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IT'S YOUR COOPERATIVEKeisha Krumm, Interim Board Chair

Spring is finally here! After a long winter, we're happy to share with you the Spring Issue of Member Insider full of important details about your coverage, frequently asked questions and current events within Common Ground Healthcare Cooperative (CGHC).

I am Keisha Krumm, your interim Board Chair. Jim Wesp, our former chairman has stepped down from his post after years of service to the cooperative as he's now eligible for Medicare. We are happy to share that Jim will continue to serve the cooperative as a non-voting member representing the interests of CGHC members. Thanks Jim for your commitment!

On Tuesday May 22nd, 2018 we will be hosting our Annual Member Meeting in Green Bay. I hope you will consider joining us for this important event. In the cooperative business model, Annual Meetings are a time for co-op Board and staff to connect directly with members to explain our decisions and their impact. We'll hear from an amazing keynote speaker that literally wrote the book on what's wrong with healthcare. Most important of all, we open the floor for your questions. We like to spend time listening to your concerns and answering questions because we understand health insurance is complex and confusing to say the least. We are committed to transparency and honesty when it comes to the cooperative decisions.

It's also important to note that our board elections are in full swing. This is your cooperative. You have a financial stake in the success of this cooperative which means you have the right and responsibilty to vote for the board candidates you deem most fit for the job. The board is an important decision-making body of our cooperative and the only people who can serve are people like you, buying insurance from the cooperative. Watch your mail for information about our candidates and your ballot to vote. You can also vote the day of our annual meeting where you'll be able to meet several of the members running for our board.

We look forward to your participation in our election and at our annual meeting. You can find more details inside the newsletter on pages 2 and 3. We hope you'll make your voice heard!

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We hope you will join us for our Annual Member Meeting in Green Bay on Tuesday, May 22, 2018. Our theme this year is Together for Tomorrow: Change. Challenge. Opportunity. By working together as a cooperative, we believe we can navigate the changes and challenges of today's healthcare landscape and turn them into opportunities for our cooperative to better serve our members.

The Annual Meeting is our chance to thank you for being a member and to talk one-on-one with you about business matters facing the cooperative. Your invitation will be arriving in the mail along with your ballot for our Board election. Please consider joining us at the meeting where we'll go over decisions we make that impact you. We will spend quite a bit of time answering members' questions honestly and openly. We'll close the meeting with an amazing keynote speaker, Elisabeth Rosenthal, who literally wrote the book on what's wrong with healthcare today. Plus, we'll be giving away some great gifts.

5:00 pm RECEPTION6:00 pm MEETING BEGINS

7:30 pm KEYNOTE SPEAKER8:30 pm ADJOURN

The election for our Board of Directors is underway! Members in good standing will recieve a ballot in the mail to vote for their top five candidates to serve on the board. Would you like to meet the candidates? Come to our Annual Meeting and cast your vote there. Or, you can view videos of the candidates on our elections webpage at CGCares.org/Election. You can vote at the annual meeting or by returning your paper ballot in the mail in the

envelope provided. Be sure to mail it so we receive it on or before May 22nd, and don't forget the stamp!

ELECTIONS ARE NOW OPEN!Vote by mail or at the Annual Meeting

We must receive your ballot by May 22nd! Learn more at CGCares.org/Election

2018 CANDIDATESMike Braun | Brett Remington | Dan Clarahan | Peter Kappelman

William Kort | Patrick Lowney | Chris Martin

2018 ANNUAL MEMBER MEETINGCHANGE. CHALLENGE. OPPORTUNITY.

KEYNOTE SPEAKER ELISABETH ROSENTHALHOW HEALTHCARE BECAME BIG BUSINESS

There is a lot that is broken in healthcare and the way individuals are being treated - both from a medical and from a customer service perspective. When we saw the release of the book by Elisabeth Rosenthal titled An American Sickness: How Healthcare became Big Business and How You Can Take it Back, we felt that someone had finally created a roadmap to what is failing us about the way we buy and deliver healthcare in the United States.

The cracks in the system, and the impacts they have on real people, is the reason our cooperative was started by community and health leaders in Wisconsin. That's why we are thrilled to have the book's author join us at our Annual Meeting to talk with our members about what she's learned over the years as a doctor turned health beat reporter.

Elisabeth Rosenthal is currently the editor-in-chief at Kaiser Health News, a favorite among health news resources here at CGHC. She is a former emergency room physician who transitioned to a 22 year career as an award -winning reporter at the New York Times covering health policy issues before working with Kaiser Health News. For years Rosenthal has been sharing eye-opening material about the healthcare system and why it's failing consumers. She provides real solutions to the system's breakdowns - solutions that our cooperative can effectively work on together. Join us on May 22nd to discuss simple ideas that we can all implement to reclaim health care.

Have you ever looked at a hospital bill and were shocked at the high prices? Have you ever been charged by a doctor that you don't remember seeing? Ever wonder why your once affordable prescription has skyrocketed in price? We've all had these or similar questions and relatable experiences that make us shake our heads in frustration, but positive change is possible.

