Wawasee Community School Corporation

Summary of Benefits 2023-2024

Hostcare Medical Navigation – Here to Help You

Navigating healthcare can feel overwhelming—but you don’t have to do it alone. Hostcare Medical Navigation is a free service available through your Wawasee Schools health plan that helps you find the right care, at the right place, often at the lowest cost to you.

What Hostcare Can Do for You

• Find the right provider – Help locating a primary care doctor, specialist, or surgeon.

• Schedule diagnostic tests – CT, MRI, X-ray, ultrasound, lab work, and more.

• Coordinate specialty care – Including orthopedic, ENT, cardiology, gynecology, bariatrics, and even organ transplants.

• Compare cost and quality – Get information on local facilities so you can make informed decisions.

• Domestic medical travel program – Explore options for specialized care outside your local area.

When to Call Hostcare

Call 1-800-933-4148 before:

• Any non-emergency MRI, CT, or PET scan

• Any scheduled hospital admission or surgery outside your doctor’s office

• Chemotherapy or radiation

• Colonoscopy or other scheduled procedure

• When you need help finding a specialist

In some cases, using a Hostcare preferred facility could mean no cost to you for certain procedures.

This benefit applies when a Covered Person, while under this Plan, incurs covered dental charges.

Deductible

Deductible Amount – This is an amount of covered dental charges for which no benefits will be paid. Before benefits can be paid in a Calendar Year, a Covered Person must meet the deductible shown in the Schedule of Benefits.

Family Unit Deductible Amount – When the Family Unit Deductible Amount shown in the Schedule of Benefits has been incurred by members of a Family Unit toward their Calendar Year deductibles, the deductibles of all members of that Family Unit will be considered satisfied for that Calendar Year.

Benefit Amount

Each Calendar Year, benefits will be paid to a Covered Person for covered dental charges in excess of the deductible. Payment will be made at the rate shown under “Dental Percentage Payable” in the Schedule of Benefits. No benefits will be paid in excess of the Maximum Benefit Amount.

Maximum Benefit Amount

The Maximum Benefit Amount for covered dental charges is shown in the Schedule of Benefits.

Dental Charges

Covered Dental charges are the Reasonable and Customary Charges made by a Dentist or other Physician for necessary care, appliances, or other dental material listed as a covered dental service.

A dental charge is incurred on the date the service or supply is performed or furnished. However, if one overall charge is made for all or part of a course of treatment, the Plan will apportion that charge to each visit or treatment, with the pro rata charge considered incurred as each visit/treatment is completed.

Covered Dental Services

Class A Services: Preventive and Diagnostic Dental Procedures – Covered at 100%

The limits on Class A Services are for routine services. If a dental need is present, this Plan will consider for reimbursement services performed more frequently than the limits shown.

1. Routine Oral Exams, including cleaning and scaling of teeth – Limit of two exams per covered person each calendar year

2. Two Fluoride Treatments for covered Dependent children under age 19 each Calendar Year

3. Emergency Palliative Treatment for pain

Class A Services: Preventive and Diagnostic Dental Procedures – Covered at 50%

1. X-rays:

   • One bitewing x-ray series as required

   • One full mouth x-ray every 36 months

2. Space Maintainers for covered Dependent Children under age 19 to replace primary teeth

3. Sealants on the occlusal surface of a permanent posterior tooth for covered Dependent Children under age 19, once per tooth in any 36 consecutive months

Class B Services: Basic Dental Procedures – Covered at 50%

1. Oral Surgery (limited to removal of teeth, preparation of the mouth for dentures, and removal of tooth-generated cysts of less than 1/4 inch)

2. Periodontics (gum treatments)

3. Endodontics (root canals)

4. Extractions (includes local anesthesia and routine post-operative care)

5. Re-Cementing bridges, crowns, or inlays

6. Fillings, other than gold

7. General Anesthetics (upon demonstration of Medical Necessity)

8. Injectable Antibiotic Drugs

Class C Services: Major Dental Procedures – Covered at 50%

1. Gold Restorations (inlays, onlays, foil fillings – covered in excess of other materials only when gold is necessary)

2. Installation of Crowns

3. Installation of Precision Attachments for removable dentures

4. Installation of partial, full, or removable Dentures (to replace one or more natural teeth extracted while covered) – includes adjustments within 6 months of installation

