Health Insurance

1
Health Insurance

• Marshall Public Schools

2
Insurance Committee

• I want to thank the members of the Insurance
  Task Force, Geoff Collins, Gerri Hansen, Marla
  Hellenbrand, Gene Henning, Gail Leslie, Nancy
  Mair, Darlene Raisbeck, and Jill Stuntebeck, for
  their time and dedication to this effort and for
  their thoughtfulness and advocacy on behalf of
  all of our employees.

3
Health Insurance Proposals

• WEA Trust Health Plan
• (current plan)
• or
• Dean/ Physicians Plus Health Plan
• (proposed choice between Dean Point of Service or
  P-Plus Point of Service)

4
WEA Trust Making a difference in the lives of
those who make a difference

• Fully staffed customer service no automated
  phones, no buttons to push but a staff person
  ready to help
• Board of Trustees composed solely of active or
  retired public school employees who serve without
  financial compensation
• Wisconsin Public Schools are our only business.
  We understand key insurance issues in public
  schools financing, bargaining, and the need for
  comprehensive insurance benefits

5
About Dean Health Plan

• Provider owned by Dean Health System and SSM
  Health Care
• Over 275,000 Members and over 1300 Employer
  Groups
• 35 Existing School Districts
• Medical Directors that are committed to quality
  health care
• Retain more than 97 of our members each year
• One of the lowest Administrative costs in South
  Central WI (based on percentage of premium)
• 7th Consecutive NCQA Excellent Accreditation
• AM Best Rating B and Weiss Rating of B

6
Physicians Plus Insurance

• Wide provider network including Meriter UW
  Hospitals Also access to independent doctors
  and clinics like WI Heart, Wildwood Clinic
• No written referrals required to visit network
  specialists
• Anytime phone access to a registered nurse
• Unmatched health wellness programs including an
  online personal health manager
• Big rewards for making healthy lifestyle choices
• www.healthychoicesbigrewards.com

7
Array of Delivery Options

• Medical Product Spectrum

8
Providers

• WEA Trust
• Level 1 PPO Network
• Level 2 Non network
• Dean / Physicians Plus family chooses each
  year from either Dean or Physicians Plus Point
  of Service
• Dean level 1 Dean care providers for local.
• National out of area plan available (for
  full- time college students and retirees)
• Dean level 2 All other providers
• Physicians Plus level 1 Physicians Plus and
  UW providers
• Physicians Plus level 2 All other providers

9
Provider Locations
10
(No Transcript)
11
Deductibles(amount a family pays per contract
year before benefits are paid)
12
Coinsurance(benefit amount paid by insurance
company)
13
Out of Pocket Maximum (maximum out of pocket
payment per contract year)(maximum out of pocket
does not include copays on prescriptions)(each
policy has additional exceptions)
14
Lifetime Maximum

• WEA 2,000,000
• Dean 5,000,000
• Physicians Plus 2,000,000

15
Office Visits(amount paid by insurance)
Ancillary services associated with that office
visit will be subject to deductible and
coinsurance.
16
Prescription Drugs
17
Hospital Services(In patient Out patient)
18
Emergency Room
19
Dependent Children
20
Retirement Benefits
21
Mental Health

• WEA pays 90 of the first 50,000, 100
  thereafter for in-network and 90 of the sate
  mandate, 50 thereafter for out of network.
• Dean pays 100 of charges, unlimited visits in
  and out of network as long as prior authorized.
• P-Plus pays 100 up to 12 days for inpatient, 18
  days for transitional and 20 visits for
  outpatient. (AODA will be paid up to 6300 per
  member per calendar year subject to the visit
  limits.) as long as prior authorized.

22
Transplants(all plans require preauthorization)
23
Home Health Services
24
Skilled Nursing Facility
25
Waiver of Premium for Disability
26
Physical, Speech, Occupational Therapy
27
Chiropractic
28
Questions?

• Hand out comparisons / QA.
• Obtain Index cards / pencils handed out at
  beginning of presentation for questions
• After questions (WEA, Dean and Physicians Plus
  reps available)
• If not now
• 1. grab a business card and coordinate time with
  them to talk through details.
• 2. One on one meetings?.
• Prefer to Email? E-mail Heather Frohmader
  heather.frohmader_at_associatedfinancialgroup.com
• Prefer to call? Heather Frohmader 608 268
  4669
• Questions and Answers will be posted along with
  QA handed out.