Answers to VASD Insurance Questions
1. How will the transition of care work with GHC?
Answer: There is not any set standard for a specific time frame and it completely depends on the individual circumstances of the new member. The Care Management Transition Team at GHC-SCWdeterminescontinuity of care provisions to make certain that existing scheduled specialist care is not interrupted for the well-being of the member. In many instances, members in existing treatment programs will continue for an adequate amount of time to safely transition into the GHC-SCW network. For those employees already scheduled to be seen by specialty providers in a different medical system not typically included in the GHC-SCW HMO network, the Care Management Transition Team evaluates and schedules a limited number of visits to the member’s current provider, in order to prepare a smooth transition and ease the patient into the GHC-SCW network of HMO providers.
2. What if I am currently pregnant? How will my care be transitioned?
Answer: All deliveries from GHC-SCW are performed at St. Mary’s in both the HMO and POS. However, GHC-SCW allows expectant moms in their third trimester at the effective date of the policy to finish out their term with their current physician and hospital.
3. Is the Physicians for Women clinic included in the GHC network?
Answer:The Melius, Schurr, and Cardwell – Physicians for Women practice can be accessed through the GHC Point of Service (POS) plan on an out of network basis.
4. Will my current prescription drugs be in the same tier with GHC as they were with WEA?
Answer: The plan design for prescription drugs has not changed. Effective July 1, employees will have the Rx tiers of $0 value/generic,$5 Brand/ 50% co-pay min $75 max $150 non-formulary/ 50% co-pay min-$75 max- $150 for specialty medicines.
HOWEVER, GHC’s formulary is different from WEA’s, which means that your current prescriptions could fall into a different tier. Employeesshould look up their medicines on the GHC-SCW website formulary section. The link to the GHC-SCW formulary list is:
5. Will there be enough primary care providers availableto absorb 500 new patients?
Answer: The GHC-SCW clinics do have capacity to absorb new patients and the anticipation is that the Sauk Trails and Hatchery Hill clinics will be the closest GHC-SCW clinics. A typical provider panel consists of approximately 1,500 patients, and this level of new patients will notbe an issue for GHC-SCW. The GHC-SCW primary care clinic network includes 15 clinics in Dane County, and eight additional clinics in Sauk and Columbia Counties. There is plenty of capacity within the network.
6. Will GHC consider addingproviders in Verona or Belleville and an urgent care in Verona?
Answer: GHC-SCW has been discussing the potential of the VASD contract with our partners at UW, and they are aware of the potential new patients for them as well.
7. Will there also be a “transition” for primary care providers?
Answer: Unfortunately, there is not a transition for primary care, and each member will need to select a GHC-SCW primary care physician at enrollment. Employees who select the Point of Service (POS) plan can keep their out of network primary doctor if they choose.
8. What will happen if someone needs to see specialist at UW before they see their new primary provider?
Answer: A new member can continue seeing their UW specialist prior to their first appointment with their PCP, and GHC-SCW encourages new members to see their new primary care physician as soon as possible.
9. What will the exact POS difference be for an employee per month if they choose to take a POS instead of the HMO?
Answer: Refer to the premium chart.
10. Will the Good Health Bonus continue?
Answer: GHC-SCW administers a wellness program with rewards for services such as exercise, Community Supported Agriculture, and a variety of other wellness services similar to most other programs in the community. The Wellness Incentive benefit though is $100 per person, with a $200 annual family limit. In addition, members with children under 18 can be reimbursed up to $25 per plan year for athletic shoes (on top of the $200 family limit).
11. Will the biometric screening continue? Will we still receive a $25 gift card for completing the HRA?
Answer: VASD will continue to use Interra for the Biometric screening and the Health Risk Assessment online. GHC does not offer a $25 incentive for completing the HRA. However, VASD will continue with the $150 gift card per employee and spouse/dependent over age 18 (1 per employee only) for HRA and biometric completion.
12. When does our current insurance contract end?
Answer: June 30, 2016.
13: Why aren’t we considering PPIC or WEA?
Answer: Both WEA and PPIC submitted bid proposals; however their proposed 20-30% premium increases would have meant the district would have a $2-3 million deficit from health insurance alone, on top of another million dollar deficit from other cost increases and no additional revenues from the state budget.
14: What doctors can we see with the GHC HMO Plan?
Answer: GHC has 6 primary clinics and the following UW clinics for primary care: UW clinics in Cottage Grove, Cross Plains, Mt. Horeb, Belleville, Northeast Family, or Verona Clinic. UW Hospital, Meriter and St. Mary’s Labor and Delivery are hospitals.