5. Addition of Clasp or Rest to existing partial removable dentures

6. Initial installation of Fixed Bridgework (to replace natural teeth extracted while covered)

7. Installation of Implants

8. Repair of crowns, bridgework, and removable dentures

9. Rebasing or Relining of removable dentures

10. Replacement or addition to dentures/bridgework under specific conditions:

    • Required due to extraction of natural teeth

    • Existing device is at least 5 years old and unserviceable

    • Temporary denture replaced by permanent within 12 months

11. Splinting for crowns, fillings, or appliances used to connect/splint teeth or alter bite (not for Cosmetic purposes)

Class D Services: Orthodontic Treatment and Appliances

• Available for covered Dependent Children under age 19

• Includes preliminary study (x-rays, diagnostic casts, treatment plan), active treatments, and retention appliance

• Payments for comprehensive treatments made in installments (portioned every 90 days)

• Coverage ceases at the end of the Calendar Year the Dependent turns 19

Predetermination of Benefits

For treatments expected to cost $250 or more, submit a “Predetermination of Benefits” form before starting.

Process:

• Use a regular dental claim form; employee completes their section

• Dentist itemizes services, attaches x-rays, and sends to:

Group Administrators, Ltd.
915 National Parkway, Suite F
Schaumburg, Illinois 60173
Phone: 847-519-1880

Alternative Treatment

If a more expensive treatment is chosen over a standard effective treatment, benefits will be based on the cost of the standard option. The patient pays the difference.

Expenses Not Covered

Charges not covered include (but are not limited to):

1. Administrative Costs of completing claim forms/reports

2. Services/supplies furnished after coverage ends (with specific limited exceptions)

3. Broken appointments

4. Cosmetic Dentistry

5. Crowns for teeth restorable by other means or for periodontal splinting

6. Services excluded under Medical Plan

7. Experimental services/supplies

8. Oral hygiene programs/dietary instructions

9. Medical services payable under medical plan

10. Orthognathic Surgery

11. Personalization of dentures

12. Replacement of lost/stolen appliances

13. Splinting for Cosmetic purposes

FitStop24 Membership

All full-time and part-time employees of Wawasee Community School Corporation are eligible for a free FitStop24 membership. Your key fob and initial registration fees are waived.

Please note: Memberships are for the individual employee only. Guests may accompany you for $7 per visit, payable by cash or Venmo at the time of the visit.

How to Sign Up

1. Visit the Syracuse FitStop at 734 S. Huntington St. during staffed hours:

   • Monday–Thursday: 9:00 a.m. – 5:00 p.m.

   • Friday: 9:00 a.m. – 1:00 p.m.

2. Bring verification that you are a WCSC employee (school ID, All-Sports Pass, or other proof of employment).

3. Registration takes about 5 minutes.

Membership Perks

• Access any FitStop or Eastlake gym 24/7/365.

• Use your membership at multiple convenient locations in the region.

FitStop24 Locations (partial list)

• 734 S Huntington St., Syracuse, IN 46567

• 905 Lincolnway S, Ligonier, IN 46767

• 2088 Peace Tree Village, Rochester, IN 46975

• 304 N. Main St., Middlebury, IN 46540

• 352 W North St, Kendallville, IN 46755

• 2822 Old U.S. 20, Elkhart, IN 46514

Full list of FitStop locations: View here

Eastlake Locations

• 1530 E Market St., Nappanee, IN 46550

• 2856 Eisenhower Dr. N, Goshen, IN 46526

• 201 Chicago Ave, Goshen, IN 46526

• 13160 State Road 23, Granger, IN 46530

• 5150 Verdant Dr., Elkhart, IN 46516

• 3400 Henke Rd., Elkhart, IN 46514

WAWASEE COMMUNITY SCHOOL CORPORATION 

2025 GROUP INSURANCE RATES LUTHERAN PROVIDER 

FULL-TIME Personnel (Family Plan) Corporation pays 70% of group health premium  (Single Plan) Corporation pays 50% of the 70% paid on family plan 

PART-TIME and BUS DRIVERS Corporation pays 50% of the board’s portion of the  (≥30 hrs/wk) above family and single plans.

WAWASEE COMMUNITY SCHOOL CORPORATION 

2025 GROUP INSURANCE RATES THREE RIVERS PROVIDER 

FULL-TIME Personnel (Family Plan) Corporation pays 70% of group health premium (Single Plan) Corporation pays 50% of the 70% paid on family plan 

PART-TIME and BUS DRIVERS Corporation pays 50% of the board’s portion of the  (≥ 30 hrs/wk) above family and single plans.