Frequently Asked Questions

Owned by Froedtert Health, Exceedent is a third-party administrator (TPA) that provides support to health benefit plan members by helping them get the most from their employer’s benefit plan. Exceedent processes medical claims on behalf of your employer’s benefit plan.

A TPA is a company that your employer hires to handle the many tasks associated with managing your health benefit plan. For example, Exceedent handles general enrollment tasks when new plan members sign up to receive health benefits. We also process our health claims, making sure they are handled quickly and accurately. Exceedent even has medical professionals on staff who can help coordinate your care if you are in the hospital or are dealing with a chronic health condition.

A self-funded benefit plan is financed by your employer, not an insurance carrier. Your employer pays for most of your health plan and claim costs.

Most TPAs work with a preferred provider organization (PPO). A PPO is a network of health care providers who have agreed to discount (reduce) what they charge for services when treating members of a benefit plan. When you choose to see an in-network PPO health care provider, you will pay less for their services than if you had chosen an out-of-network (non-PPO) health care provider. You have the option to see non-PPO providers, but you will pay more for their services.

Your member ID card contains important information regarding your plan’s PPO. Contact your PPO directly or your Exceedent customer service team to check a health care provider’s participation.

We provide you with prompt, personalized service. As a plan member served by us, you have a customer service team of helpful people available to assist you and answer questions about the benefits of your employer’s health plan. For example, you can ask us about the medical care your plan covers or about a specific health claim. One phone call is all it takes to reach us and speak to someone who can help you get the answers you need.

You may also receive other services, depending on your health plan’s features, to help you and your covered family members use the health care system and receive appropriate health care at a reasonable cost.

A lot! First, choose a participating PPO provider whenever possible, so you’ll receive the discounts your plan has made available for you. Your benefit plan ID card displays your PPO information. Always show your ID card to your health care provider at each visit.

Next, learn about the features of your benefit plan. Knowing about the options to receive your health care, like taking advantage of preventive care services, can help you save money.

Also, read and understand your explanation of benefits (EOB). It can help you track your health care costs and get a better understanding of what you’re spending. “How to Read Your EOB” is available on the member portal to help you understand how your health claims are charged, processed and paid.

Lastly, learn how you and your family can prevent illness and maintain your health. Make health conscious choices every day. You’ll feel better, improve the quality of your life and have more money you can use for other things – instead of health care!

You should receive your ID Card in the mail prior to your new year of benefits. If you are enrolling in the health plan in the middle of the year, your ID card will be mailed as soon as your enrollment is processed.

If you haven’t received your card and need one for an upcoming appointment, you have a few options to obtain a copy:

1. Download the app to access an electronic copy.
2. Log in to the member benefits portal and print a copy.
3. Contact Exceedent Member Services 844-532-5240 to request a paper copy of your ID card.

You can search the Provider Directory to find providers in our network. The link to the Provider Directory is located on Scout and is accessible from home by going to: www.exceedenthealth.com/froedtert.

If you’re not sure whether you need a prior authorization for a service, please refer to your Summary Plan Description (SPD) for a complete list of services or call the Exceedent Member clinical team 844-532-5241 to speak with someone from our team.

If you have any questions regarding your Medical benefits, please contact Exceedent Member Services 844-532-5240 to speak with someone from our team. For more information visit our website at: https://www.exceedenthealth.com/.

As a dependent enrollee, we are annually required to obtain other insurance information, better known as coordination of benefits(COB). If you or your dependent(s) are enrolled in medical coverage, a coordination of benefits form must be completed and returned before any claims can be processed. Other insurance may include, but is not limited to, coverage through a spouse’s plan, court ordered insurance coverage, coverage required in a divorce decree or paternity suit, or Medicare. If you provide incorrect or inadequate information, claims may be delayed or denied.

The Summary Plan Description (SPD) requires that we investigate third party liability, better known as subrogation. In the event a medical claim has a diagnosis where there may be a third party involved, we are required to investigate the claim prior to making payment. In addition, the law requires that we pay or deny the claim within 30-days of receipt. It is standard practice in the industry to deny the claim with a remark code explaining additional information is required and to follow-up with a letter requesting the information. If there is no other party involved, Exceedent will reconsider the claim for payment.

As part of your benefit plan, you have access to the following:

Wellness Works Workplace Clinic – 414-805-9959

• Available to all staff members at no cost. Also available to dependents age 16 and older, enrolled in the Froedtert Health medical plan.

Virtual Clinic – 844-805-2030 – www.froedtert.com/virtual-clinic

• Available to all staff members at no cost. Also available to dependents enrolled in the Froedtert Health medical plan.

FastCare Clinics – www.froedtert.com/fastcare

• Available to all staff members and dependents age 18 months and older, enrolled in the Froedtert Health medical plan.

It’s important to remember, that In-Area vs Out-of-Area designation for a member is based on the information Exceedent receives on the INFOR/Lawson Eligibility file from Froedtert Health. The Froedtert Health caregiver (employee) must enter in INFOR/Lawson the dependent’s address where they are living, if different from the caregiver (employee). The address provided for each dependent will determine the zone and, therefore, the network to which the dependent will have care access.

For example, if a dependent is attending college away from home, a school address should be provided in order to have that dependent eligible to be seen by providers in a network near their school. This may change during the year, too, and the address should be updated to reflect this. If the dependent lists a home address and sees a provider near school, you may pay more for that providers care because it may be out of network.