MEMBER INSIDER

HELPFUL INFO FOR CGHC MEMBERSMEMBER SERVICES

877.514.2442PHARMACY BENEFITS (Optum Rx)

855.577.6545

WELCOME TO YOUR COOPERATIVE Keisha Krumm, Board Chair

Welcome to Common Ground Healthcare Cooperative (CGHC), your local health insurance company! We are a 64,000-member strong non-profit cooperative that is committed to being here to ensure you have access to health insurance. This is the first of our quarterly newsletters you will receive this year. Our newsletters are intended to keep you updated about your cooperative and to provide you with helpful information, so you can better use and better understand your health insurance plan.

We are proud to be member-governed but we realize this comes with great responsibility. Our primary goal is not to maximize profits but to invest in the service we provide our members. Our call center has been strained both during and after open enrollment with long hold times. Correcting this issue is a central focus of ours and we are committed to ensuring our members get the service they deserve.

I encourage you to consider running for our Board of Directors and we provide you with more information about this opportunity on page 2. The CGHC Board of Directors, which is nominated and elected by our membership, guides all our business decisions and has a direct impact on our direction and focus. I have been a member of the Board since 2013 and it’s been a rewarding experience to represent the members who buy our health insurance. Being a member governed cooperative makes us unlike other health insurance companies because we give our members a voice.

Our members always ask us what they can do to help strengthen their cooperative. In response, we want to encourage you that if you only do one thing, be a good steward of your healthcare dollars. Our new Fast Facts member education initiative (page 4) will provide you with information to help you make smart healthcare decisions and help keep costs down for all cooperative members.

Thank you for being a member of Common Ground Healthcare Cooperative! I hope to have the opportunity to meet with you at our Annual Meeting in May!

MEMBER SERVICESinfo@commongroundhealthcare.org

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May 22nd, 2019

Each year we host a member annual meeting. This is a great opportunity to meet other members, our staff, board members and partners of CGHC.

We invite you to join us on Wednesday, May 22nd, 2019 at 5:30 pm for ourAnnual Meeting at the Italian Community Center (ICC) in Milwaukee.

It is our pleasure to host an event at the ICC that brings members together with our employees and other stakeholders to learn more about CGHC and ask questions of our CEO, Cathy Mahaffey. For us, the best part of this annual event is to hear from you, our members. We'll discuss the legislative landscape, our year in review, financial performance and educational tools to help you best utilize your benefits within the cooperative. Come to learn, enjoy tasty Italian hors d'oeuvres, games and good people!

Registration | Meet & Greet Market | Executive Report | Q&A

Are you passionate about making a difference? Do you like to share honest and constructive feedback? Consider serving your cooperative through our board of directors or member advisory committee.

RUN FOR THE BOARD Our members are the most important part of our cooperative. Every year we give our members an opportunity to nominate themselves or another member to run for our board of directors. Ever considering running? Have experience with nonprofits, cooperatives, insurance, healthcare, marketing, the list goes on! Our board is made up of members elected by members who meet on a monthly basis. This year at least 4 seats will need to be filled. Submit your nomination through CGCares.org/Nominations.

JOIN OUR ADVISORY COMMITTEEDid you know that we have a member advisory committee? We meet quarterly to discuss important upcoming topics, review material and discuss strategies to better engage our members and keep you informed. Interested? Send your contact information and resume to MemberMail@CommonGroundHealthcare.org.

TAKE THE LEAP & SHARE YOUR VOICE

2019 ANNUAL MEETINGMARK YOUR CALENDARS

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Your time is valuable and we'd like to share with you easy ways to cut down on the time you spend trying to find answers to a few of our most common questions.

HOW CAN I MAKE A PAYMENT? We have several payment options including:

online | check | electronic funds transfer (EFT) | ACH | CGHC office

For checks, you can mail your payment to CGHC Box 78553, Milwaukee, WI 53278-8553. For in person payments, you can visit our office located at 120 Bishop's Way, Suite 150, Brookfield, WI 53005.

WHERE DO I FIND MY ID CARDS? If you have paid your monthly premium, you will receive the hard copy of your ID cards in the mail within three weeks of making your payment. To access other versions of your ID card, you can 1. download the CGHC mobile app and enter your name, member ID and pin (your 5 digit zip code) OR 2. register for the My Health portal at CGCares.org/MyHealth where you can view and print the pdf version of your card and access other valuable resources including your plan benefit information, network providers and more. We encourage you to confirm your ID card information is accurate with your plan documents in your My Health account.

HOW DO I KNOW IF A PROCEDURE REQUIRES PRIOR AUTHORIZATION? Before you get a procedure or service done, it's best to check with us if the service requires prior authorization. We encourage you to confirm that your provider has requested authorization on your behalf before receiving the service to avoid the penalty fees. For more information visit CGCares.org/prior-authorization.

WHEN WILL I GET MY MONTHLY INVOICE? Invoices are typically mailed at the beginning of each month. Invoice balances are due on the 25th of the month prior (i.e. March's payment is due February 25th). You can view and pay your monthly invoice by registering for the Pay My Premium portal at CGCares.org/Pay.

