Health Tradition handbooks, forms and instructions

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.

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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.

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Transfer of Medical Records

If you are new to Health Tradition Health Plan and are interested in having your medical records transferred to Mayo Clinic Health System – Franciscan Healthcare, please click on the link below, complete the forms and send them to:

Mayo Clinic Authorization for Release of Medical Information PDF

Mayo Clinic Health System – Franciscan Healthcare
ATTN: Clinic Medical Records
800 West Avenue South
La Crosse, WI 54601

OR

Mayo Clinic Health System – Franciscan Healthcare
ATTN: Hospital Medical Records
700 West Avenue South
La Crosse, WI 54601

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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.

Health Tradition Health Plan information for Adult Dependents/Students PDF

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:

Mayo Clinic Health System – Franciscan Healthcare Forms:

If you or your family receive health care from a Mayo Clinic Health System – Franciscan Healthcare provider, you must authorize Mayo Clinic Health System – Franciscan Healthcare to discuss your patient accounts and financial information with any other party before they can do so. In order to authorize Mayo Clinic Health System – Franciscan Healthcare, you are required to complete the designated release form and have it notarized. The form must then be returned to Mayo Clinic Health System – Franciscan Healthcare Patient Financial Services. See link below for appropriate release form.

Mayo Clinic Health System – Franciscan Healthcare Release Form

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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 Health Tradition toll free at 1-877-832-1823.

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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.

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65Plus and Premier One Bank Funds Authorization form

Allows monthly premium to be automatically deducted from a bank account:

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Additional claim and other forms

You can print a variety of forms the plan needs to process your claims should you not receive or lose your copy. These forms are available at Mayo Clinic Health Solutions Online Service Center by clicking on the Forms link. Some of the forms available are:

  • Accident Form
  • Pre-Existing Condition Form
  • Dependent Verification Form – Requires School Stamp
  • Request For Medicare Coverage Form
  • Catamaran Prescription Drug Reimbursement Form
  • Health Reimbursement Account (HRA) Claim Form

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.

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Rebate forms

Health Tradition offers employer group health plan members rebates when they participate in the Eat Well Move More program. This program provides up to a $200 total combined rebate for membership at an eligible fitness center, Community Supported Agriculture (CSA) farm, A New Me™, Camp Wabi and/or Weight Watchers®! Eligibility requirements apply.

See program details, watch the required educational video and apply for your rebate at Rebate Central.

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