WPS Small Group Health Insurance Employee Guide to Using Your Coverage. Discover how to maximize the value of your health plan

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1 WPS Small Group Health Insurance Employee Guide to Using Your Coverage Discover how to maximize the value of your health plan

2 For more than 70 years, WPS Health Insurance has been serving the people of Wisconsin and beyond. Today WPS, a leading not-for-profit health insurer based in Wisconsin, offers high-quality coverage and networks, affordable plans, and a wide range of benefit choices, so you can protect your health. Comprehensive, cost-effective networks locally and nationwide Help managing your health care Midwestern service Ethical business practices Independent to serve you better LOCAL. HONEST. INDEPENDENT. WPS Statewide Network offers easy access Convenient access to thousands of health care professional service locations and hospitals throughout the state. More than 25,000 health care professional service locations 165 hospitals Top providers Take advantage of health care access throughout the state, including the following providers and systems: Agnesian Healthcare Ascension Health Aspirus Network, Inc. Aurora Health Care Bellin Health Children s Health System Dean Clinics/SSM Health Care Froedtert & Medical College of Wisconsin Gundersen Health System Holy Family Memorial Hospital Sisters Health System/Prevea Health Marshfield Clinic Mayo Clinic Health System Medical College of Wisconsin OakLeaf Medical Network, Inc. ProHealth ThedaCare UnityPoint Health Meriter UW Health/UW Medical Foundation WPS Statewide Network Find a complete list of providers in the WPS Statewide Network at wpshealth.com; click on Find a Doctor. 2 wpshealth.com

3 Expanded network coverage available Get health care provider access with the First Health/PreferredOne wrap network in all 49 states outside Wisconsin. More than 510,000 practitioners 5,000 hospitals 90,000 ancillary facilities For a complete list of providers, go to wpshealth.com and click on Find a Doctor. First Health PreferredOne The Find a Doctor tool makes finding a preferred provider easy! Go to wpshealth.com and select Find a Doctor at the top of the WPS home page. You may initially search under Groups. Once you receive your WPS ID card, you may log in as an Existing Subscriber. For help locating a preferred provider, please call Customer Service at the number shown on your WPS ID card, Monday through Friday, 7:30 a.m. to 5 p.m. CT. Providers can leave or enter the network at any time. It is recommended that you check the network status of your provider on a regular basis Monday through Friday 7:30 a.m. 5 p.m. CT WPS Health Insurance 1717 W. Broadway P.O. Box 8190 Madison, WI For questions about your coverage or claims, please log in to your customer account for secure communications. wpshealth.com

