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

Medicare Plus
Administered by WPS Health Insurance
(800) 634-6448 wpsic.com/state
Not Available
Overall Quality Rating
See Report Card section
What’s New for 2013
In the past, members have asked for a
true Medicare supplement plan. Medicare
Plus will be that plan for eligible annuitants
and their dependents who select the
Standard Plan. Medicare Plus will pay your
Medicare Part A and B deductibles and
coinsurance. This group plan is superior
to individual Medicare supplements as it
provides protections from fees that exceed
usual, customary and reasonable amounts if
members use a provider who is not affiliated
with Medicare. It also offers coverage
during foreign travel. Note, however, in
other cases if Medicare excludes coverage
for a service, this plan will also deny
coverage.
Last year WPS offered a basic health risk
assessment (HRA) as an option to allow
members to better understand the health
risks associated with responses given to the
health and wellness questions. To continue
assisting our members with your health
and wellness goals, WPS will offer a more
complete HRA that will include biometric
screenings, which determine the risk level of
an individual for certain diseases and other
medical conditions. By knowing risk levels an
individual can better make decisions related
to their health and wellness. To request an
HRA, see the contact information below.
General Information
The Medicare Plus plan is designed to
supplement, not duplicate, the benefits
available under Medicare for Wisconsin
Public Employers Group Health Insurance
Program annuitants.
For benefit differences, see the Comparison
of Benefit Options section starting on Page
22 and view the Health Care Benefit Plan
booklet at etf.wi.gov/publications/et4113.
pdf.
Provider Directory
None. This plan provides you with freedom
of choice among hospitals and physicians
in Wisconsin, nationwide and for travel
abroad.
Referrals and Prior Authorizations
Referrals and prior authorizations are not
necessary under this plan as benefits are
only supplemental to approved Medicare
benefits.
Mental and Behavioral Health Services
Medically necessary services are available
when performed by licensed mental health
professionals practicing within the scope of
their license. Inpatient services will be limited
to 120 days.
Dental Benefits
No dental coverage provided.
Health Risk Assessment Information for Enrolled Members:
Contact Mark Mitchell at (888) 333-5003
Decision Guide Page 44