WHAT PRESCRIPTIONS ARE COVERED? To learn more about what prescriptions are covered you can visit CGCares.org/Formulary. Please note that "covered" does not mean all prescriptions are covered in full by CGHC. Depending on your plan, you may have a copay for your prescriptions or out of pocket costs that apply to your deductible. Please contact OptumRx at 855-577-6545 if you have questions about your pharmacy benefits.

WHAT PHARMACIES ARE IN MY NETWORK? You can review our 2019 pharmacy network listing at CGCares.org/Rx. You can fill your prescriptions at any Walgreens pharmacy, Aurora pharmacies, and many local pharmacies throughout eastern Wisconsin.

HELPFUL RESOURCESGet the answers you need when you need them.

If you have additonal questions, please contact Member Services at 877.514.2442, email info@commongroundhealthcare.org or

visit our Facebook page.

CGHC.EO.1013-2019

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WHAT'S AN EPO?An EPO stands for an "exclusive provider organization" plan. In an EPO, ONLY services provided by our network providers are applied to your benefits or "covered." We have contracted rates with specific providers and hospital systems to provide you with the care you need. Offering you this type of plan helps us keep your costs down.

AM I COVERED IN AN EMERGENCY? (ex: When I have a serious or life-threatening condition)Emergency care claims are received for both in and out-of-network care and are applied to your benefits; follow-up care is NOT covered out-of-network. You could be billed much higher costs from the out-of-network health system because we do not have contracts with these providers; this is called balance billing. Costs related to medically necessary emergency care and urgent care will be paid by CGHC at our maximum allowable fee (or appropriate payment amount), but it is important to stay in our network to avoid costly financial surprises.

WHAT IF I NEED TO VISIT AN URGENT CARE FACILITLY?Out-of-network urgent care is ONLY covered when you are outside of the CGHC service area. When within our service area, you must visit an in-network urgent care facility for the services to apply to your benefits. For example, if you visit an out-of-network facility, like Wheaton Franciscan/Ascension in Milwaukee, your claim will be denied. For non-emergent care, skip the waiting room and visit virtuwell.com, your 24/7 online clinic to get a treatment plan and prescriptions based on your needs.

WHAT IF I CAN'T GET THE CARE I NEED? Your in-network doctor may submit a request to CGHC for approval to receive out-of-network care. Such a request will ONLY be approved if there are no in-network physicians that can provide the service. The request or referral must be approved by CGHC prior to you receiving care. Approval is not based on patient choice.

WHAT TO KNOW ABOUT YOUR PLAN

For more information about your EPO plan you can visit CGCares.org/FAQ.

Insurance isn't always easy to understand or use, but we're here to help you navigate by providing you tools and resources to help you make your healthcare decisions.

We're bringing you FAST FACTS, short and sweet bite sized facts that are easy to understand and put into action. We want to help you lower your out of pocket costs and be a savvy healthcare consumer. Follow us on facebook for FAST FACTS updates, tips and tools!

FAST FACT: Do you have a doctor you see regularly to monitor your overall health? Schedule your FREE wellness visit and preventive screenings to catch signs of things like heart disease, cancer and diabetes in the early stages. See page 5 for more information about selecting your doctor.

@CommonGroundHealthcare

FASTFACTS

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For more information about your EPO plan you can visit CGCares.org/FAQ.

Like a doctor's visit, but online. We've partnered with virtuwell, a 24/7 online clinic to bring healthcare to your fingertips. Virtuwell is an easy to use tool for common ailments including pink eye, UTI's, bronchitis, allergies, and more. You can get a personalized treatment plan AND prescriptions sent to your local pharmacy. Visit CGCares.org/OnlineClinic to learn more.

10 FREE visits for CGHC members. Members with a health savings account compatible plan will pay no more than $49 for a consultation before the deductible is met.

Our network is intentially desiged to keep costs low for you. In the event there is a coverage gap, we actively seek contracts to resolve these gaps for our members. As a result we've added new providers to our network. Did you know that we've partnered with more local clinics including Parternship Community Health Center located in the Fox Valley region?

WHAT IS A PRIMARY CARE PROVIDER? A primary care provider (PCP) is a healthcare professional who practices general medicine. This can be a MD or nurse practioner. When selecting your PCP, we encourage you to speak with one of our contracted provider health systems (listed below) to help you find an in-network PCP that fits your needs. As a reminder, always seek care from an in-network provider to limit your out of pocket expenses.

HOW DO I FIND A PROVIDER?To find a provider in your network you can visit CGCares.org/Find-A-Doctor. Review our searchable directory or our pdf listing to determine which doctors are near you. It is a good practice to contact the provider facility to confirm the doctor is still practicing at the location listed and is accepting new patients. You'll likely have questions about your provider and we recommend that you contact the provider health system directly for the most accurate information (i.e. location, accepting new patients). It is your responsibility to ensure your provider participates in our network before paying them a visit.

Our network includes Aurora Health Care, Bellin Health, ThedaCare, Children's Hospitals and Health System, Door County Medical Center, and many more individual providers listed at CGCares.org/Find-A-Doctor.

PROVIDER PARTNERSYOUR ENVISION NETWORK

Common Ground Healthcare Cooperative120 Bishop’s Way, Suite 150Brookfield, WI 53005

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