4 Make the Most of Your Health Benefits Telehealth services from Teladoc Connect with a licensed physician over the phone or via video consult 24/7/365. Effective Jan. 1, 2019, behavioral health and dermatology services will be available; check your policy for details. Mobile device: Teladoc app Computer: teladoc.com Phone: 800-Teladoc ( ) Teladoc: wpshealth.com/resources/ customer-resources/telehealth.shtml The Active&Fit Direct program 1 Get access to a fitness center for $25 per month plus applicable taxes Choose from 9,000+ participating locations nationwide Get started with a low $25 enrollment fee, $25 for your current month, $25 for your next month, and any applicable taxes From the wpshealth.com home page, click on the Customers link, then log in to your account and click on the Active&Fit Direct link that applies to you. The ExerciseRewards program 1 Eligible members of your household over 18 years old who work out at least 10 times per month at a qualified fitness center can receive a $30 reward per month! Online fitness center search lets you find a participating fitness center near you Participants can use the ASHConnect mobile app to track visits at 41,000+ fitness centers nationwide Track your visits and redeem your rewards online Go to the exerciserewards.com website to register for this program Covered preventive services WPS pays benefits at 100% for certain preventive services and medications 2 when care is received from an in-network provider. Services received from an out-of-network provider are subject to out-of-pocket costs in the form of copayments, deductibles, and coinsurance amounts. Covered services include: Routine immunizations Routine medical exams Well-child care Mammograms Preventive screenings Preventive drugs And more see wpshealth.com 1 The Active&Fit Direct and ExerciseRewards programs are provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Incorporated (ASH). If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify by different means. Hear in America hearing program Includes an annual hearing screening at no extra cost Discounts on nine top hearing aid brands plus a threeyear repair and loss warranty Three years of hearing aid batteries included at no extra cost Call Hear in America at EyeMed Vision Care discount program You get access to the EyeMed Vision Care discount program at no additional cost! Show your WPS ID card when you visit participating EyeMed providers and use EyeMed discount No Find an EyeMed provider in your area by contacting EyeMed: EnrollWithEyeMed.com/access Benefits may not be combined with any discount, promotional offering, or other group benefit plans, except as indicated. Vision Care Services Eye exam (with dilation, as necessary) Complete pair eyeglass purchase* Frames Any available frame at provider location Standard Plastic Lenses Single vision $50 Bifocal $70 Trifocal $105 Lens Options UV coating $15 Tint (solid and gradient) $15 Standard scratch-resistant coating $15 Standard polycarbonate $40 Standard anti-reflective coating $45 Standard progressive (add-on to bifocal) $65 Other add-ons and services Contact Lenses (discount applies to materials only) Conventional Laser Vision Correction LASIK or PRK from U.S. Laser Network Customer Benefits $5 off routine exam $5 off contact lens exam 35% off retail price 20% off retail price 15% off retail price 15% off retail price or 5% off promotional price Frequency of use for examination, frames, lenses, or contact lenses unlimited. *Frame, lens, and lens option discounts apply only when purchasing a complete pair of eyeglasses. If purchased separately, customers receive 20% off the retail price. 2 Preventive care services include routine exams, screenings, immunizations, and other services ranked A or B by the U.S. Preventive Services Task Force. 4 wpshealth.com

5 Prescription drug coverage $0 copay on select preventive drugs for common conditions (e.g., high blood pressure, high cholesterol, heart conditions, and asthma) Keep your costs down with lower-cost generic drugs Convenient home delivery service available For more information, visit wpshealth.com and click Customers>>My Account Information>>Pharmacy Information for a list of drugs that require prior authorization, instructions on how to obtain prior authorization, and a guide to drugs that are preferred by your health plan and offered at lower copay levels. Preventive drugs include specific supplements, contraceptives, immunizations, and other preventive drugs ranked A or B by the U.S. Preventive Services Task Force. Home delivery recommended for prescription drugs You can speak with a prescription drug benefit specialist by calling Express Scripts at or you can visit Express-Scripts.com/Decide for more information. You have the option of choosing home delivery from the Express Scripts Pharmacy, which offers up to a 90-day supply of your medications with free shipping, or using an in-network retail pharmacy to fill your prescriptions. Case Management program Our case managers are dedicated to hearing your story while assisting you with your health care needs. Case Managers are registered nurses who can help you by: Coordinating your health care Helping you navigate through a complex health care system Providing education specific to your health care needs Supporting you and acting as an advocate for you to improve your health care experience and outcomes Helping you reach your health care goals Learning about available community resources Understanding your health insurance benefits Helping you become a better health care consumer How to Use Your Health Plan Prior authorizations help ensure you get the best care Before requesting prior authorization, review your health plan for specific authorization requirements, excluded services/ treatments, and referral requirements. Prior authorization is required for some inpatient admissions: Different standards apply depending on whether the admission is elective or acute. Elective admissions: Your health care provider must submit a prior authorization request a minimum of three (3) days prior to an elective (non-emergency) admission. Acute admissions: You or the facility must notify WPS in writing or by phone within two (2) days of an acute (direct or emergency) admission. Use the number on your customer ID card or the Customer Service number: Check out the WPS Health Center Go to wpshealth.com and click on Resources, then Wellness to access our online Health Center for information, tools, and support you need to achieve your best health. You'll find: An online health encyclopedia providing information on thousands of topics A wealth of tools designed to help you make wise health decisions Healthy Living and Chronic Care Centers that provide guidance to help you manage common health risks and chronic conditions Information about health club discounts and other incentives for healthy choices A Patient Safety page that provides links to hospital quality and safety data to help you choose providers who deliver high-quality clinical outcomes FREE quarterly newsletters to help keep you and your family healthy and get the most from your health plan Visit wpshealth.com and click Customers for details about these benefits and more

