Presentation on theme: "WCA Group Health Insurance Plan Health Reimbursement Arrangement Plan (HRA) March 4 th and March 6 th, 2014 Janice L. Wavra Corporate Benefits Specialist."— Presentation transcript:
WCA Group Health Insurance Plan Health Reimbursement Arrangement Plan (HRA) March 4 th and March 6 th, 2014 Janice L. Wavra Corporate Benefits Specialist
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
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) The Insurance Center
WCA Group Health Trust Health Insurance Plan Plan Effective 9/1/13 In-NetworkOut-of-Network Deductible** $500 Single $1,000 Family $1,000 Single $2,000 Family Coinsurance 90%80% Maximum Out-of-Pocket $1,000 Single $2,000 Family $1,500 Single $3,000 Family Office Visit Copay $25 Per Visit Chiropractic Services Copay$25 Per Visit 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 plans deductible on September 1, 2013 and run through June 30, 2014.
Explanation of Benefits EOB Patient Network
EOB Continued 90% Coin surance BC A A minus B minus C = Coinsurance Maximum HRA Benefit: $250 Single ~ $500 Family
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 Districts group health plan with WCA Group Health Trust. The plan year runs September 1, 2013 through June 30, 2014.
What is My Maximum Out-of-Pocket Exposure? Benefit WCA Health Plan In-Network HRA PaysEmployee Pays Deductible ** $500 Single $1,000 Family $0 Single $0 Family $500 Single $1,000 Family Coinsurance $500 Single $1,000 Family $250 Single $500 Family $250 Single $500 Family Maximum Out- of-Pocket $1,000 Single $2,000 Family $250 Single $500 Family $750 Single $1,500 Family ** Plan year September 1, 2013 and through June 30, 2014
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.
When receiving a service, you must present your WCA ID Card to your health care provider. WCA reviews and processes the claim and provides you with the Explanation of Benefits (EOB). Your health care provider submits the claim to WCA. 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. How to Use the HRA Plan
How to File Your HRA Claims to EBC Fax Online Mail Employee Benefit Corporation PO Box Madison, WI Phone Support or M-F 8:00-5:00 Central
EBCS HRA Claim Form Name Employer Name Code H
EBCS HRA Claim Form Continued
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)
Cost Savings Ideas Preventive Care Services Utilize In-Network Providers Health Care Access Neighborhood Family Clinic ChiroMed, LLC Nurses Help Line $4 Script Programs
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
Health Care Access 17 Express CareUrgent CareEmergency Room Bladder, urinary tract infections Non-life threatening illness or injury Life threatening illness or serious injury BronchitisAfter regular clinic hoursChest pain, heart attack Common WartsColds, sore throatBroken bones Ear pain, infections or excess wax Cuts, scrapes, bruises, skin rash, minor burns Numbness or weakness on one side, stroke symptoms Flu, influenzaBack painSevere headache Insect, tick bitesStrains, sprainsLoss of consciousness Mononucleosis Your primary care provider is not available Shortness of breath, confusion, dizziness Pink eyeSevere abdominal pain Sinus infections
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.