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 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 Statewide Service Area Find a complete list of providers in the WPS Statewide Network online at wpsic.com; click on Find a Doctor. 2

3 Expanded network coverage available Get health care provider access with the First Health/SelectCare 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 wpsic.com and click on Find a Doctor. First Health SelectCare The Find a Doctor tool makes finding a preferred provider easy! Go to wpsic.com and select Find a Doctor at the top center of the WPS home page. You may initially search under Groups. Once you receive your WPS member 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 member 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 member account for secure communications. wpsic.com 3

4 Make the Most of Your Health Benefits Telehealth services from Teladoc You can talk to a board-certified doctor anytime by phone, video, or mobile app visits. Skip the waiting room for nonemergent care. Mobile device: Teladoc app Computer: teladoc.com Phone: 800-Teladoc ( ) Teladoc: wpsic.com/telehealth ExerciseRewards program 1 Plan members in 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! Online fitness center search lets you find a participating facility near you Choose from more than 42,000 fitness facilities nationally Track your visits and redeem your rewards online Fitness reimbursement program information can be found on the Members page at wpsic.com Covered preventive services WPS pays benefits at 100% for certain preventive services and medications 2 when care is received from a participating provider. Services received from a non-participating 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-baby care Mammograms Preventive screenings Preventive drugs And more see wpsic.com EyeMed Vision Care discount program You get access to the EyeMed Vision Care discount program at no additional cost! Show your WPS member 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 Member Benefits Eye exam (with dilation, as necessary) Complete pair eyeglass purchase* Frames $5 off routine exam $5 off contact lens exam Any available frame at provider location 35% off retail price 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 20% off retail price Contact Lenses (discount applies to materials only) Conventional 15% off retail price Laser Vision Correction 15% off retail price or LASIK or PRK from U.S. Laser Network 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, members receive 20% off the retail price. 1 The ExerciseRewards program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). If you think you might be 4unable to meet a standard for a reward under this wellness program, you might qualify by different means. Please see the Members link for more information. 2 Preventive services listed are covered subject to the terms and conditions set forth in your Arise certificate. Age-appropriate screenings are set by the United States Preventive Services Task Force and are subject to change.

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 Visit wpsic.com, click Members, and then select 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. 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. Health Management program If you have a chronic health condition, we can help with an integrated health care approach just for you. Supported self-care for patients Decision support tools Continuity of care Available programs include: Asthma Hypertension (high blood pressure) For more information on managing these conditions, visit wpsic.com, click Members, and then select Disease Management. How to Use Your Health Plan Prior authorizations help ensure you get the best care Also known as pre-service authorization, pre-authorization, and pre-certification. 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 member ID card or the Member Services number: Check out the WPS Health Center Go to wpsic.com and click the Health Center button for information, tools, and support you need to achieve your best health, including: 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 The Patient Safety page 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 wpsic.com and click Members for details about these benefits and more. 5

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. You can find this list at wpsic.com/members/forms/. Click Members and then Forms & Documents for information. 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 wpsic.com and select Find a Doctor at the top center of the WPS home page. You may initially search under Groups. Once you receive your WPS member 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 Member Account for Quick Access to Information How to navigate the site The online member 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 member account until after your health plan effective date. How to register for your member account Make sure you have your ID card handy. 1. Visit wpsic.com, click Members, and then click the Register Now button. 2. Read the Terms, Conditions, and Disclaimers, and then if you agree, check the I Agree box at the bottom of the page and click Continue. 3. Enter the requested policy information from your ID card. 4. Create a user ID and easy-to-remember password, then click Register. How to find your Explanation of Benefits (EOB) 1. Log in to your member account at wpsic.com and use the Documents tab to click on Search your Documents. 2. From the Choose a document type drop-down menu, select Explanation of Benefits (EOB) or Summary Explanation of Benefits (EOB). 3. Under the Show documents for drop-down menu, select Everyone. This means all those who are on your health insurance plan. The calendar option allows you to select the time frame the EOB applies to. You can access all EOBs pertaining to your current effective date. Click the Search button to access your EOB. 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 wpsic.com to log in to your member account. Then look under the Benefit & Claim Information tab to click on Plan Benefits. 2. Scroll to the middle of the Member Information page under Benefits, and click on Plan Name for your Medical plan benefits. 3. On the Benefits Description page, scroll down to the Deductible Accumulators in the middle of the page for your current total of accumulated deductible. 6

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8 Local. Based in Madison, covering all of Wisconsin. Honest. In 2017, WPS was named one of the World s Most Ethical Companies for the eighth straight year.* Independent. Working for you for more than 70 years. * World's Most Ethical Companies, Ethisphere Institute, worldsmostethicalcompanies.ethisphere.com/ honorees/. Questions? Visit wpsic.com Call and click on the Members portal. Monday Friday, 7:30 a.m. 5 p.m., CT 2017 Wisconsin Physicians Service Insurance Corporation. All rights reserved. JO