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

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Choose Your Health Plan HEALTH PLAN MAP 2013 The map on the following page shows which health plans are available in each county. Qualified plans are highlighted in underlined, bold text. If a plan is non-qualified, it has limited provider availability in that area. The Standard Plan and Medicare Plus do not appear on this map since they are available everywhere. Health plan codes used on the map are explained in the chart on this page. Plan specific information is available on the Health Plan Description pages later in this Guide. Plan Name Anthem Blue - Northeast Anthem Blue - Northwest Anthem Blue - Southeast Arise Health Plan Dean Health Plan Group Health Cooperative of Eau Claire GHC of South Central Wisconsin Gundersen Lutheran Health Plan Health Tradition Health Plan HealthPartners Humana - Eastern Humana - Western Medical Associates Health Plan Medicare Plus MercyCare Health Plans Network Health Plan Physicians Plus Security Health Plan Standard Plan: Balance of State 1 Standard Plan: Dane 2 Standard Plan: Milwaukee 3 Standard Plan: Waukesha 4 State Maintenance Plan UnitedHealthcare of Wisconsin Northeast UnitedHealthcare of Wisconsin Southeast Unity - Community Unity - UW Health WEA Trust PPO - East WEA Trust PPO - Northwest WPS Metro Choice Northwest WPS Metro Choice Southeast Plan code AE AW AS A D GEC GSC GL HT HP HE HW MA NA MC N PP S NA NA NA NA SMP UN US UC UU WT WN WW WS Decision Guide Page 20
Choose Your Health Plan HEALTH PLAN MAP 2013 WW GEC HP WN AW AW HP WW WN HW AW HP HW WN WW WW AW HP WN HW SMP HW S WN AW GEC HP HW S WN AW GEC S WN HP SMP S AW WW GEC S WN GL HP GEC S WN WW HP SMP S SMP S A HW S WN WW GL WW HW WN SMP HT WN SMP AW GEC HP S WN S WW WN GL HW S WN WW AW GL WW HW S WN GL WN HT GL HT GL HT S WN S A WT S WN GL A HT GL HT GL UC D GL HT UC MA D UC MA GL HT PP GL PP D UC HT S A WT WT GL HT UC D S MA PP D UC MA D PP UC WT S A D PP UC HT GL SMP S A S A WT HP D UC WT S PP S WT A PP D GSC UU UC D HE MC WT S A SMP S A SMP A WT SMP WT A AE HE UN WT N N HE WT AE N S AE PP UN UN HE HE N WT A UNWT PP WT AE A UN D N UC PP D PP UC WT N HE UN A AE S AS D US MC UC HE WT PP * Qualifi ed in a county with no hospital. ** Hospital four miles from major city. WT A N AE WT A AE WT HE N UN AE D HE N UC UN A WS AS D HE N UC US WT A AS D MC HE UC WS US WT PP WT UC MC US HE WT ASD A UN HE WT AE HE UN A AE N AE HE UN WT A AS HE US WT WS HE US AS WS WT D A* N* AE* N HE WT* UN WT HEUN WT A AE UN** N HE A AE N HE UN WT HE AS US WT N A UN AE WT HE AS US HE WS WT AS US HE WS WT US AS WT WS HE Decision Guide Page 21
Page 1 and 2: It’s Your Choice: 2013 Decision G
Page 3 and 4: Table of Contents Choose Wisely....
Page 5 and 6: Choose Wisely Sheboygan Fiesta Hisp
Page 7 and 8: Choose Wisely Standard Plan Benefit
Page 9 and 10: FREQUENTLY ASKED QUESTIONS IT’S Y
Page 11 and 12: Choose Wisely dependents through th
Page 13 and 14: Choose Wisely back of this Guide or
Page 15 and 16: Choose Wisely When you use in-netwo
Page 17 and 18: Choose Your Health Plan radiology (
Page 19 and 20: Local Government Employees and Annu
Page 21: LOCAL HEALTH PLAN TIERS Choose Your
Page 25 and 26: Comparison of Benefit Options BENEF
Page 27 and 28: Comparison of Benefit Options BENEF
Page 29 and 30: Choose Your Health Plan coordinated
Page 31 and 32: Health Plan Features - At a Glance
Page 33 and 34: Anthem Blue Preferred - Northeast N
Page 35 and 36: Anthem Blue Preferred - Southeast N
Page 37 and 38: Dean Health Plan Inc. (800) 279-130
Page 39 and 40: Group Health Cooperative of South C
Page 41 and 42: Health Tradition Health Plan (877)
Page 43 and 44: Humana - Eastern (800) 4humana [(80
Page 45 and 46: Medical Associates Health Plans (80
Page 47 and 48: MercyCare Health Plans (800) 895-24
Page 49 and 50: Physicians Plus (608) 282-8900 or (
Page 51 and 52: Standard Plan Administered by WPS H
Page 53 and 54: UnitedHealthcare of Wisconsin North
Page 55 and 56: Unity Health Insurance - Community
Page 57 and 58: WEA Trust PPO - East (800) 279-4000
Page 59 and 60: WPS Metro Choice Northwest (800) 63
Page 61 and 62: Choose Quality HEALTH PLAN REPORT C
Page 63 and 64: Quality Composite Rating Chart Unde
Page 65 and 66: CAHPS ® Composite Rating Chart Und
Page 67 and 68: Choose Quality GRIEVANCE AND COMPLA
Page 69 and 70: Choose Quality OTHER QUALITY INFORM
Page 71 and 72: NAVITUS HEALTH SOLUTIONS — Pharm
Page 73 and 74:
NAVITUS MedicareRX (PDP)— Pharmac
Page 75 and 76:
For Medicare eligible, retired, dis
Page 77 and 78:
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Page 79 and 80:
myETF Benefits System Instructions
Page 81 and 82:
Department of Employee Trust Funds
Page 83 and 84:
ETF Use Only State of Wisconsin Dep
Page 85 and 86:
Applicant Name Social Security Numb
Page 87 and 88:
DUPLICATE APPLICATION FOR YOUR RECO
Page 89 and 90:
DUPLICATE APPLICATION FOR YOUR RECO
Page 91 and 92:
Glossary Coinsurance: Your share of
Page 93 and 94:
Glossary In-network Copayment: A fi
Page 95 and 96:
Glossary Preventive Services: Routi
Page 97 and 98:
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Page 99 and 100:
Health Plan Contact Information Ant
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It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF

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