2025 Insurance Information

A spousal carve out is a health insurance plan provision which limits coverage for an employee's spouse. In the EACS plan, it is called the "Spousal Rule".

You can find the full language on the Spousal Rule in the Health Summary Plan - Full Document on page 3.

Note: The Spousal Rule does not apply to those teachers and non-teachers who were hired BEFORE Aug. 1, 2010.

For those hired after Aug. 1, 2010, the biggest question has to do with part (c): The Spouse is employed but is either not eligible for health coverage through his or her employer or the Spouse’s share of the cost of employee only health coverage for which the Spouse is eligible is greater than two (2) times the Employees’ cost for the single plan at East Allen County Schools;

For the 2025 insurance year, this breaks down to the following figures.

The spouse’s employer’s health insurance premiums would have to be more than:

$2184/year or $182/month if you are on the PPO Plan
$1732/year or $144.33/month if you are on the HDHP-Opt 1
$1526/year or $127.16/month if you are on the HDHP-Opt 2

Women's Health Advantage will stay an in-network provider (Tier 2) for office-based services only.

Women’s Health Advantage just announced they will remain in-network with Signature Care for office-based services. They will be considered a Tier 2 Provider.

I found the following information on the WHA website at https://www.heradvantage.com/resources/latest-news/

Women’s Health Advantage providers will remain in-network with Signature Care for office-based services.

Recently, we shared some updates regarding our practice’s decision to resign privileges at Parkview Health facilities taking effect over the past several weeks, as well as our expected removal from Parkview’s Signature Care network as a result of this decision beginning March 1, 2025.

After extensive discussions with leaders at Parkview Health and Signature Care, however, we’re pleased to report that Women’s Health Advantage providers will remain in-network with Signature Care for office-based services moving forward.

At the same time, it’s important to note that our planned removal from Parkview Health facilities for hospital services will move forward as planned; any WHA patients requiring hospital-based care will be referred to a Signature Care provider who has privileges at a participating facility.

We are thankful for Signature Care and PPG – OB/GYN’s collaborative approach that enables us to remain in-network for office-based services, which we believe is in the best interest of our patients, physicians and staff. We are proud to be one of the largest providers of comprehensive women’s health care in northeast Indiana – and to be independent and physician-owned.

As always, Women’s Health Advantage is dedicated to providing prompt, comprehensive care of the highest quality to our patients. We will work with any patient who may be impacted by these updates to ensure the compassionate care they’ve come to expect from our team continues through every stage.

For additional FAQ’s, please see our Resources Administrative and Pregnancy pages.

HR will be posting information in the March 7th Administrative Bulletin.

Email from Jen Rose - 01/29/25

Thank you for your continued understanding and patience as we navigate through our current PHP (Third Party Administrator) transition process. We are aware that some of you have experienced issues with claims that are no longer being handled by Employee Plans. We apologize for any confusion this may have caused, as we are committed to ensuring a smooth process for everyone. Please allow PHP TPA Services until February 17, 2025, to load all claim history from your previous plan (Employee Plans) into our system. We are working diligently to ensure that all claims from 2024, as well as new claims for 2025, are processed efficiently.

To help streamline the resolution of these claims, please be advised that any claims-related issues should be directed to PHP TPA Services. We ask that you follow these instructions moving forward:

Email: customerservice@phpni.com
Customer Service Phone Numbers:
- 800-551-7334
- 260-436-9495
Mailing Address:
PHP TPA Services
PO BOX 9648
Fort Wayne, IN 46899

This should help eliminate any unnecessary delays and ensure your claims are processed promptly for all services that have been incurred in 2024 as well as new claims for 2025. Employee Plans is no longer handling any questions or claim processing, please contact PHP TPA services.

Thank you again for your cooperation during this time of change.

Jennifer Rose

Human Resources Benefit Specialist

East Allen County Schools

1240 State Rd. 930 East

New Haven, IN 46774

260-446-0100 ext. 1025

260-446-0107 – fax

jrose@eacs.k12.in.us

Vision Plan Info from Patty Prosser via 2/14/25 Admin Bulletin

VISION CARE UPDATE

NOTE from EAEA: You will use the same insurance card for vision and dental. The information the eye doctor/dentist need to use is on the back of the card under "Other Claims/Correspondence:" and "Claims, Eligibility, Benefits:"

There have been many questions regarding the vision claim process after the move to PHP. We have found that Employee Plans had some agreements with some of the local Vision care providers regarding filing claims. PHP is currently working to put into place similar agreements so that our Employees can use the same providers they have in the past.

With that said, this is still work in progress. If you have a provider that is stating that you are “out of network,” this [only] means that they will not file the claims for you. There is an option to pay for services up front and get reimbursed by PHP. [PHP Claim Form is linked above.] The vision plan and coverage is exactly the same as we have had previously.

PHP has managed to put into place agreements with Hockemeyer Eye Care and Hicksville Family Eye Care. If you have questions regarding vision, dental and medical coverage, please contact PHP Customer Service at 260-436-9495.

