1. City Electric Supply

2. CostPlus PPO Plan
0% Increase in Premiums for employees, 10% decrease for families,
Reduced deductibles & Co-pays
Changing facilities charges to Cost Plus model
GPA is the Third Party Administrator (TPA) that processes claims.
PHCS/Multiplan Network is the Network-for doctors and Specialists
ELAP “ cost plus” is the “Balance Bill” Manager
Envision/Rx Options is the Pharmacy Benefit Manager that processes pharmacy benefits
Orchard Specialty Pharmacy is the Specialty Pharmacy Benefit Manager that manages expensive specialty drugs.
HealthWatch will Monitor all Hospital Confinements and Outpatient Surgeries
Nurse Navigator - Is our Employee Benefit Concierge
One Call Medical – Provides access to network imaging centers at reduced cost

3. Cost of CES’s Employee’s Healthcare
Medical Plan Changes
Healthcare Costs Continue to Rise Significantly
Those Costs Have to be Absorbed by Someone
The Traditional Approaches to Reducing Costs :
We Increase Employee Monthly Contributions
We Increase Employee Deductibles, Co-insurance, Co-pay and Out-of-pocket Maximums to Offset Increased Costs
The Above Solutions are NOT acceptable!

4. CostPlus PPO Plan
Most abuse of healthcare costs are from facilities such as hospitals
Being in a traditional network does not allow us to audit or negotiate any costs.
We have to pay what the network and facility dictates.
The only alternative is a reference based pricing model which is what has lead
Us to the Cost Plus solution.
In general terms, there is very little change from the way the plan works now.
The major difference being that facility charges will be audited and priced
at fair levels and any difference will be dealt with by Cost Plus (ELAP)

5. PROBLEM OPPORTUNITY The Problem and the Opportunity OUT of CONTROL!
Medical Plan Changes
Hospital Charges are
OUT of CONTROL!
PROBLEM
THE
OPPORTUNITY
THE
BIGGER DISCOUNTS!
Negotiate

6. Why Medical Bills Are Killing Us
Medical Plan Changes
Gauze Pads: $77
Charge for each of four boxes of sterile gauze pads, as itemized in a $348,000 bill following a patient’s diagnosis of lung cancer
Sean Recchi Diagnosed with Non-Hodgkin’s Lymphoma at Age 42
Total cost, in advance, for Sean’s treatment plan and initial doses of chemotherapy: $83,900.
Charges for blood and lab tests amounted to more than $15,000; with Medicare, they would have cost a few hundred dollars
Why?

7. How “CostPlus” Works Medical Plan Changes
ALL Selected In-Patient and Out-Patient FACILITY Claims are Audited Applying the “CostPlus” Method:
Claims are Paid at the Greater of:
Cost of care plus a 12% profit margin
Or Medicare plus a 20% profit margin
Certain Medical Products and Services are Paid at a Cost Plus Margin Basis (Bottom-Up), Rather Than a Percentage Off Over Inflated Charges (Top-Down)
“By using a baseline of payment such as the “Cost of Care” or “Medicare Payment”, City Electric Supply can use an alternate reference for payment that gets us out of paying based on traditional in-network facility contracts”
Medical Plan Changes

8. ELAP is Your Safety Net
Medical Plan Changes

9. What is a “Balance Bill”
Medical Plan Changes
A “Balance Bill” is an Amount That is Billed by the Facility to the member for any medical claim charges in excess of what the health plan authorized to be covered..
Example
Hospital Bill $10,000 (But Cost is Only $1,000)
Payment from Plan $ 1,120
BALANCE BILL $8,880
Amount that a facility may try to collect from you!

10. Strictly Follow ELAP’s Guidelines
Medical Plan Changes
Do not pay any facility bill directly.
GPA will Instruct you on the
Amount of Your Financial Responsibility
Deductible
Coinsurance
DO NOT PAY THIS BILL

11. FAQ BALANCE BILL BASICS FREQUENTLY ASKED QUESTIONS:
A provider is stating that they do not accept my insurance, what do I do?
It is likely that they do not recognize the Physicians Only logo on the ID card. Explain that you have
health benefits and request that they call GPA to verify your benefits— the number is on your card.
If you are still having difficulties call GPA for assistance.
Could the provider ask me to pay for my procedure upfront?
The hospital performing your medical procedure may request money from you upfront however
you as the patient are only responsible for your co-pay, co-insurance, and deductible. To confirm
this dollar amount, contact GPA. You can also refer to your Employee Benefit Booklet in the
schedule of benefits. The only out-of-pocket you should pay upfront is your co-pay. Your deductible
and co-insurance is determined once the hospital has sent their bill to GPA. This amount will be
listed on your Explanation of Benefits.
What if the provider asks me to pay more than my OOP?
Your benefits plan does not require you to pay anything upfront outside of your copay,
co-insurance, or deductible. If the provider will not perform your treatment without money being
paid upfront outside of your personal responsibility, contact GPA immediately and have a GPA
representative speak to the provider.
I’ve been balance billed; will my account be put into collections?
Each provider treats its billing practices differently. When a provider sends a bill to a collection
agency, it does not necessarily mean that it was reported to any credit reporting agency impacting
your credit score. This means that the provider has ceased their collection efforts within the
hospital billing department and sent your bill to an outside vendor to attempt to collect the
alleged balance due. If you receive a collection notice, please send it to ELAP right away.
The collection notice will clearly state that you have 30 days to respond and dispute the debt,
and it must be sent to an attorney in a timely manner so that they have enough time to respond
on your behalf. It is very important to remember that if your bill is sent to collections, once the
collection agency is made aware that you are represented by an attorney they are no longer, by
law, permitted to communicate with you in any way other than continued mail notices.
Please contact ELAP immediately if you continue to be contacted by the collection agency.
Why is the provider center still calling me?
The provider is within their legal rights to attempt to contact you by telephone, but there is no
reason for you to speak to them. If you do speak to a representative, take their name and their
phone number and relay that information to your assigned ELAP Claims Examiner.
How long will the provider continue to bill me?
Different providers have different collection practices. Please be assured that ELAP will continue to
support you throughout this process. It is important that you send ELAP all correspondence that
you receive in a timely manner.
What if I need additional treatment at this hospital/surgery center? Will they turn me away?
It has not been ELAP’s experience to have a provider turn away a member due to balance billing.
If you encounter any admissions issues, please call GPA right away so that ELAP and GPA can work
together to resolve the issue.
HOW DO I CONTACT ELAP?
961 Pottstown Pike, Chester Springs, PA 19425
p: am- 7pm EST | f: ATTN Balance Bill Response Team |
WHAT INFORMATION SHOULD I INCLUDE WITH MY BILL?
To ensure that your claim is set up quickly, include the following information with your balance bill:
Member Name | Patient Name | Company or Group Number | Provider
Date(s) of Service | Phone Number | | Fax Number | Preferred Method of Contact

13. + Mark Elliott or Kim Norman: 407-541-6006 CES Internal Assistance
If you need to talk confidentially to a City Electric employee about any ELAP issues
Please contact our internal advocates team of:
Mark Elliott or Kim Norman: +

14. GPA Health watch is the center for helping member’s coordinate all aspects of healthcare

15. Onecall is a network of imaging centers where members can receive care at steeply reduced rates and avoid “balance bills
Access more that 2,900 radiology centers nation wide
No paperwork of claims submission forms
Rigorous provider credentialing and peer review process
National concierge service

16. Thank You!