The City of Fond du Lac currently has a self-insured PPO health plan where levels of benefits provided and employee participation are determined by the City and applicable to state and federal regulations.
All full-time and part-time City employees who are regularly scheduled a minimum of 20 hours per week are eligible for Single or Family benefits. Married couples, where both individuals are employed by the City of Fond du Lac and are both eligible for health insurance, may each elect single coverage, or one employee may elect family coverage and enroll the spouse and any dependents under that person.
Enrollment is offered according to the following:
New employees hired between the 1st and the 15th of the month are eligible to begin coverage on the 1st of the month following their hire date.
New employees hired after the 15th of the month will be eligible to begin coverage on the 1st of their second full month of employment.
Special Enrollment rights occur if there is a loss of health coverage or a change in family status such as marriage, divorce, birth, or adoption. These changes need to be brought up to Human Resources within 30 days of the qualifying event.
Open enrollment is offered in the fall prior to the start of each benefit year.
It is the City’s policy that employees pay 20% towards the monthly premium cost of their health insurance. The City pays the balance of 80%. The City may provide additional incentives for completing a Health Risk Assessment.
Part-time Employees: The City will contribute towards single coverage plan premiums at the full-time active employee rate for part-time employees who regularly work a minimum of 20 hours per week. Regular part-time employees electing family coverage are responsible for paying the difference between the total monthly family premium and the City’s contribution to the single coverage plan premium for full-time active employees.
Auxiant & Health Payment Systems
Auxiant is the City’s Third Party Administrator that processes claims for the health plan while Health Payment System (HPS) is the company that manages the provider network. Auxiant and HPS work very closely together to provide access to a comprehensive network of medical providers and process claims quickly and efficiently.
Auxiant provides users access to their personal claims, flex accounts, provider directories, deductible and out-of-pocket amounts, prescription benefit information, and just about anything necessary to navigate and organize their health coverage plan by registering on their website (www.auxiant.com).
HPS provides access to medical providers and pays the doctors on the employee’s behalf for in-network visits. Employees are billed by HPS once a month so they spend less time figuring out their health care bills and paying each separately. Their website (www.hps.md) also contains a provider search as well as billing and transaction history.
The full Summary of Benefits and Coverage explains how the plan distributes costs for covered health care services. This summary can be found through Auxiant or Human Resources. It is also provided in the open enrollment packet each year.
Surviving Spouse & Dependent Children Health Insurance Continuation
The City believes that the benefits discussed under Wisconsin Statutes §66.0137 (municipalities are required to contribute towards the health insurance premiums for fire fighters and continue to pay those premiums for the spouse and/or dependent children of a fire fighter who dies in the line of duty) should be extended to the surviving spouse and dependent children of all City employees who die in the line of duty. Therefore, the City provides the following benefits should this occur:
The City will continue to pay the premiums for a surviving spouse until the spouse remarries or reaches age 65.
The City will continue to pay the premiums for a dependent child until the child reaches the age of 18 unless the child is a full-time student in secondary school OR a full-time or part-time student in an accredited college or university and has not reached the end of the calendar year in which he/she turns 27.
Prescription Drug Coverage
The City of Fond du Lac is currently contracted with OptumRx for all prescription coverage through 12/31/2020. OptumRx specializes in the delivery, clinical management and affordability of prescription medications and allows users to view their prescriptions on their website (www.optumrx.com).
Specific costs can be found in the Summary of Benefits and Coverage.
Beginning 1/1/2021, National CooperativeRx will be the City of Fond du Lac’s PBM. National CooperativeRx is a not-for-profit, member-owned cooperative made up of employers and coalitions who provide pharmacy benefits to employees and their dependents. They provide high-quality, cost-effective pharmacy benefit management (CVS Caremark) with honest, transparent pricing. Since National CooperativeRx is a large group with high purchasing power, they see more savings, better discounts, rebates, and more fair terms and customization opportunities.
CVS Caremark has convenient and affordable medication options as well as a multitude of digital tools. Save time, keep costs down and stay on top of your prescriptions. See information below or on their website (www.caremark.com/).
Specific costs can be found in the Summary of Benefits and Coverage.
Wisconsin Vision has developed a special discount program that is available to City of Fond du Lac employees and dependents who do not have any vision insurance. (Click here to see the vision insurance benefit offering.) This discount plan is good all year and can be used multiple times.
The City of Fond du Lac works with FABOH and the Corporate Care Clinic (920-926-5666) to provide members under the health plan ways to save money. The City’s contract with the Corporate Care Clinic has a set list of several common services that are provided to City health plan members at no cost. (The list includes new patient visits, established patient visits, preventative visits, and disease management, with different levels based on care needed and the age of the patient.) There are other services provided that will be covered by insurance but may be subject to deductible and coinsurance. You can verify what coverage level your visit will likely be set at ahead of time by contacting Human Resources and/or Auxiant.
Teladoc: Another great option for fast, cost-effective, non-urgent care is Teladoc. This popular program provides employees on the City’s health plan access to licensed physicians by phone, video, and mobile app 24 hours a day, 7 days a week. All services available through Teladoc are provided to members covered under the City’s health plan at no cost.
The City believes that if the health plan is saving money, the employee should be given a portion of those savings to help with the expenses of the visit and this is why Smart Choice MRI and NOVO Health were brought into the City’s consumer incentive program.
Smart Choice MRI is an in-network provider where lower deductible costs are incurred for those on the City’s health plan since the overall costs are less than the average MRI fee. The same state-of-the-art technology is used as in any other MRI facility and patients can generally schedule a visit more quickly than at a hospital location. The cost savings the City sees on the health plan are shared with the covered employee at a $200 incentive rate per MRI.
NOVO Health is physician led healthcare where experts in specific care choose to participate at reduced cost while still delivering the best outcome. They do this by designing facilities to provide specific services while controlling cost. Since there is a focus on retail experience as well, patients have reduced stress and anxiety with seamless service and lower re-admission rates. NOVO Health can save health plans an average of 30% for the specialist services they provide which in turn allows the City to incentivize covered employees $250-$2,000 depending on the service.