Marathon CountyJanuary 1, 2021

Benefit Overview

WCA Group Health Trust (GHT)

• Group Health Trust (GHT) formed in 1991

• Initially Formed for Counties Only

– Amended Trust Parameters to Include School Districts & Municipalities in 1/2006

• Participants in the Trust have ownership in the management of the

Trust’s operations; the Board is made up of representatives of our

members.

• Works with approximately 100 school districts, counties, and

municipalities throughout the state

Who Does What?Group Health Trust (GHT)

Plan changes effective January 1, 2021

• Change from NEHA provider network to UHC Choice

Plus. Everyone will be enrolled in the UHC Choice Plus

provider network, so everyone will receive access to the

national broad provider network.

• Prescription Benefit Manager change from Optum Rx to

CVS/Caremark.

• Health Club Reimbursement and Annual Wellness Gift

Cards sponsored by the WCA GHT will no longer be

offered in 2021.

• Adding Maternity Management and Real Appeal

Programs.

(Customer Service)

UMR will provide the customer

service and assistance with

managing your healthcare. In

addition, they will serve at the

Third Party Administrator to

process health claims incurred

by the members of the District's

Health Plan.

Understanding Your New

Medical Plan

(Health Insurance Provider)

Group Health Trust (GHT), serves as the administrator of the trust. In addition,

GHT facilitates the group implementation process and manages the day to day

operations of the trust to provide ongoing support to their customers.

Choice+ PPO Network(Provider Network – PPO)

Providers contract with a

network to achieve greater

savings to pass along to you

and the health plan.

(Pharmacy Benefit Manager)

Caremark manages the

prescription benefits coverage

and processes pharmacy claims.

(includes Nationwide Pharmacy

network for retail scripts)

January 1, 2021 Medical Plan

Benefit Plan

Network UHC Choice Plus

In-Network Out-of-Network

Deductible $2,000/2,750/3,500 $2,000/2,750/3,500

Coinsurance 90% 70%

Maximum Out of Pocket

(Ded/Coins/Medical Copays)

$4,000/5,250/6,500 $4,500/6,000/7,500

Medical Benefits

Inpatient Hospital Deductible/90% Deductible/70%

Outpatient Hospital Deductible/90% Deductible/70%

Office Visit $25/Deductible/90% $50/Deductible/70%

Specialist Office Visit $25/Deductible/90% $50/Deductible/70%

Preventive Exam 100%/Ded Waived $50/Deductible/70%

Annual Vision Exam 100%, Deductible Waived

Chiropractic Office Visit $25/Deductible/90% $50/Deductible/70%

Phys/Occ/Speech Therapy $25/Deductible/90% $50/Deductible/70%

Urgent Care $25/Deductible/90% $50/Deductible/70%

Emergency Room Care $200/Deductible/ 90% $200/PPO Ded/ 90%

January 1, 2021 - Medical Plan Continued

Benefit Plan Continued

Mental Health/Subst. Abuse:

Office Visit

Inpatient

Outpatient

$25/Deductible/90%

Deductible/90%

Deductible/90%

$50/Deductible/70%

Deductible/70%

Deductible/70%

High Tech Imaging Coverage Deductible/90% Deductible/70%

Dental Injury/Extraction of 7> teeth Deductible/80% Deductible/70%

All Other Medical Services Deductible/90% Deductible/70%

Teladoc Benefits 100%/Deductible Waived

Pharmacy Benefits National Rx /CVS Caremark

Drug Plan Value Priced

Retail, 30 Days

Mail Order 90 Days

Specialty, Mail, 30 Days*

$0

$5/25%/25%

$5/25%/25%

Applicable Tier

Mandatory Generic: No

Rx Out-of-Pocket: $2,000 Single/$4,000 Family

Pharmacy Benefit - Retail

• $0 Value Priced Rx list

• Pharmacy formularies can differ and the medications you are taking

could be in a different tier.

• You will want to check the CVS/Caremark website to see which tier your

prescription is in.

• All pharmacies are in-network; however some pharmacies charge more

than others. You will want to check to see which pharmacy gives you the

best deal.

• Formularies are subject to change.

Pharmacy Benefit – Mail Order

Partner with CVS/Caremark™

• Mail Order Program – Information will be mailed to your home.

• Specialty prescriptions are obtained through mail order for a

30-day supply.

Current prescriptions set up with the Optum Mail Order Program will

be transferred to CVS/Caremark.

Watch For Your New ID Card

Two ID cards will be provided initially

and additional cards will follow for each

dependent in your family.

www.umr.com

UMR Website

Register On Line to Access to Your Claims Information

You can:

•Check your benefits and see what’s

covered

•Look up what you owe and how

much you’ve paid

•Find a doctor in your network

•Learn about medical conditions and

your treatment options

•Access tools and trusted resources

to help you live a healthier life

• 24/7 Physician Access just a click or call away.

• Largest Telehealth company in the United States and the only one with

a physician credentialing system certified by the National Committee on

Quality Assurance (NCQA).

• Physicians can diagnose, treat, and prescribe medication by phone,

online video or mobile app.

• NO appointments, NO driving to the doctor’s office, NO waiting for hours

in an Urgent Care waiting room.

• Prescriptions are called into the patient’s pharmacy of choice.

• FREE for all WCA GHT members!

Teladoc

When you are thinking about going to Urgent Care or the Emergency Room

for non-urgent medical situations you can use Teladoc instead. It’s also

FREE!

• Strep Throat

• Pink Eye

• Headache/Migraine

• Cold & Flu symptoms

• Allergies

• Bronchitis

• Skin problems

• Respiratory infection

• Sinus problems

https://www.youtube.com/watch?v=8Zl7oqokjNo

Teladoc

New Programs for 2021

Maternity Management

High risk maternity case

management.

Register and receive:

• One-on-one calls with a

nurse

• No-cost educational

materials

• Incentive gift for

participating

Real Appeal

Weight Management

Program

If you meet the program

criteria you receive:

• Coaching

• Personalized Support

• Engaging Entertainment

• Tools and Tracking

• Next steps

– Check to make sure your provider is in the

UHC Choice Plus Network

– Watch your mail. We will make every effort to

notify you if the prescription you are currently

taking is affected by the change.

(You will want to make sure to get your prescription filled timely to

allow for review if you have questions.)

14

Questions

You are welcome to call

WCA GHT

1-800-236-6885

Your Partner in Health.