1. What is required to join the NEHA?
Only employers with self-funded medical plans can become a member company of NEHA. Members must be willing to make a three-year commitment to NEHA including participating in at least three membership meetings each year.
2. Will NEHA work with our brokers?
Yes. NEHA will work cooperatively with brokers to help preserve the unique value of the employer’s plan and the distinctive employee health plan goals of the company.
3. How many provider networks does NEHA offer?
Currently, NEHA offers four networks. The NEHA PPO Broad network includes providers at Aspirus, Ascension and Marshfield Clinic along with over 200 ancillary providers under contract with NEHA. Three community-based narrow networks are also available. One is affiliated with the Aspirus network, one is affiliated with the Ascension network and the other network is affiliated with Marshfield Clinic. All community networks include access to the ancillary providers under contract with NEHA. These enrolled community networks offer higher savings by encouraging employees and their family members to utilize the providers within the primary health care system they have selected.
4. What dues and other fees does a member company pay?
- Employers pay nominal annual dues to be an NEHA member company
- Employers pay a monthly direct network access and management fee to Coalition Services
- Employers pay a monthly administrative services fee to one of the preferred medical TPAs
Your broker or consultant will work with Coalition Services to develop a proposal quantifying these fees for your company.
5. What if the employer has eligible employees working outside the area?
NEHA serves members primarily in north central Wisconsin. Regional networks are available for employees who live outside of north central Wisconsin, so a separate plan is not necessary for those employees. When members and their employees travel outside of their enrolled network region, they will use the national wrap/travel network their third party administrator has put in place. Network information is provided on the member’s ID card. As a result of using multiple networks, claim savings are achieved, and typically very few claims are processed as out-of-network.
6. Can the employer use their present third party administrator (TPA) and pharmacy benefit manager (PBM)?
As a member company of NEHA, the employer is required to use NEHA’s preferred partners: Auxiant, Prairie States, UMR for medical claims processing and OptumRx (a UnitedHealthcare Company), Serve You, RxBenefits – OptumRx or RxBenefits – CVS for prescription drug management.