Be a part of a bigger discussion on actionable solutions on May 22nd. We'll even save you a seat!

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Information You'll Receive: • 5 Questions to Ask During Your Hospital Stay • 6 Questions to Ask Before Every Doctor's

Appointment• How to Choose a Doctor• How to Deal with Medical Bills

2018 ANNUAL MEMBER MEETINGMay 22, 2018 at 5:00 pm, Radisson Hotel in Green Bay

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I am a cancer survivor. Thankfully, I am on a follow-up plan. Now I am in another fight for what I feel is fair. In prior years, when I was with a different insurance company, I went to the Vince Lombardi Cancer Clinic in Sheboygan for oncology office visits and labs.

When I went in, I expected to pay my specialist and lab co-pays under my plan. These were follow-up appointments with an oncologist which I was doing once or twice a year. Instead, the visits and labs were applied to my deductible and coinsurance resulting in my having to pay hundreds of dollars for each service. I called my insurance company; they told me the health system was coding my visits and labs as “hospital outpatient services.”Last summer I called the health system. It was not easy to get an answer to my question but eventually I was told by a Vice President that the system was required to bill that way because the hospital has a “340B” designation. This means the hospital (administrator of the clinic) participates in a federal program which requires drug manufacturers to provide medications at a significantly discounted price. She said it would be “illegal” for them to honor my co-pays because of government rules based on the premise that I am receiving hospital-based services through my clinic. I am NOT receiving hospital outpatient services when I see my specialist for a clinic office visit or labs.I took this information to a Common Ground Healthcare meeting held last October. I talked to one of the executives at the meeting who told me the same thing would happen if I moved to Common Ground Healthcare, because insurance companies cannot change the way health care providers “code” the bills for their services. If it was billed as hospital outpatient, Common Ground would be required by their contract to pay it that way, and it would once again apply to my deductible and coinsurance.Because this resulted from a federal program and because I was told by my health system VP that I needed to contact my government officials, I contacted my Congressman's office. I wanted to know why this program that is supposed to help people was having a negative effect on my billing and allowing healthcare providers to charge more. After several months of being persistent in getting an answer, the Congressman's office referred me back to the provider after they were told by the health system that this may not be a 340B issue.I am tired of the run around I feel I am getting. The only reason I stick with it is the hope that what I am doing will somehow help someone else who is facing the same situation. People need transparency from their healthcare providers and insurance companies – we cannot afford these surprise charges.I hope sharing my story helps raise awareness for other people. Know before you go how the “clinic” you are visiting bills for their services.

~ A member from Sheboygan

MEMBER TO MEMBERLEARNING ABOUT HEALTHCARE TOGETHER

If you have a story you’d like to share with other CGHC members, please reach out to

us at MemberStories@CGCares.org

SITE OF CAREWhy it Makes a Big Difference

We often remind our members how important it is to choose the right care setting to avoid higher charges. For example, we encourage our members that are not having a medical emergency to avoid the emergency room if possible, as it will cost you a lot more to go there for care. But sometimes it gets more complicated, such as the story from our member on the opposite page. These stories are all too familiar in the healthcare industry.

You think you are going to a "clinic" because that's what the sign says on the door but you end up getting a hospital bill for services. Office visit copays don't apply to hospital bills and it's a much higher charge than a non-hospital clinic charge would be.

General rule of thumb: If a clinic is attached to a hospital or located on its property, it's probably going to be a hospital-based bill. If you are in doubt, you should always ask the clinic.

Another example: a specialist recommends an MRI at the local hospital. This fairly routine test can cost somewhere between $1,000 and $2,000 if received at the hospital. But in a non-hospital, in-network clinic setting, it can cost half that amount. This can apply to any kind of imaging (x-rays and CTs), echocardiograms, chemotherapy or any other medications that require infusion.

On the right of this page you'll find some tips to help you save money and avoid costly surprises.

1. Establish a relationship with an in-network primary care provider (PCP) such as a nurse practitioner or a doctor that specializes in general, internal or family medicine. PCPs can help you navigate the healthcare system which is so important in large, complex health systems. Make sure your provider is in-network or you may not have coverage.

2. For now, the least expensive site of care is a QuickCare or Fast Care clinic. Aurora, Bellin and ThedaCare all offer these clincs that can treat minor concerns such as respiratory ailments, rashes, urinary tract infections, pink eye or immunizations. See www.CGCares.org/Urgent for locations.

3. Your primary care doctor’s office is typically the next least expensive site of care, followed by an urgent care clinic.

4. Talk with your doctor’s office (either your PCP or someone you have an appointment with) to understand their billing practices. The billing department is the most likely place to get these questions answered. Are they billing from their own clinic or is it the hospital? Will you get a separate bill for a facility fee? Find out all the providers involved in your care (i.e. labs, radiologists, anesthesiologist) so you understand your potential cost of care.

5. If a doctor recommends you go to a hospital for a test, find out if there are any less expensive alternatives to where you get the test. Sometimes the only way to know is to ask your provider.