In addition, we will offer a “Point of Service” (POS) plan at additional employee cost if an employee wants to keep seeing a provider not in network.
15: Is our dental plan changing?
Answer: No.
16: What if I have some current, acute medical issues that won’t be wrapped up by June 30th. Answer: Employees who are in the middle of treatment will be able to work with GHC on a transition of care plan. This includes completing a “Transfer of Care” form that identifies their medical issue(s). The insurance company will decide the medically necessary timeframe for the transfer. Alternatively, the employee could sign up for a POS plan as noted in #4 to continue to see a provider that is not in network. GHC will make every effort to support individuals through provider transitions.
17: Who should I talk to if I have more questions or feedback?
Answer: Jason Olson, Greg Verhelst or MariannKropp.
18: Specialized care: American Family Children's hospital. Is this covered under GHC.
Answer: Yes, the UW American Family Children’s Hospital is in the GHC-SCW network.
19: I don't see our UW doctor who is our primary care physician listed in network. Is it possible to go out of network? What is the additional cost for this plan? We have Physical Therapy appointments that were approved by Magellen (through WEA Trust) that are valid until middle of September. Does this transfer over to the new insurance or will we lose authorization for these visits?
Answer: You can get out of network coverage on the POS plan. For cost difference refer to the premium chart. You should work with the GHC Care Management transition team concerning the physical therapy.
20: Premium amount for Employee and Employer for each of the five years of the contract
Answer: The first year’s total premium and employee contributions are identified in a Premium Chart. Premiums for future years have not been determined, but “not to exceed” rate caps of 6.1%, 6.1%, 5.5% and 5.5% respectively have been negotiated for the remaining four (4) years.
21: Provide drugs that will be covered, co-pays on any drugs.
Answer: Check the GHC formulary drug list at
Drug co-pays will stay as they are currently $0 value, Generic/ $5 brand/50% copay $75 min, $150 max tier 3 and 4.
22: Explain Point of Service (POS) and approximate amounts that employees will need to pay. Facilities that are included in this.
Answer: POS in network is the GHC-SCW HMO network. Out of network would be all Dr., clinics, and hospitals not in the GHC-SCW HMO network.
23: What happens if on vacation out of the area and you need medical services.
Answer: Emergent and urgent would be covered as in network benefits. All follow-up care must be done with a member’s Primary Care Physician.
24: Are Eye Doctors covered?
Answer: Vision examinations preformed at the GHC Eye Care Center are covered under the HMO health plan.
25: Is the District staying with Delta Dental.
Answer: Yes.
26: Who is the contact person and phone number if questions arise later.
Answer: GHC Member services (608) 828-4853 or toll free at (800) 605-4327 and request member services.
27: I am a patient of Dr. Gaumnitz at UW Health and I gave them a call to make sure I can continue to be seen at his clinic. The nurse informed me that GHC has to pre-authorize my visits there...how do I go about getting that pre-authorization? Do I need to wait until the switch is made? My visits are ongoing
Answer: UW specialists are considered in-network. Work with the GHC Care Management Transition team for continuity of care.
28: I am retiring this June and moving to south-eastern WI. How do I find information about the PPO option? I would like information on the monthly cost and how to locate primary care physicians/urgent care/hospital allowed in my new area.
Answer: Information on the PPO plan will be available upon request. The PPO Dr. network can be found on the GHC-SCW website ghcscw.com under find a provider.
29: When my very young children wake up at 2:00 a.m. and are crying in a way that indicates they are in pain, whom do I call? What options do I have?
Answer: GHC wants to provide you with expert medical care immediately to help you decide what steps to take next. You can call the GHC 24/7 nurse connect line, call your primary care physician clinic phone number, or go online and use the GHC virtuwell service. Any of these services would direct what next steps to take, whether it is an 911 for the ER, and appointment at our Urgent Care, or a visit with a primary the next morning.
30: Why some UW clinics, but none of the major ones? Do we have any kind of option to stick with our current physicians - the options are severely limited? What is the monthly premium cost for individual/family plans for staff? How will visiting a specialist work - will I need a referral to visit my OB/GYN, Derm, Vein/Heart, Allergist, etc.?
Answer: GHC offers 25 clinics where a member can choose their primary care, several of which are affiliated with the UW system. A member can choose the POS plan to have out of networkbenefits. Certain specialties require referrals, while others do not. Work with GHC Care Management Transition Team for specialty care.
