Health Tradition has made many of our member materials—including our handbooks,
newsletters, consent forms and sample ID cards—available
to you online. The information can be printed for your records, or simply reviewed
online.
Member Handbooks
Please select the handbook that matches your policy. If you do not know which policy
you have, please refer to the front of your ID card. If your ID card is not available,
contact Customer Service toll-free at 1-877-832-1823.
Newsletters
Health Tradition is pleased to provide quarterly member newsletters and Health Tips
to our members. These materials should be used to supplement, not replace, visits
to a professional healthcare provider.
Consent Forms
To have someone act on your behalf to inquire about claims or referrals, resolve
issues for you, make changes to your account, or file a complaint, you must send
Health Tradition a signed document that authorizes that person as your representative.
You must indicate the information that can be discussed with the representative
as well as those that cannot. You can limit the types of information and the time
frames for the authorization.
Please remember that the regulations stipulated by the Health Insurance Portability
and Accountability Act (HIPAA) and Wisconsin State Law require that authorizations
be in place for adults to inquire on their child’s account based on the ages and
subjects below:
Medical, Claims and Referral Information
Any adult over eighteen (18) years of age must give authorization. Parents of children
younger than 18 years do not need authorization. Please note that college students
must authorize their parents to act for them. Special rules apply to mental health
or family planning related information. See list below.
Mental Health Services
Any member over fourteen (14) years of age must give authorization. In order for
the parent or legal guardian to inquire about any information or service related
to the child, the child must sign an Authorization to Release Information
form. See list below.
Family Planning Services
Any member over fourteen (14) years of age must give authorization. In order for
the parent or legal guardian to inquire about any information or service related
to the child, the child must sign an Authorization For Disclosure of Information
form.
Forms:
Franciscan Skemp Healthcare Forms:
If you or your family receive healthcare from a Franciscan Skemp Healthcare (FSH) provider,
you must authorize Franciscan Skemp to discuss your patient accounts and financial information
with any other party. In order to authorize FSH, you are required to complete the designated
release form and have it notarized. The form must then be returned to Franciscan Skemp Patient
Financial Services. See link below for appropriate Release Form.
FSH Release Form
Summary of Benefits
Premier and Premier Plus
Health Tradition sends a copy of your Summary of Benefits annually to your employer.
This form is a summary of your plan, but does not include all the information and
does not replace your Certificate of Coverage.
The Summary of Benefits:
- Provides information on some covered and non-covered services, including some exclusions
- Indicates your out-of-pocket maximums for annual deductible and coinsurance per
member and per family
- Defines office copays, confinement fees or emergency room co-payments
If you need a copy of your Summary of Benefits, please contact your human resources
department or call Sales and Marketing at
Health Tradition.
Certificate of Coverage
The Certificate of Coverage, your policy, outlines the covered and non-covered benefits,
information on how to access the benefit and details any exclusions/limitations
associated with the benefits. The Certificate of Coverage also includes term definitions,
enrollment and disenrollment issues, coordination of benefit information, member
rights/responsibilities and complaints/appeals procedures. Should you have questions
about the information or if you cannot find the information you need in your certificate,
please contact a Customer Service representative
for help or clarification. If you need a copy of your certificate, please contact
your human resources department or call Sales and
Marketing at Health Tradition.
Additional Claim and Other Information Forms
You can print a variety of forms the Plan needs to process your claims should you
not receive or lose your copy. Some of the forms available are:
- Accident Form
- Pre-Existing Condition Form
- Dependent Verification Form - Requires School Stamp
- Request For Medicare Coverage Form
- SXC Prescription Drug Reimbursement Form
- Health Reimbursement Account (HRA) Claim Form
Click on the Forms link at MMSI
Services Web Site.
If you are not sure of which form to complete, contact Customer Services at
877-832-1823, or your Member Advocate locally at 608-781-9692 to get assistance.