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

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HealthPartners Health Plan (800) 883-2177 or (952) 883-5000 healthpartners.com/stateofwis What’s New for 2013 HealthPartners is offering gift cards to members for taking a an active role in their health. Participating in health assessments, biometric screenings and programs designed to improve your health can earn you gift cards! See our website for more information, at healthpartners. com/stateofwis. Virtuwell by HealthPartners is our 24/7 online clinic available to all Minnesota and Wisconsin residents. Visit the website at virtuwell.com to have your symptoms reviewed by a nurse practitioner for the diagnosis and treatment of up to 30 common medical conditions. As always, members can also register online to view claims, explanations of benefits and other personal health information. Provider Directory Go to healthpartners.com/stateofwis and click on the find a doctor or specialist link. Click on the PDF listing or search our online directory for providers. No registration is necessary. Search providers as well as facilities to make sure they are in our network. Call (800) 883-2177 to request a directory or for assistance in finding a provider. Referrals and Prior Authorizations No referrals are necessary to see in-network providers. Certain services will require a prior authorization. Call member services at (800) 883-2177 for more information see healthpartners.com/stateofwis. Your doctor will request the authorization, and HealthPartners will notify you in writing of the coverage decision. Care Outside Service Area Members are covered for emergency and urgently needed care outside of the HealthPartners plan service area when medically necessary. Call (800) 316-9807 within 48 hours if an admission occurs. Overall Quality Rating See Report Card section Qualified Plan Non-Qualified Plan See Glossary for definitions Mental and Behavioral Health Services No referrals are necessary to see in-network behavioral health providers. Dental Benefits No routine dental coverage provided. Health Risk Assessment Information for Enrolled Members at: healthpartners.com/stateofwisconsin Decision Guide Page 40
Humana – Eastern (800) 4humana [(800) 448-6262] or Enrollment Hotline (888) 393-6765 humana.com Overall Quality Rating See Report Card section What’s New for 2013 Humana offers HumanaVitality, a health and wellness program that rewards healthy lifestyle choices for members and their families. Visit humana.com/Vitality for more information. Humana’s robust online tools help you choose a provider, see claim status and more. For more information go to humana.com/custom_clients/stateofwi. Provider Directory Go to apps.humana.com/egroups/ Wisconsin/home.asp. Or go to humana.com to search for a provider. Select Find a Doctor, enter your member ID or select Employer Group Plan (if on Medicare, select Medicare). Enter your zip code. Select HMO Premier (if on Medicare, select Medicare PPO). HMO Premier (or Medicare PPO) will not appear in the list if no providers are found in the area. Call (800) 4humana to request an HMO directory. HMO Premier is a national network, but you must select a Wisconsin-based primary care physician, regardless of your address. Providers outside of Wisconsin may require a referral in addition to those required by Humana. Referrals are not required in the Medicare PPO plan. Humana is Unique for Members on Medicare If you are retired and enrolled in Medicare Parts A and B, Humana will automatically enroll you in a Humana Medicare Advantage PPO plan. You will still have the Uniform Benefits coverage, plus more. You have flexibility to see virtually any provider in the country, but will pay 10% coinsurance, up to an annual $500 out-of-pocket limit when seeing providers out of the network. For enrollment questions or to request an enrollment kit with area PPO directory, call Humana Group Medicare Enrollment at (866) 396-8810. Referrals and Prior Authorizations Referrals are required to see some network providers and all providers outside the HMO Premier network. Prior authorizations are required for certain services. Your primary care physician must call (800) 523-0023 to make the request. Verify the status of the request by logging on to your MyHumana web page or call (800) 4humana. Care Outside Service Area Call Humana at (800) 523-0023 within 48 hours after receiving emergency or urgent care outside Humana’s network. Mental and Behavioral Health Services Before seeking any mental or behavioral health services, call (800) 4humana between 8:00 a.m. and 5:30 p.m., and follow the prompts. A behavioral health specialist will assist you. Dental Benefits (Contact plan for full details.) Preventive Services: 100% - Exams, cleanings, fluoride, X-rays. Restorative Services: 50% after deductible ($25 per individual/$75 per family) - Emergency care, surgery, amalgam. Annual Benefit Maximum: None. Qualified Plan Non-Qualified Plan See Glossary for definitions Orthodontics: 50% - dependents younger than age 18. Lifetime maximum $1,200. Dental Network: Go to humanadental.com Follow the Provider Directory directions and select Dentists as the type of provider. Health Risk Assessment Information for Enrolled Members at: myhumana.com Decision Guide Page 41
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 and 22: LOCAL HEALTH PLAN TIERS Choose Your
Page 23 and 24: Choose Your Health Plan HEALTH PLAN
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: Health Tradition Health Plan (877)
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
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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
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Health Plan Contact Information Ant
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It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF

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