Triple Choice Enrollment Triple Choice Enrollment 2011-20122011-2012

THE BASICSTHE BASICS

DEFINITIONSDEFINITIONS

HMO (Health Maintenance Organization):HMO (Health Maintenance Organization): A form of health insurance combining a A form of health insurance combining a range of coverage in a group basis. A range of coverage in a group basis. A group of doctors & other medical group of doctors & other medical professionals offer care through the HMO professionals offer care through the HMO for a flat monthly rate with no deductibles. for a flat monthly rate with no deductibles. All visits, prescriptions and other care All visits, prescriptions and other care must be approved by the HMO in order to must be approved by the HMO in order to be covered. There is no out of network be covered. There is no out of network coverage.coverage.

DEFINITIONS, cont’dDEFINITIONS, cont’d

PPO (Preferred Provider Organization):PPO (Preferred Provider Organization): A A health care organization composed of health care organization composed of physicians, hospitals and other providers physicians, hospitals and other providers who provide health care services at a who provide health care services at a reduced fee. PPO’s allow for visits to out reduced fee. PPO’s allow for visits to out of network professionals at a greater of network professionals at a greater expense to the policy holder. There is expense to the policy holder. There is often a deductible in a PPO model.often a deductible in a PPO model.

DEFINITIONS, cont’dDEFINITIONS, cont’d

DeductibleDeductible: The flat amount a group : The flat amount a group member must pay before the insurer will member must pay before the insurer will make any benefit payments.make any benefit payments.

GHC = $0 deductibleGHC = $0 deductible

WPS Southern = $250 Single/$500 FamilyWPS Southern = $250 Single/$500 Family

WPS Statewide = $400 Single/$800 FamilyWPS Statewide = $400 Single/$800 Family

DEFINITIONS, cont’dDEFINITIONS, cont’d

CoinsuranceCoinsurance: A method of cost-sharing in : A method of cost-sharing in a health insurance policy that requires a a health insurance policy that requires a group member to pay a stated percentage group member to pay a stated percentage of all remaining eligible medical expenses of all remaining eligible medical expenses after the deductible amount has been paid.after the deductible amount has been paid.

GHC – 100% in-network, no out-of-network coverageGHC – 100% in-network, no out-of-network coverage

WPS Southern/Statewide – 100% in-network, 70% WPS Southern/Statewide – 100% in-network, 70% out-of-networkout-of-network

DEFINITIONS, cont’dDEFINITIONS, cont’d

Co-pay:Co-pay: The flat fee that you pay at the The flat fee that you pay at the point of service to share in the cost of point of service to share in the cost of covered medical services. Co-pays often covered medical services. Co-pays often apply to office visits and prescription apply to office visits and prescription drugs.drugs.

DEFINITIONS, cont’dDEFINITIONS, cont’d

Out of Pocket Maximum:Out of Pocket Maximum: Dollar amount set by Dollar amount set by the insurance carrier that limits the amount a the insurance carrier that limits the amount a member has to pay out of pocket for particular member has to pay out of pocket for particular healthcare services during a particular time healthcare services during a particular time period.period.

GHCGHC – None – None

In-Network, WPS SouthernIn-Network, WPS Southern = $250 single/$500 family = $250 single/$500 family

In-Network, WPS StatewideIn-Network, WPS Statewide = $400 single/$800 family = $400 single/$800 family

Out-of-Network, WPS Southern & StatewideOut-of-Network, WPS Southern & Statewide = =

30% to $1500 single/$3000 family30% to $1500 single/$3000 family

Deductible

Coinsurance & Co-pays

ReachOut-of-Pocket Maximum

Plan Pays 100%...Co-pays still Apply

Primary Care vs. Specialty CarePrimary Care vs. Specialty Care

Primary Care Provider (PCP)Primary Care Provider (PCP) – non-specialized – non-specialized physicians whose primary practice is one of the physicians whose primary practice is one of the following: following:

-Family Practice-Family Practice-Internal Medicine-Internal Medicine-General Practice-General Practice-OB/GYN-OB/GYN-Pediatrics-Pediatrics-Psychologist-Psychologist-Psychiatrist-Psychiatrist

Primary Care vs. Specialty CarePrimary Care vs. Specialty Care

Specialty ProviderSpecialty Provider – any physician whose primary – any physician whose primary practice is other than those listed on the practice is other than those listed on the previous page. Some examples include:previous page. Some examples include:

-Physical Therapist-Physical Therapist-Chiropractor-Chiropractor-Podiatrist-Podiatrist-Cardiologist-Cardiologist-Surgeon-Surgeon-Oral Surgeon-Oral Surgeon

GHC HIGHLIGHTSGHC HIGHLIGHTS

Rates remain the same Rates remain the same

Employee premium contribution remains at 4%Employee premium contribution remains at 4%

$0 deductible plan$0 deductible plan

Complementary Medicine benefitComplementary Medicine benefit

Refer to the Notice of Benefit Changes included in Refer to the Notice of Benefit Changes included in the mailing for other benefit changes the mailing for other benefit changes implemented by GHC.implemented by GHC.

WPS CHANGESWPS CHANGES

WPS SOUTHERN PPO WPS SOUTHERN PPO HIGHLIGHTSHIGHLIGHTS

More cost-efficient network with access to clinics More cost-efficient network with access to clinics & hospitals in a 12 county area in the southern & hospitals in a 12 county area in the southern region of WI.region of WI.

Includes Dean & Meriter, but does not include Includes Dean & Meriter, but does not include UW Health as “in-network”.UW Health as “in-network”.

4% employee premium contribution4% employee premium contribution

In-network office visits – no deductible (specialty In-network office visits – no deductible (specialty care - $30 co-pay)care - $30 co-pay)

““Find a doctor” demonstration on WPS websiteFind a doctor” demonstration on WPS website

WPS Plan Design ChangesWPS Plan Design Changes

StatewideStatewide – 8% employee premium – 8% employee premium contributioncontribution

StatewideStatewide – deductible changed to – deductible changed to $400/single $800/family$400/single $800/family

Statewide Out of Pocket MaxStatewide Out of Pocket Max - $400/$800 - $400/$800 in-network, $1,500/$3,000 out-of-networkin-network, $1,500/$3,000 out-of-network

Southern Out of Pocket MaxSouthern Out of Pocket Max - $250/$500 - $250/$500 in-network, $1,500/$3,000 out-of-networkin-network, $1,500/$3,000 out-of-network

WPS Plan Design ChangesWPS Plan Design Changes

Southern/StatewideSouthern/Statewide

-Office co-pay: $0 PCP, $30 Specialty – -Office co-pay: $0 PCP, $30 Specialty – deductible deductible does not have to be met does not have to be met

-Coinsurance: 100% in-network, 70% out-of--Coinsurance: 100% in-network, 70% out-of-networknetwork

-Prescriptions: $5 generic, $20 preferred brand, -Prescriptions: $5 generic, $20 preferred brand, $35 non-preferred brand. $35 non-preferred brand. Please consider mail-Please consider mail-order for your maintenance drugs. It can mean 3 order for your maintenance drugs. It can mean 3 months for the price of 2 months!months for the price of 2 months!

Please find additional information in the Please find additional information in the Triple Choice Enrollment Toolkit on the Triple Choice Enrollment Toolkit on the

College website at: College website at: http://matcmadison.edu/in/toolkithttp://matcmadison.edu/in/toolkit

Questions?Questions?