6. If you need to go to the hospital or doctor’s office for medication infusion therapy, you will save money by receiving these services at home. Call us at 855.829.3911 to find out if you are eligible for this convenient and less expensive solution.

DON'T SPEND MONEYIF YOU DON'T NEED TO

COMING SOON!Watch for an exciting announcement about

a new service we will offer our members this summer. Get care from the comfort of your own home through Virtuwell. Check it out!

www.virtuwell.com

Couldn't attend a Talk. Learn. Summit? There's good news! We are launching a webinar series to bring you more opportunities to learn more about your cooperative and your insurance benefits. Watch your email for an invitation to this webinar coming your way soon.

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TALK. LEARN. SUMMITSWHAT WE LEARNED FROM OUR MEMBER MEETNGSEvery spring, we hold a series of meetings in communities around the state to engage our members in a dialogue about health insurance and help them understand their benefits. We call them Talk. Learn. Summits to support the idea that learning goes both ways - for us and our members. Below are the headlines we took away from the summits, and on the next page are some frequently asked questions and answers we wanted to share with all our members.

What we heard:• Members are confused by the term "covered." When something is covered, it means it applies to your

benefits. It does not mean paid in full. You can get the care for our discounted rate, but you might have to pay a copay, or pay toward your deductible and coinsurance, whatever is applicable for the service. Once you hit your out of pocket maximum, medically necessary covered services from an in-network provider will be fully paid by us.

• Members want to understand how deductibles, coinsurance and copays work. We have created a video entitled Health Insurance 101 to help you understand these terms. You can view the video on our Common Ground Healthcare Youtube Channel. Subscribe today!

• Members want to better understand preventive care, and may not realize that only certain preventive care services as defined by the US Preventive Services Task Force are paid by health insurance companies at no cost to the member. Other tests that doctors might order for preventive reasons are not covered at 100% but may apply to benefits. Services such as a colonoscopy, labs or an office visit are not paid at 100% if they are done for diagnostic reasons (ie. you have a health concern that you're getting checked out, which includes a history of polyps in the case of a colonoscopy).

• Members do not realize the power they hold with doctors. Members should always ask questions to try to understand all the implications of getting a test or procedure versus not getting one. If your doctor does not welcome these questions to make decisions with you, you may want to consider a different in-network doctor.

• Members want to better understand costs, but it takes participation by doctors, hospitals and insurance companies to give you the full picture. Our member services department can help you understand your cost-sharing responsibilities (deductibles, copays and so on) but we cannot predict which codes a doctor will bill for services you receive.

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ANSWERS TOQUESTIONS MEMBERS ASK US

A. Our wait times are longer in the weeks during and after open enrollment than any other time of year. Call volumes ramp up in November and peak in January when we get a lot of questions from members about their new coverage. We cannot hire and train enough great staff to work with us only during this short time. That's why we offer the alternatives of online portals, phone-based ID cards (in our phone app) and help via email through info@commongroundhealthcare.org. Outside of these months, wait times are typically less than ten minutes. If it's busy when you call, you may want to wait and try later.

Q. Why are wait times so long when I call?

Q. What are the different portals and how do I access them?

A. As a CGHC member you have access to two member portals - the Pay My Premium portal and the My Health portal. Each portal requires you to login separately. The Pay My Premium portal allows you to make your monthly premium payments, view your bill and set up recurring payments. You can access the Pay My Premium portal at CGCares.org/Pay. The My Health portal allows you to access your medical claim history, search for providers, access the self-assessment health tool and more. You can access this portal by visiting CGCares.org/My-Health.

Q. How are Quick Care and Fast Care clinics different from Urgent Care?

A. Aurora QuickCare clinics are located in certain Walgreens locations. The Bellin or ThedaCare Fast Care clinics are located in Shopkos, shopping malls and other convenient locations. These options are generally faster and typically less expensive alternatives to urgent care facilities. You can visit these convenient care locations for minor conditions including strep throat, ear or sinus infections. See CGCares.org/Urgent for more information.

Q. What blood tests during an Annual Physical are covered under the no cost preventive benefits?

A. There is a longer list of covered preventive health services, but when it comes specifically to blood tests, only those recommended by the United States Preventive Services Task Force for your age are covered at 100% as long as you stay in-network. For adults over 40, this includes a blood glucose screening for diabetes and a cholesterol (lipid) panel. Other screenings may be covered either at no cost or they may apply to your deductible/coinsurance depending on your age and health history. Please be aware if your doctor orders more than a lipid panel and blood glucose, you might end up paying out of your pocket for tests not be recommended by the US Preventive Services Task Force.

Q. What is going on with health reform now?

A. Before the state legislature adjourned for the session, it passed enabling legislation that allows the state of Wisconsin to apply for a waiver from the federal government that would allow a reinsurance program to be created in Wisconsin. This will have a positive impact on health insurance premium increases. At the federal level, there has been a lot of talk by Congress but little action. The US Department of Health and Human Services rolled back regulations and consumer protections for certain plans, which is not likely to help consumers that need insurance. You can always find the latest news on this front on our Knowlege to Action page, www.CGCares.org/Action.

CGHC.EO.1034-2018

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

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