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

Glossary
TPA (Third-Party Administrator): A
company that the Group Insurance
Board contracts with to provide
administrative services for self-funded
plans. A TPA reviews for medical
necessity, create networks, pay claims,
etc.
Uniform Benefits: The standardized level
of benefits offered to Wisconsin Public
Employer’s Group Health Insurance
members through the HMOs and as the
in-network benefit for PPOs, such as WEA
Trust PPO and WPS Metro Choice.
UCR (Usual, Customary and Reasonable):
The amount paid for a medical service
in a geographic area based on what
providers in the area usually charge
for the same or similar medical service.
The UCR amount sometimes is used to
determine the allowed amount.
Urgent Care: Care for an illness, injury
or condition serious enough that a
reasonable person would seek care right
away, but not so severe as to require
emergency room care.
Wisconsin Public Employers (WPE):
Employers who have voluntarily chosen
to participate in the Wisconsin Public
Employers Group Health Insurance
Program. This includes some villages,
towns, cities, counties and school
districts.
Wrap Benefit: A supplemental prescription
drug benefit for Medicare-eligible
participants covered under an annuitant
contract, who are enrolled in the WPE
Group Health Insurance Programs. This
benefit will pay for prescription drug
claims up to the level of the Uniform
Benefits coverage after Medicare Part D
has paid its portion.
WRS: Wisconsin Retirement System.
Decision Guide Page 94