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Corporate Benefits Specialist

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Presentation on theme: "Corporate Benefits Specialist"— Presentation transcript:

1 Corporate Benefits Specialist
WCA Group Health Insurance Plan Health Reimbursement Arrangement Plan (HRA) March 4th and March 6th, 2014 Janice L. Wavra Corporate Benefits Specialist

2 Agenda The Insurance Center Group Health Insurance Plan
Understanding your Explanation of Benefits (EOB) Health Reimbursement Arrangement Plan (HRA) How to File HRA Claims Cost Savings Ideas Recap & Questions

3 The Insurance Center Locally Owned, Established in 1960
03/13/2012 The Insurance Center Locally Owned, Established in 1960 Located 701 Sand Lake Road, Onalaska, WI Service Team Janice L. Wavra (22 years) Kim Ness (19 years) Nancy Silbaugh (28 years) Kari Steele (11 years) Stacey Sila (16 years) T.I.C., Inc.

4 WCA Group Health Trust Health Insurance Plan
Plan Effective 9/1/13 In-Network Out-of-Network Deductible** $500 Single $1,000 Family $1,000 Single $2,000 Family Coinsurance 90% 80% Maximum Out-of-Pocket $1,500 Single $3,000 Family Office Visit Copay $25 Per Visit Chiropractic Services Copay Prescription Drug Copay $0 Generic $10 Generic $25 Preferred Brand $50 Non Preferred Brand ** Any portion of the current deductible met from January 1, 2013-August 31, 2013 will apply to the new plan’s deductible on September 1, 2013 and run through June 30, 2014.

5 Explanation of Benefits “EOB”
Patient Network

6 A minus B minus C = Coinsurance
“EOB” Continued 90% Coin surance B C A A minus B minus C = Coinsurance Maximum HRA Benefit: $250 Single ~ $500 Family

7 Health Reimbursement Arrangement Plan “HRA”
The HRA plan is 100% funded and paid by the District so there is no additional cost to you and your family. Single Coverage: The HRA plan will reimburse up to the maximum of $250 in coinsurance expenses. Family Coverage: The HRA plan will reimburse up to the maximum of $500 in coinsurance expenses. In order to be eligible for the HRA plan, you must be enrolled in the District’s group health plan with WCA Group Health Trust. The plan year runs September 1, 2013 through June 30, 2014.

8 What is My Maximum Out-of-Pocket Exposure?
Benefit WCA Health Plan In-Network HRA Pays Employee Pays Deductible ** $500 Single $1,000 Family $0 Single $0 Family Coinsurance $250 Single $500 Family Maximum Out-of-Pocket $1,000 Single $2,000 Family $750 Single $1,500 Family ** Plan year September 1, 2013 and through June 30, 2014

9 How Does the HRA Plan Work for
In-Network Providers? Note: Copays for Office Visits, Chiropractors, Emergency Room, and Prescriptions do NOT apply to the Deductible, Co-Insurance, or Maximum Out-of-Pocket.

10 Your health care provider submits the claim to WCA.
How to Use the HRA Plan Your health care provider submits the claim to WCA. When receiving a service, you must present your WCA ID Card to your health care provider. You must submit your HRA claim for reimbursement to EBC by completing an EBC HRA Claim Form and attaching a copy of the EOB from WCA. WCA reviews and processes the claim and provides you with the Explanation of Benefits (EOB).

11 How to File Your HRA Claims to EBC
Fax Online Mail Employee Benefit Corporation PO Box 44347 Madison, WI Phone Support or M-F 8:00-5:00 Central

12 EBC’S HRA Claim Form Name Name Employer Code “H”

13 EBC’S HRA Claim Form Continued

14 Preventive Care Services
100% Coverage for: Preventive Care Exams Well-Child Care Well-Woman Gynecological Exams Mammograms Adult and Child Immunizations Hearing Exam (1 per calendar year) Vision Exam (1 per calendar year)

15 Cost Savings Ideas Preventive Care Services
Utilize In-Network Providers Health Care Access Neighborhood Family Clinic ChiroMed, LLC Nurses Help Line $4 Script Programs

16 WCA Group Health Trust In-Network Providers
Website: Click on: “Find A Provider” Then, “Medical”, “Medical Provider Search”, Select “U” Select a Plan “United Healthcare Option” Click on, “Medical, click here to access the UHC Provider Search Application” Select State, City, Physician, or Facility

17 Health Care Access Express Care Urgent Care Emergency Room
Bladder, urinary tract infections Non-life threatening illness or injury Life threatening illness or serious injury Bronchitis After regular clinic hours Chest pain, heart attack Common Warts Colds, sore throat Broken bones Ear pain, infections or excess wax Cuts, scrapes, bruises, skin rash, minor burns Numbness or weakness on one side, stroke symptoms Flu, influenza Back pain Severe headache Insect, tick bites Strains, sprains Loss of consciousness Mononucleosis Your primary care provider is not available Shortness of breath, confusion, dizziness Pink eye Severe abdominal pain Sinus infections

18 Urgent Care vs Emergency Room
Average Urgent Care Visit $185 Average Emergency Room Visit $800 Gundersen Lutheran **1900 South Avenue, La Crosse, M-F: 7am – 9pm, Sat-Sun: 9am – 7pm 3111 Gundersen Drive, Onalaska, M-F: 7am – 9pm, Sat-Sun: 9am – 5pm Franciscan Skemp ** West Ave & Market, La Crosse, Daily: 6am – Midnight 191 Theater Road, Onalaska, M-F: 5pm – 9pm, Sat-Sun: 9am – 5pm 1303 Main, Holmen, M-Thur: 7am – 7pm, Fri: 7am – 5pm Winona Health M-Thur: 8am – 8pm, Fri-Sun: 8am – 5pm ** Note: All services at this location are billed as emergency room.

19 Recap & Questions


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