Patty Prosser, ext. 1009

Lutheran Health Physician group (Tier 3 or "out-of-network") Information

One of our teachers saw a sign posted in their Lutheran Health Physician (LHP) doctor's office addressing Signature Care Insurance members. I called the number at the bottom and asked questions. Then I contacted PHP-TPA to find out how to file. Here is what I found out:

If you elect to self-pay to get the discount, LHP will not file your claim.

You pay the discounted amount then send PHP-TPA an itemized bill and the receipt of your payment to customerservice@phpni.com. Include your name and insurance Member ID number.
You will also need to fill out the EACS Health Claim Form.
If the claim is for a Preventative Care service which is covered at 100%, you will be reimbursed the full amount you paid.
If the service not a Preventative Care and you have met your Tier 3 Deductible , they will reimburse you according to your plan (PPO pays 50%, HDHP Opt. 1 pays 70%, and HDHP Opt. 2 pays 50%).
If the service not a Preventative Care and you have not met your Tier 3 deductible, then the amount paid will go towards the deductible and you will not be reimbursed.

*Tier 3 payments do not go towards your Tier 1 or Tier 2 deductibles.

If you have problems with the claim because Lutheran Health coded it incorrectly, contact Jen Rose at Ext. 1025 or jrose@eacs.k12.in.us to help you.

If you elect to not self-pay, you can ask your LHP office to file the claim for you. It is up to them if they will file or not.

I would recommend if they don’t file, that you submit the itemized bill so you get credit towards your Tier 3 deductible.

*Tier 3 payments do not go towards your Tier 1 or Tier 2 deductibles.

If by some chance your LHP provider will give you the self-pay discount AND file your insurance (which I don’t think will happen), you will want to make sure when they submit the claim that they make you the payee. Otherwise, you would have to get the refund from the LHP provider and that will take forever.

Notice from Lutheran Health Physicians:

Patients with Signature Care insurance can continue scheduling primary care and specialist appointments with Lutheran Health Physicians (LHP).

Effective Jan. 1, 2025

While patients are responsible to pay for their office visit, a 30% discount is given if self-pay and a 44% discount is given when paying fully at time of service.

Often patients can submit the office visit receipt to their plan administrator for some reimbursement. Patients are responsible for checking with their third party administrator (TPA) regarding out-of-network reimbursement. This information is located on your insurance card.

Examples:

If a patient has a low acuity office visit charge of $139, the self-pay price (30%) discount) is $97.30. Full payment at time of service (44% discount) is $77.84.

For a moderate acuity office visit charge of $206, the self-pay price (30% discount) is $144.20. Full payment at time of service (44% discount) is $115.36

We are providing the above options so patients can continue to receive medical care from their established trusted provider because one’s relationship with their provider is important.

Questions?

Please call (833)546-4968, Option 1.

Dental Plan with Ortho for ALL TEACHERS

All teachers have the Dental Plan with Ortho. The benefit booklet states that the plan does not cover patients over 18 years old. This is incorrect for teachers.

The teachers Dental Plan with Ortho covers all patients on the plan no matter the age.

Make sure PHP has enrolled you in the correct Dental Plan with Ortho by logging on to the PHP-TPA online member portal and clicking on the Member and Plan Information toggle on the right-hand side of the screen.

2024 Flexible Spending Account (FSA) formerly with BRI) & FSA vs HSA definitions

Everyone with Medical and Childcare Reimbursements for 2024 will need to complete the PHP reimbursement form and send it into PHP. All reimbursements will need to be submitted to PHP by 3/31/2025.

Click here for the PHP Reimbursement Form

Difference between FSA and HSA:

FSA (Flexible Spending Account) is for those on the PPO Insurance Plan. The money contributed to this account must be spent within the current calendar year. Example: Money you deposited into this account in 2024 must be used on 2024 expenses or you will lose that money. Claims for the previous year can be submitted until March 31st. You can use the total amount of your scheduled contribution for the year at any point (it doesn't have to be deposited into the account first - Example: You are scheduled to deposit a total of $1000 into your FSA for 2025. You can use the full $1000 starting January 1st.) You can access your FSA account on my.wexhealthcard.com or contact PHP TPA's customer service at customerservice@phpni.com or call (260)436-9495.

HSA (Health Savings Account) is for those on the HDHP Insurance Plans and the money in this account carries over from year to year and you can take it with you if you leave EACS. EACS uses UMB for the HSA accounts. You can use your HSA card to pay for expenses or request a reimbursement using your online account at https://www.umb.com/hsa. The EACS Board contributes money to HSA accounts. They deposit 65% of their contribution at the end of January and the remaining 35% at the end of September. You can only use the current balance of your HSA at any time, so keep track of what is in your account. UMB HSA contact by phone at 1-888-401-0113.

CVS Caremark Mail Service Pharmacy

CVS Caremark Mail Service Pharmacy -

Skip the trip to the pharmacy with home delivery.

