Frequently Asked Questions
Frequently Asked Questions
Any Medical, Dental, Vision, and Prescriptions claims MUST be submitted through ALL health insurance carriers BEFORE submitting for Flex Reimbursement under the Wisconsin Electrical Employees Health & Welfare Plan (the "Fund"). You will receive an Explanation of Benefits (EOB) when an Insurance Carrier process's your claim. This EOB must be attached to the Flexible Benefit Reimbursement Form IF you file a paper Flex Reimbursement request. PLEASE BE ADVISED: You may now file your flex reimbursement directly from the website by logging in under your username and password and select FSA Account, follow the instructions posted.
If you have a secondary Insurance Carrier, the secondary carrier's EOB must be included with your paper Flex Reimbursement request (if filing online follow instructions). If you are filing for Dental or Vision Flex Reimbursement and you do not have this optional coverage under the Fund you can handle filing one of two ways listed below:
- Run the claim through the Fund Office and receive an EOB stating the claim was denied as you do not have this benefit; or
- Submit your Flexible Benefit Reimbursement Form with a copy of the itemized bill and state on the front page that you do not have the optional dental and/or vision benefit and are requesting reimbursement.
When filing for prescription co-pays by paper, just attach the Pharmacy print-out or copy of the prescription receipts which should indicate the co-payment amount that you paid, date of service, prescription name, patient name, etc. with the Flexible Reimbursement Claim Request.
Wisconsin Electrical Employees Health & Welfare plan (the "Fund") mails out explanation of benefits (EOBs) to the participant upon process of a claim. You have access to your claim EOBs and claim history on the website under your participant username and password with the ability to print any EOB listed. The Fund does not keep copies of EOBs, and if the participant requests the Fund for a duplicate EOB, the Board of Trustees require a fee to offset the costs of labor, supplies and postage. Upon receipt of a request for a duplicate EOB, the Fund will send you an invoice for the cost and upon receipt of payment your duplicate EOB will be mailed. You will be charged $20 for the first form, 10 cents for each additionalform plus the cost of postage. Remember you can print the same EOBs from the website under your participant account free of charge.
The Plan will pay at 100% per eligible individual per calendar year for routine physical examinations. This benefit
includes physician's charges for complete history and physical examinations, well-child expenses for a dependent child including charges for routine
immunizations, and x-ray and laboratory charges, such as electrocardiogram, blood count, chest x-ray, pap smear and routine mammogram. This benefit is
not subject to the deductible or co-pay percentage of the Plan.
Note: Services provided by a NON-PPO Provider are limited to $450 paid at 100%, 10% paid thereafter per person per calendar year.
- A better option for child immunization shots, even adult flu shots, is to get these shots at your County Health Office where they cost $6 to $9 as opposed
to over $100 at your Doctor's office. As you can see there is quite a cost difference, although always remember where you receive your health care is your decision.
- Notify your Provider that you have a routine benefit and your diagnosis must be coded as such, otherwise your claim will be processed under your medical benefits and
subject to your deductible and co-pay. In order to be changed from medical to routine, the Fund Office requires the treatment notes for that date of service with a
"Corrected Claim" sent to our attention for reconsideration. The Fund will not pay for those records.
Any rental or purchase of durable medical equipment (wheelchairs, C-Pap machines, insulin pumps, tens unit, bone growth stimulator, CPM machine,
etc) must be approved by the Fund Office.
The Plan shall not provide any benefits directly or indirectly relating to programs for monitoring and management of pain. Prior approval is
recommended before receiving any type of treatment including but not limited to epidural and steroid injections, therapeutic injections, intraarticular injections, medical
branch blocks, medical branch neurotomy, RFA of medical branches, etc.