Presentation on theme: "Corporate Benefits Specialist"— Presentation transcript:
1Corporate Benefits Specialist WCA Group Health Insurance Plan Health Reimbursement Arrangement Plan (HRA) March 4th and March 6th, 2014Janice L. WavraCorporate Benefits Specialist
2Agenda The Insurance Center Group Health Insurance Plan Understanding your Explanation of Benefits (EOB)Health Reimbursement Arrangement Plan (HRA)How to File HRA ClaimsCost Savings IdeasRecap & Questions
3The Insurance Center Locally Owned, Established in 1960 03/13/2012The Insurance CenterLocally Owned, Established in 1960Located 701 Sand Lake Road, Onalaska, WIService TeamJanice L. Wavra (22 years)Kim Ness (19 years)Nancy Silbaugh (28 years)Kari Steele (11 years)Stacey Sila (16 years)T.I.C., Inc.
4WCA Group Health Trust Health Insurance Plan Plan Effective 9/1/13In-NetworkOut-of-NetworkDeductible**$500 Single$1,000 Family$1,000 Single$2,000 FamilyCoinsurance90%80%MaximumOut-of-Pocket$1,500 Single$3,000 FamilyOffice Visit Copay$25 Per VisitChiropractic Services CopayPrescription 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.
6A minus B minus C = Coinsurance “EOB” Continued90%CoinsuranceBCAA minus B minus C = CoinsuranceMaximum HRA Benefit:$250 Single ~ $500 Family
7Health 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.
8What is My Maximum Out-of-Pocket Exposure? BenefitWCA Health PlanIn-NetworkHRA PaysEmployee PaysDeductible **$500 Single$1,000 Family$0 Single$0 FamilyCoinsurance$250 Single$500 FamilyMaximum Out-of-Pocket$1,000 Single$2,000 Family$750 Single$1,500 Family** Plan year September 1, 2013 and throughJune 30, 2014
9How Does the HRA Plan Work for In-Network Providers?Note: Copays for Office Visits, Chiropractors, Emergency Room, andPrescriptions do NOT apply to the Deductible, Co-Insurance, or Maximum Out-of-Pocket.
10Your health care provider submits the claim to WCA. How to Use the HRA PlanYour 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).
11How to File Your HRA Claims to EBC FaxOnlineMailEmployee Benefit CorporationPO Box 44347Madison, WIPhone SupportorM-F 8:00-5:00 Central
14Preventive Care Services 100% Coverage for:Preventive Care ExamsWell-Child CareWell-Woman Gynecological ExamsMammogramsAdult and Child ImmunizationsHearing Exam (1 per calendar year)Vision Exam (1 per calendar year)
15Cost Savings Ideas Preventive Care Services Utilize In-Network ProvidersHealth Care AccessNeighborhood Family ClinicChiroMed, LLCNurses Help Line$4 Script Programs
16WCA 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
17Health Care Access Express Care Urgent Care Emergency Room Bladder, urinary tract infectionsNon-life threatening illness or injuryLife threatening illness or serious injuryBronchitisAfter regular clinic hoursChest pain, heart attackCommon WartsColds, sore throatBroken bonesEar pain, infections or excess waxCuts, scrapes, bruises,skin rash, minor burnsNumbness or weakness on one side, stroke symptomsFlu, influenzaBack painSevere headacheInsect, tick bitesStrains, sprainsLoss of consciousnessMononucleosisYour primary care provideris not availableShortness of breath, confusion, dizzinessPink eyeSevere abdominal painSinus infections
18Urgent Care vs Emergency Room Average Urgent Care Visit $185Average Emergency Room Visit $800Gundersen Lutheran**1900 South Avenue, La Crosse, M-F: 7am – 9pm, Sat-Sun: 9am – 7pm3111 Gundersen Drive, Onalaska, M-F: 7am – 9pm, Sat-Sun: 9am – 5pmFranciscan Skemp** West Ave & Market, La Crosse, Daily: 6am – Midnight191 Theater Road, Onalaska, M-F: 5pm – 9pm, Sat-Sun: 9am – 5pm1303 Main, Holmen, M-Thur: 7am – 7pm, Fri: 7am – 5pmWinona HealthM-Thur: 8am – 8pm, Fri-Sun: 8am – 5pm** Note: All services at this location are billed as emergency room.