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

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Choose Wisely New Health Plan WPS Metro Choice Northwest Offered in 11 counties in northwest Wisconsin including Barron, Burnett, Chippewa, Dunn, Eau Claire, Pierce, Polk, Rusk, Sawyer, St. Croix, and Washburn. Health Plan Name and/or Provider Network Changes Health plans listed below have made significant changes by adding or terminating contracts with provider groups in two or more counties. Other plans have also made changes. Refer to the map on Page 21 and call the health plan for more details. Anthem Blue Northeast Anthem Blue Northwest Humana Eastern Physicians Plus Security Health Plan WEA Trust PPO East (Formerly WEA Trust PPP East) WPS Metro Choice Southeast (Formerly WPS Metro Choice) Added providers in Door, Green Lake, Marinette, Oconto, Waupaca and Waushara counties Added providers in Ashland, Douglas, Polk, St. Croix and Washburn counties Added providers in Calumet, Door and Oconto counties Primary care providers located at UW Health East, West, University Station and Oakwood clinics will no longer be available. Specialty providers at these locations will require approved prior-authorization. Providers at three new clinics, Meriter-Fitchburg, Stoughton and Dermatology, are now available. UW Hospital is no longer in-network, but out-of-network referrals may be available if prior approved by the health plan. Will no longer offer providers in Green Lake and Vernon counties and is no longer qualified in Juneau county. Expanding into Adams, Juneau, Langlade, Lincoln, Menominee and Taylor counties Expanding into Dodge and Jefferson counties Health Plan Tier Changes Changing to Tier 3 • Anthem Blues (Northeast, Northwest and Southeast) • Humana Eastern • Security Health Plan • WPS Metro Choice Southeast Decision Guide Page 4
Choose Wisely Standard Plan Benefit Changes Standard Plan Changed to a Preferred Provider Organization (PPO) plan where you will incur additional out-of-pocket costs if you see a non-PPO provider. See the Comparison of Benefit Options and the health plan description page in this Guide for more information. Some benefits have been changed to modernize the plan. Overall, these changes do not materially alter the benefit value of the plan. Detailed information will be mailed to existing subscribers prior to the It’s Your Choice Open Enrollment period and is available from WPS, the plan administrator. Annuitants and their dependents who are eligible for Medicare will no longer be enrolled in the Standard Plan. Instead, they will be automatically enrolled in Medicare Plus, a Medicare supplement plan. Plan Change for Annuitants Currently in the Standard Plan Medicare Plus Medicare Plus is the name for Standard Plan benefits for annuitants and their dependents* who are eligible for Medicare. This plan is a Medicare supplement that also allows for coverage during foreign travel. See the Comparison of Benefit Options starting on Page 22 for more information. In addition, information will be mailed to existing subscribers prior to It’s Your Choice Open Enrollment period and is available from WPS, the plan administrator. *Note, these members must enroll for Medicare when first eligible or you may be liable for some portion of your claims. See the Medicare Information section of the It’s Your Choice: Reference Guide Frequently Asked Questions for details. SMP (State Maintenance Plan) Changes State Maintenance Plan SMP has been redesigned to offer Uniform Benefits. The Uniform Benefits section of the It’s Your Choice: Reference Guide will serve as the plan’s certificate of coverage. No dental coverage is included. SMP is newly available in Price, Oneida and Vilas counties. Decision Guide Page 5
Page 1 and 2: It’s Your Choice: 2013 Decision G
Page 3 and 4: Table of Contents Choose Wisely....
Page 5: Choose Wisely Sheboygan Fiesta Hisp
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 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
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WEA Trust PPO - East (800) 279-4000
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WPS Metro Choice Northwest (800) 63
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Choose Quality HEALTH PLAN REPORT C
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Quality Composite Rating Chart Unde
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CAHPS ® Composite Rating Chart Und
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Choose Quality GRIEVANCE AND COMPLA
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Choose Quality OTHER QUALITY INFORM
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NAVITUS HEALTH SOLUTIONS — Pharm
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NAVITUS MedicareRX (PDP)— Pharmac
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For Medicare eligible, retired, dis
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myETF Benefits System Instructions
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Department of Employee Trust Funds
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ETF Use Only State of Wisconsin Dep
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Applicant Name Social Security Numb
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DUPLICATE APPLICATION FOR YOUR RECO
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DUPLICATE APPLICATION FOR YOUR RECO
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Glossary Coinsurance: Your share of
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Glossary In-network Copayment: A fi
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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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