To start filling by mail, you'll need a new 90 day prescription. You can either:

Ask your doctor to send a prescription to CVS Caremark® Mail Service Pharmacy or,
Sign in to request a new prescription and CVS Caremark will contact your doctor to get approval.
Sign in to request a new prescription https://www.caremark.com/wps/myportal/CHECK_DRUG_COST_FAST?src=newrx

Review options on how to get your prescriptions

https://www.caremark.com/manage-prescriptions/get-prescriptions.html

PHP Member Portal

Information summary from Insurance Meeting on 11/14/24 at Annex:

To register on the PHP Member Portal at https://tpaservices.vbagateway.com/, follow the directions below. Once you have completed those steps, you will receive an email confirmation. Your new username and password will NOT work until you have opened that email and clicked on the link provided.

Member Portal Registration Steps:

Visit https://tpaservices.vbagateway.com/
Click the Register button.
Click the drop down menu for "Which portal would you like to register for?" and select "Member".
Enter your SSN and birthdate.
Follow the directions for creating a username and password.
Once this process is completed, you will receive a confirmation email. Click on the link in this email. (Your new username and password will NOT work until you have done this step.)

PHP TPA Services Mobile App

Search for PHP TPA Services from the Apple App Store or Google Play.

Once downloaded, login using your member portal credentials.

12/20/2024
Changes with Women's Health Advantage and the Fertility and Midwifery Care Center

Members,

Included in the Dec. 20th Administrative Bulletin is information (Enclosure #1) which will impact patients of Women’s Health Advantage and the Fertility and Midwifery Care Center.

I do not know any details and cannot answer specific questions at this time. I will, of course, do what I can to try to get answers. In the meantime, if this impacts you, I would highly recommend that you reach out to any of the following:

Patty Prosser, Director of HR at ext. 1009 or pproser@eacs.k12.in.us

Jen Rose, HR Specialist at ext. 1025 or jrose@eacs.k12.in.us

Employer Solutions at ParkviewEmployerSolutions@parkview.com or 260-373-9017.

Working for you,

Andra Kosmoski, President

Insurance Information for 2025

Information summary from Insurance Meeting on 11/14/24 at Annex:

The three plans – PPO, HDHP Opt. 1, and HDHP Opt. 2 – are still through Signature Care and have not changed as far as what is covered, the provider discounts, etc. If you are comfortable with the current plan you are on, stay on it. If you are considering changing plans, and want more information on which one is best for you, Jen Rose is happy to sit with you to talk about your specific needs. (I have also put together a PPO vs. HDHP comparison, if interested.)

PHP-TPA is taking over for Employee Plans. This is the Third Party Administrator who handles the claims and sends out the Explanation of Benefits (EoBs). They will send out new insurance ID cards after enrollment and they have an online member portal and member app for us to keep track of claims. They will be who you contact with claim questions or when you want to verify if a provider/facility is in-network.

PHP will also take over the FSAs. New cards will be mailed to those who participate in an FSA (for PPO insurance only. The HSAs have not changed. These will still be through UMB.)

Change with the In-Network vs. Out-of-Network options

Our current insurance has two “tiers”: in-network and out-of-network.

The new system will have three tiers:

Tier 1: EPO (Exclusive Provider Organization) Parkview providers and facilities (This would be the same as the current “in-network”.)

Tier 2: Signature Care Facilities (These are facilities which are partnered with Parkview and not individual providers .)

Tier 3: Non-Preferred Providers (This would be the same as the old “out-of-network”.)

In this new 3-tier system, the coverage of services along with the provider discounts will be the same as our current plan. The difference is how the amounts you pay will be applied to the deductibles in each tier.

If all of your services are through Tier 1 providers and facilities, all of the claims will go towards the Tier 1 deductible. If you go to a Tier 2 facility, those claims will go towards the Tier 2 deductible. What is still not clear is whether the Tier 2 deductible counts towards the Tier 1 deductible. (Jen Rose is looking into the answer.) We were told that the Tier 1 deductible DOES GO TOWARDS the Tier 2 deductible, so you don’t have to start all over. (I have requested that Signature Care/PHP provide an example scenario of claims so we can better understand.)

How to tell if your provider is a Tier 1 provider or is out-of-network

Parkview Select Care 3-Tier Directory -
https://www.parkview.com/employer-solutions/select-care/parkview-select-care-3-tier-directory

Signature Care has a searchable Provider Directory at http://www.Parkview.com/SignatureCareDirectory

Signature Care EPO Network - Top-Tier (Tier #1) Facilities - www.parkview.com/employer-solutions/signature-care/epo-top-tier-facilities

IMPORTANT: Lutheran Health Physicians and Fort Wayne Orthopedics providers will continue to be in network through December 31, 2024 and appear in the following directory.
Effective January 1, 2025, all Lutheran Health Physicians and Fort Wayne Orthopedics providers WILL NO LONGER BE PARTICIPATING IN SIGNATURE CARE.
For a list of providers impacted by this change, click here.

To make certain your physician, ancillary, hospital or other healthcare provider is currently a preferred provider, always ask the provider before you receive care, check online, or contact PHP-TPA.