31: How will we find out which doctors and clinics from UW Health are covered by GHC?
Answer: Dr. and clinics are listed on the GHC website under find a provider.
32: Will GHC offer a Good Health Bonus to help pay the cost of gym membership or a farm share, as our insurance companies have in the past?
Answer: Yes. GHC-SCW administers a wellness program with rewards for services such as exercise, Community Supported Agriculture, and a variety of other wellness services similar to most other programs in the community. The Wellness Incentive benefit though is $100 per person, with a $200 annual family limit
33: Is there going to be a transition period to continue seeing our Drs if we have been seeing them go a specific issue that could conclude a major surgery?
Answer: Refer to first answer of FAQ.
34: I may be losing my doctor, as I was using the POS plan to stay with my Dean clinic doctor. How can I find out if she is still included or how do I find a new doctor?
Answer: Dean primary care Dr. are not part of the GHC HMO network, but could be retained if the employee selected the Point of Service (POS) plan. A list of Dr. can be found on the GHC website under find a provider.
35: How do we move forward if we have a specialist that is a Dean carrier that is seen regularly?
Answer: Work with the GHC Care Management Transition Team for specialty care or select a Point of Service (POS) plan.
36: How are out-of-state college-age students covered to receive care close to campus?
Answer: Urgent and emergent care would be covered same as in network at any out-of-state clinic.All follow-up care must be done with a member’s Primary Care Physician if you have selected the HMO plan.
37: Do we still have the HRA?
Answer: Yes.
38: What does it mean to be able to use massage and other complementary services? They are in part covered?
Answer: Complementary Medicine is part of your health plan with GHC. Massage therapy falls under Complementary medicine using GHC practitioners for a separate copay.
39: Can I go to Meriter?
Answer: Under special cases only unless the employee has selected the Point of Service plan.
40: Under WEA I could see my specialists (gastroenterologist, colorectal surgeons) without needing a referral from my primary. Will this stay the same? Or will I need authorization from my primary before seeing my gastro?
Answer: Prior authorization will be needed to see specialists. GHC-SCWmembers who choose the POS and use Out of Network providers do not need to obtain prior authorization from their In Network PCP to see specialists Out of Network. Instead, the Out of Network primary care provider is coordinating the care.
41: I am currently pregnant and would like to continue my care with my current provider. My current provider is Meriter affiliated. Is this a possibility?
Answer: All deliveries from GHC-SCW are performed at St. Mary’s in both the HMO and POS. However, GHC-SCW allows expectant mom’s in their third trimester at the effective date of the policy to finish out their term with their current physician and hospital.
42: What are the differences in coverage and cost for those that use non-UW providers like Meriter or Dean?
Answer: Out of network providers would be covered under the out of network benefit on the POS.
43: If you currently see "specialty" providers through the UW, what will be the process to get approval to continue with these doctors through GHC? When will we receive the specific plan and be able to access Verona specific plan information on the GHC website?
Answer: Work with the GHC Care Management Transition Team for Specialty care. The Verona specific plan will be available on the GHC website the week employee enrollment meetings start.
44: What do "complementary" health services (yoga, massage) mean?
Answer: Complementary medicine is a benefit that is part of your health plan. These include many of the eastern medicines.
45: If GHC uses mainly UW health doctors and clinics, then why do they partner with St. Mary's hospitals only for birthing? This seems a bit of a stretch as most UW Health doctors partner with Meriter Hospital, as my current doctor does. I will be in my third trimester, due in early September, and my current UW Health OBGYNs do not partner or work with St. Mary's. What am I supposed to do? This is way too stressful for me to even think about finding another doctor, let alone delivering my baby at a different hospital.
Answer: All deliveries from GHC-SCW are performed at St. Mary’s in both the HMO and POS. However, GHC-SCW allows expectant mom’s in their third trimester at the effective date of the policy to finish out their term with their current physician and hospital.
46: How and when will I be able to find out if I am going to be able to stay with my primary care physician? Will my child be able to stay with his specialists at UW Hospital and Children's Hospital? If so, will there be any additional costs? If so, will there be forms that need to be filled out to make this happen?
Answer: A list of in network primary care Dr. can be found on our website at ghcscw.com. UW Specialists and UW Hospital and UW Children’s Hospital are in the GHC HMO network.
47: What clinics and hospitals can I go to?
Answer: All in network Dr., clinics, and hospitals can be found on the GHC website at ghcscw.com
48: what the deductible and coverage will be
Answer: Refer to benefit summary.