6 Inpatient admissions include your admission to an inpatient hospital, hospice inpatient facility, inpatient rehabilitation facility, skilled nursing facility (when Medicare is not primary), or an inpatient and residential facility for behavioral health services. Prior authorization is required for all non-emergency ambulance transfers between facilities. In addition to inpatient admissions, prior authorization is required for any service, procedure, or equipment on the Prior Authorization List found at wpshealth.com click Customers>>My Account Information>>Forms and Documents. On that page, select Prior Authorization Forms & Documents for links to the lists and more. Please share this information with your health care provider, who can submit the Prior Authorization Form and your relevant clinical information directly to us. Drug prior authorization Prior authorization is required for some drugs to ensure they re used appropriately. Decisions are based on medical records, FDA-approved labeling, published and peer-reviewed scientific literature, and evidencebased guidelines. How to File Claims Present your ID Card to your provider at the time of your visit. Most providers will file your claim for you. If the provider does not file your claim, contact your provider for a copy of the completed claim or itemized bill and forward it to the address shown on your ID card. You and your provider will each receive an Explanation of Benefits (EOB) explaining the processing of your claim. Payments will be forwarded directly to your provider unless otherwise indicated on the claim. For questions, please call Customer Service at the tollfree phone number on your ID card. How to Find a Doctor Go to wpshealth.com and select Find a Doctor at the top of the WPS home page. You may initially search under Groups. Once you receive your WPS customer ID card, you may log in as an Existing Subscriber. Providers can leave or enter the network at any time. It is recommended that you check the network status of your provider on a regular basis. Use Your Online Customer Account for Quick Access to Information How to navigate the site The online customer account offers access to everything you need, all in one place. This allows more flexibility and control in managing your personal account information. Clearly labeled tabs take you straight to what matters to you most, whether it s your policy, billing information, claims status, EOBs, or other important documents. NOTE: You re not able to register and access your online customer account until after your health plan effective date. How to register for your customer account Make sure you have your ID card handy. 1. Visit wpshealth.com, click Customers, and then click the Register button. 2. Enter the requested policy information from your ID card on the registration form. 3. Create a user ID, easy-to-remember password, and set up your security questions/answers. 4. Read the Privacy Policy, and then if you agree, check the I Agree box at the bottom of the page and click Register. How to find your Explanation of Benefits (EOB) 1. Log in to your customer account at wpshealth.com, click on Customer Resources, and then click on Document Center to search your documents. 2. From the Document Type drop-down menu, select Explanation of Benefits or Episodic Explanation of Benefits. 3. Click on the Document ID to view the document. How to use your deductible accumulator The deductible accumulator shows how much of your deductible you have met in the current calendar year, compared to your total deductible amount. 1. Go to wpshealth.com to log in to your customer account. Click on My Benefits, and then click Medical. 2. Scroll to the bottom of the Medical Coverage page to the Deductible/Out-Of-Pocket Accumulators section for your current total of accumulated deductibles and out-of-pocket amounts. 6 wpshealth.com

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8 Local. Based in Madison, covering all of Wisconsin. Honest. In 2018, WPS was named one of the World s Most Ethical Companies for the ninth straight year. 1 Independent. Working for you for more than 70 years World's Most Ethical Companies, Ethisphere Institute, worldsmostethicalcompanies.ethisphere.com/ honorees/. Questions? Visit wpshealth.com and click Call on the Customer portal. Monday Friday, 7:30 a.m. 5 p.m., CT Health insurance partner of the Green Bay Packers 2 Proud partner of the Milwaukee Brewers 2 2 Green Bay Packers and Milwaukee Brewers partnerships are paid endorsements Wisconsin Physicians Service Insurance Corporation. All rights reserved. JO