Meet GHC Eau Claire 2022 Open Enrollment Vendor Q&A Webinar - This session will be recorded for records retention purposes, but will not be shared ...
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Meet GHC Eau Claire
2022 Open Enrollment Vendor Q&A Webinar I
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This session will be recorded for records retention purposes, but will not be shared publicly
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Agenda Ground Rules & Introductions Health Plan Highlights Q&A Session Wrap-Up & Close
Welcome • ETF is hosting a series of webinars throughout the 2022 open enrollment period • Today’s Q&A session is intended to provide the same personal interaction with a health plan as a benefit fair – from the comfort of your own home or office
Ground Rules
Please mute yourself
During this session, we ask that only moderators
and health plan representatives engage in active
discussion
Please mute yourself if not actively speaking
Enter all questions via the chat function
No personally identifiable information (PII) or
protected health information (PHI) allowed
All general, vendor-appropriate questions are
welcomeIntroductions • ETF moderator(s) • Vendor attendee(s)
Group Health Cooperative
of Eau ClaireOur Purpose Optimize the health of our members through the Cooperative’s pooling of health-related resources.
Customer Service
• Calls answered quickly by experienced representatives.
- No phone trees, no automated messages. A real person, right away.
• Issues are resolved in one call.
• Available Monday – Friday, 7 AM to 6 PMProvider Network
Contracted with all major providers within our subscriber area.
Interactive online Provider Directory
• www.group-health.com/members/find-a-doctor
• Directory available upon requestService Area
■ Counties our ETF members reside in
Bar n R
,.,Covered Benefits
• Preventive, Specialist, Primary Care and Telehealth are
all covered under (T)he Cooperative’s benefit structure.
- Cost share may apply and some services may require prior
authorization.
• Additional covered benefits can be found by visiting
our website.Benefit Restrictions
• Out of Network Services
- Only Emergency Room and Urgent Care coverage
outside of Provider Network
• Some services may require prior approval or may not
be covered based on medical necessity.
• Exclusions and limitations based on benefits can be
found on our website or by calling Member Services.Utilization Management Procedures Pre-service Review A request for coverage of medical care or services which provider must have approved within 14 calendar days prior to rendering services.
Utilization Management Procedures Pre-service Review A request for coverage of medical care or services which provider must have approved within 14 calendar days prior to rendering services. Urgent Concurrent Review A request for coverage of medical care or services made while the member is in the process of receiving care. Must meet criteria and be completed within 24 hours of request.
Utilization Management Procedures Pre-service Review A request for coverage of medical care or services which provider must have approved within 14 calendar days prior to rendering services. Urgent Concurrent Review A request for coverage of medical care or services made while the member is in the process of receiving care. Must meet criteria and be completed within 24 hours of request. Post Service Review A request for coverage of medical care or services that have already been received. Must be completed within 14 calendar days.
Utilization Management Procedures Pre-service Review A request for coverage of medical care or services which provider must have approved within 14 calendar days prior to rendering services. Urgent Concurrent Review A request for coverage of medical care or services made while the member is in the process of receiving care. Must meet criteria and be completed within 24 hours of request. Post Service Review A request for coverage of medical care or services that have already been received. Must be completed within 14 calendar days. Filing an Appeal A member may appeal any adverse medical necessity and benefit decision within 45 days of receiving a denial notification.
Notice of Privacy Practices
Our Privacy Responsibilities include:
• Protecting the privacy of any protected health
information created or received about you
• notifying you if there is a breach of your protected
health information.
• Using and sharing protected health information only as
outlined in our Notice of Privacy Practices and by state
and federal laws.Questions? The information contained in this presentation is not a complete description of benefits and/or services. Any benefits, prices, and/or rates listed in this presentation are only examples, do not constitute a quote, and do not serve as an offer or guarantee of coverage. The information in this presentation is proprietary and only for information of the intended recipient(s). This presentation may not be used, published, or redistributed without the prior written consent of Group Health Cooperative of Eau Claire.
Q&A Session
Enter all questions via the chat
function
No PII/PHI allowed
All general, vendor-appropriate
questions are welcomeQ&A Session – Time to Wrap Up
Time for one last question…Member Resources ETF website Health landing page – etf.wi.gov/health Important Changes for 2022 State employees Local employees – same for all Local Program Options See meeting materials for PDF versions Health Plan and Vendor contact information 2022 Decision Guides
2-minute overview of 2022 changes to health
2022 Open benefits
Enrollment Applies to all members
Preview Video Available to view here: etf.wi.gov/video/etf-2022-
open-enrollment-preview2022 Open Enrollment Webinars
ETF Benefit Webinars Benefit Vendor Q&A
• Throughout open enrollment Webinars
• Health Insurance & • All health plans and vendors
Pharmacy Benefits for participating
Active Members • Throughout open enrollment
• Health Insurance &
Pharmacy for Retirees • Registration required via ETF website
• Dental & Supplemental • No PII/PHI permitted
Programs • See ETF website for session details
• Wellness Program and to register
• Pre-Tax Savings Accounts • Open Enrollment Health Webinars
• Open Enrollment Vendor Q&A
(State only) WebinarsEvaluation Survey You will receive an evaluation survey following this session Please take a few minutes to complete the survey
Thank You!
We appreciate your attendance today, as well as the
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cooperation of our health plans and vendor partners
608-266-3285
wi_etf etf.wi.gov ETF E-mail Updates
1-877-533-5020You can also read
