WCA Group Health Insurance PlanHealth Reimbursement Arrangement Plan (HRA)

March 4th and March 6th, 2014

Janice L. WavraCorporate 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-Network Out-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 $25 Per Visit

Chiropractic Services Copay $25 Per Visit $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 plan’s deductible on September 1, 2013 and run through June 30, 2014.

Explanation of Benefits “EOB”

Patient

Network

“EOB” Continued 90%Coin

surance

B C

A

A minus B minus C = CoinsuranceMaximum 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 District’s 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 Pays Employee 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

WCA Group Health TrustEmployee Deductible responsible for 100% of

$500 Single covered expenses.WCA Group Health Trust

responsible for 90% co- insurance.

WCA Group Health TrustEmployee Deductible responsible for 100% of

$1,000 Family covered expenses.WCA Group Health Trust

responsible for 90% co- insurance.

Employer responsible for the first 10% in coinsurance up to the maximum $500.

Employee responsible for the next 10% in coinsurance up to the maximum $500.

Employer responsible for the first 10% in coinsurance up to the maximum $250.

Employee responsible for the next 10% in coinsurance up to the maximum $250.

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 608-831-4790

• Emailparticipantservices@ebcflex.com

• Online www.ebcflex.com

• Mail Employee Benefit CorporationPO Box 44347 Madison, WI 53744-4347

• Phone Support800-346-2126 or 608-831-8445 M-F 8:00-5:00 Central

EBC’S HRA Claim Form

Name

Email

Employer

Name

Code “H”

EBC’S 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 TrustIn-Network Providers

Website: www.umr.com• 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 Care Urgent Care Emergency RoomBladder, 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

MononucleosisYour primary care provider is not available

Shortness of breath, confusion, dizziness

Pink eye Severe 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 – 7pm3111 Gundersen Drive, Onalaska, M-F: 7am – 9pm, Sat-Sun: 9am –

5pm

Franciscan 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 – 5pm

Winona HealthM-Thur: 8am – 8pm, Fri-Sun: 8am – 5pm

** Note: All services at this location are billed as emergency room.

Recap & Questions