It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF

Choose Wisely
16. Can family members covered under
one policy choose different health
plans?
No, family members are limited to the
plan selected by the subscriber.
17. Can I receive medical care outside of
my health plan network?
This can be a concern for members
who travel frequently and those
who have a covered dependent
living elsewhere, such as a college
student living away from home. When
selecting a health plan, you will want
to consider the following:
• If you are covered through an
HMO, you are required to obtain
allowable care only from providers
in the HMO’s network. HMOs will
cover emergency care outside of
their service areas, but you must
get any follow-up care to the
emergency from providers in the
HMO’s network. Do not expect to
join an HMO and get a referral to
a non-HMO physician. An HMO
generally refers outside its network
only if it is unable to provide
needed care within the HMO.
• If you are covered through a
Preferred Provider Organization
(PPO) such as WPS Metro Choice,
WEA Trust PPO or the Standard Plan,
you have the flexibility to seek care
outside a particular service area.
However, out-of-network care is
subject to higher deductible and
coinsurance amounts.
• Annuitants only: If you or your
dependents are covered through
the Standard Plan, you have the
freedom of choice to see any
available provider for covered
services.
In addition, Humana’s Medicare
Advantage-Preferred Provider
Organization offers coverage for
participants with Medicare Parts
A and B, with both in- and outof-network
benefits. Note: Non-
Medicare members are limited to
Humana’s HMO network.
18. How can I get a listing of the
physicians participating in each plan?
Contact the plan directly or follow
the instructions provided in the Health
Plan Descriptions section. Neither ETF
nor your benefits/payroll/personnel
office maintains a current list of this
information.
OTHER ITEMS OF NOTE
19. What do I need to do when my spouse
or domestic partner or I become
eligible for Medicare?
Most people become eligible for
Medicare at age 65, but you may or
may not need to sign up. For some
people, Medicare eligibility occurs
earlier due to disability or End Stage
Renal Disease. (See the Medicare
Information in the It’s Your Choice:
Reference Guide for full details.)
20. What is Humana’s Medicare
Advantage Plan?
Humana offers a Medicare
Advantage Preferred Provider
Organization (MA-PPO) for members
who have Medicare Parts A and B as
their primary coverage.
Decision Guide Page 12