsurance intermediary providing the insurance for CREW. MBA provides the claims administration for CREW. MBA utilizes the state of the art Trizetto Quiclink System (formerly known as Resource Information Management or “RIMS”) in the management of benefit claims. MBA also employs Solucient Auto Audit and other similar systems as well as INGENIX (formerly Medicode) in the administration of claims.

R. J. Wilson & Associates Ltd. provides all underwriting services. All administration services are provided by or through MBA for one level management fee to reduce cost.

Other Benefits

Of course, CREW provides a selection of group life, accidental death and dismemberment coverage written on a true group basis for groups of ten or more. Optional dental and vision coverage is also available.

Who Can Participate?

Class II railroads including regional and group railroads; Class III railroads including short line railroads; switching railroads; terminal railroads; excursion railroads; small passenger railroads including excursion and scenic railroads; railroad contractors that primarily perform railroad functions or are commonly owned by a railroad group; railroad equipment and repair locomotive facilities. Other rail industry entities may be considered if approved by legal counsel and the Trustees of CREW.