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

Arise Health Plan
(888) 711-1444 toll free or (920) 490-6900
wecareforwisconsin.com
Overall Quality Rating
See Report Card section
What’s New for 2013
Arise Health Plan now has a fresh new look!
We have updated our logo to a sleeker,
more modern design. Check out our new
logo and other exciting design changes
when viewing our website.
Arise Health Plan is now offering $150
toward a health club membership of your
choice for each adult Arise member who
completes a health risk assessment (HRA)/
biometric screening.
Provider Directory
Go to wecareforwisconsin.com, select
Members and then Find A Doctor. Enter
group number “087889.” To print a provider
directory, scroll to the bottom of the Find
A Doctor page and select the link below
the search options, or call (888) 711-1444 to
request a directory.
Referrals and Prior Authorizations
No written referrals are required when
receiving necessary care from participating
providers. Pre-service authorization is
required for all non-participating providers
and tertiary-care specialists and facilities.
Arise Health Plan will send written
notification of approval or denial to you and
your provider requesting the pre-service
authorization.
Care Outside Service Area
Emergency care is covered. If you are
admitted to the hospital, you must notify
Arise within 48 hours. If you are out of area
and need urgent care, go to the nearest
appropriate facility, unless you can safely
return to the service area to receive care
from a participating provider. For follow-up
care, contact your PCP for instructions.
Mental and Behavioral
Health Services
Participating providers
must be used for all
mental health, alcohol
and other drug abuse
(AODA) services.
Pre-service authorization
is required for inpatient
services and transitional
care; however, it is not
required for outpatient
care.
Dental Benefits (Contact plan for full details.)
Preventive Services: Covered at 100%:
Exams, cleanings, fluoride treatments,
X-rays, space maintainers. Limited to
six-month intervals. Full mouth X-rays.
Restorative Services: Covered at 80%,
subject to deductible ($25 individual/$75
family): Sealants (up to age 14, one per
tooth per lifetime), fillings, and emergency
treatment to relieve pain.
Annual Benefit Maximum: Individual
maximum is $1,000.
Qualified Plan
Non-Qualified Plan
See Glossary for definitions
Orthodontics: 50% for eligible dependent
children up to a lifetime maximum of $1,500.
Dental Network: Dental benefits are
administered by Delta Dental. Go to
deltadentalwi.com and select Premier or
PPO as your dental plan. Call (800) 236-3712
with questions.
Health Risk Assessment Information for Enrolled Members:
Contact Member Services at (920) 490-6900
Decision Guide Page 34