Illinois Workers’ Compensation
Transcript of Illinois Workers’ Compensation
Marathon CountyJanuary 1, 2021
Benefit Overview
WCA Group Health Trust (GHT)
• Group Health Trust (GHT) formed in 1991
• Initially Formed for Counties Only
– Amended Trust Parameters to Include School Districts & Municipalities in 1/2006
• Participants in the Trust have ownership in the management of the
Trust’s operations; the Board is made up of representatives of our
members.
• Works with approximately 100 school districts, counties, and
municipalities throughout the state
Who Does What?Group Health Trust (GHT)
Plan changes effective January 1, 2021
• Change from NEHA provider network to UHC Choice
Plus. Everyone will be enrolled in the UHC Choice Plus
provider network, so everyone will receive access to the
national broad provider network.
• Prescription Benefit Manager change from Optum Rx to
CVS/Caremark.
• Health Club Reimbursement and Annual Wellness Gift
Cards sponsored by the WCA GHT will no longer be
offered in 2021.
• Adding Maternity Management and Real Appeal
Programs.
(Customer Service)
UMR will provide the customer
service and assistance with
managing your healthcare. In
addition, they will serve at the
Third Party Administrator to
process health claims incurred
by the members of the District's
Health Plan.
Understanding Your New
Medical Plan
(Health Insurance Provider)
Group Health Trust (GHT), serves as the administrator of the trust. In addition,
GHT facilitates the group implementation process and manages the day to day
operations of the trust to provide ongoing support to their customers.
Choice+ PPO Network(Provider Network – PPO)
Providers contract with a
network to achieve greater
savings to pass along to you
and the health plan.
(Pharmacy Benefit Manager)
Caremark manages the
prescription benefits coverage
and processes pharmacy claims.
(includes Nationwide Pharmacy
network for retail scripts)
January 1, 2021 Medical Plan
Benefit Plan
Network UHC Choice Plus
In-Network Out-of-Network
Deductible $2,000/2,750/3,500 $2,000/2,750/3,500
Coinsurance 90% 70%
Maximum Out of Pocket
(Ded/Coins/Medical Copays)
$4,000/5,250/6,500 $4,500/6,000/7,500
Medical Benefits
Inpatient Hospital Deductible/90% Deductible/70%
Outpatient Hospital Deductible/90% Deductible/70%
Office Visit $25/Deductible/90% $50/Deductible/70%
Specialist Office Visit $25/Deductible/90% $50/Deductible/70%
Preventive Exam 100%/Ded Waived $50/Deductible/70%
Annual Vision Exam 100%, Deductible Waived
Chiropractic Office Visit $25/Deductible/90% $50/Deductible/70%
Phys/Occ/Speech Therapy $25/Deductible/90% $50/Deductible/70%
Urgent Care $25/Deductible/90% $50/Deductible/70%
Emergency Room Care $200/Deductible/ 90% $200/PPO Ded/ 90%
January 1, 2021 - Medical Plan Continued
Benefit Plan Continued
Mental Health/Subst. Abuse:
Office Visit
Inpatient
Outpatient
$25/Deductible/90%
Deductible/90%
Deductible/90%
$50/Deductible/70%
Deductible/70%
Deductible/70%
High Tech Imaging Coverage Deductible/90% Deductible/70%
Dental Injury/Extraction of 7> teeth Deductible/80% Deductible/70%
All Other Medical Services Deductible/90% Deductible/70%
Teladoc Benefits 100%/Deductible Waived
Pharmacy Benefits National Rx /CVS Caremark
Drug Plan Value Priced
Retail, 30 Days
Mail Order 90 Days
Specialty, Mail, 30 Days*
$0
$5/25%/25%
$5/25%/25%
Applicable Tier
Mandatory Generic: No
Rx Out-of-Pocket: $2,000 Single/$4,000 Family
Pharmacy Benefit - Retail
• $0 Value Priced Rx list
• Pharmacy formularies can differ and the medications you are taking
could be in a different tier.
• You will want to check the CVS/Caremark website to see which tier your
prescription is in.
• All pharmacies are in-network; however some pharmacies charge more
than others. You will want to check to see which pharmacy gives you the
best deal.
• Formularies are subject to change.
Pharmacy Benefit – Mail Order
Partner with CVS/Caremark™
• Mail Order Program – Information will be mailed to your home.
• Specialty prescriptions are obtained through mail order for a
30-day supply.
Current prescriptions set up with the Optum Mail Order Program will
be transferred to CVS/Caremark.
Watch For Your New ID Card
Two ID cards will be provided initially
and additional cards will follow for each
dependent in your family.
www.umr.com
UMR Website
Register On Line to Access to Your Claims Information
You can:
•Check your benefits and see what’s
covered
•Look up what you owe and how
much you’ve paid
•Find a doctor in your network
•Learn about medical conditions and
your treatment options
•Access tools and trusted resources
to help you live a healthier life
• 24/7 Physician Access just a click or call away.
• Largest Telehealth company in the United States and the only one with
a physician credentialing system certified by the National Committee on
Quality Assurance (NCQA).
• Physicians can diagnose, treat, and prescribe medication by phone,
online video or mobile app.
• NO appointments, NO driving to the doctor’s office, NO waiting for hours
in an Urgent Care waiting room.
• Prescriptions are called into the patient’s pharmacy of choice.
• FREE for all WCA GHT members!
Teladoc
When you are thinking about going to Urgent Care or the Emergency Room
for non-urgent medical situations you can use Teladoc instead. It’s also
FREE!
• Strep Throat
• Pink Eye
• Headache/Migraine
• Cold & Flu symptoms
• Allergies
• Bronchitis
• Skin problems
• Respiratory infection
• Sinus problems
https://www.youtube.com/watch?v=8Zl7oqokjNo
Teladoc
New Programs for 2021
Maternity Management
High risk maternity case
management.
Register and receive:
• One-on-one calls with a
nurse
• No-cost educational
materials
• Incentive gift for
participating
Real Appeal
Weight Management
Program
If you meet the program
criteria you receive:
• Coaching
• Personalized Support
• Engaging Entertainment
• Tools and Tracking
• Next steps
– Check to make sure your provider is in the
UHC Choice Plus Network
– Watch your mail. We will make every effort to
notify you if the prescription you are currently
taking is affected by the change.
(You will want to make sure to get your prescription filled timely to
allow for review if you have questions.)
14
Questions
You are welcome to call
WCA GHT
1-800-236-6885
Your Partner in Health.