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

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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
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It’s Your Choice: 2013 Decision G
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Table of Contents Choose Wisely....
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Choose Wisely Sheboygan Fiesta Hisp
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Choose Wisely Standard Plan Benefit
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FREQUENTLY ASKED QUESTIONS IT’S Y
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Choose Wisely dependents through th
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Choose Wisely back of this Guide or
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Choose Wisely When you use in-netwo
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Choose Your Health Plan radiology (
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Local Government Employees and Annu
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LOCAL HEALTH PLAN TIERS Choose Your
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Choose Your Health Plan HEALTH PLAN
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Comparison of Benefit Options BENEF
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Comparison of Benefit Options BENEF
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Choose Your Health Plan coordinated
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Health Plan Features - At a Glance
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Anthem Blue Preferred - Northeast N
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Anthem Blue Preferred - Southeast N
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Dean Health Plan Inc. (800) 279-130
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Group Health Cooperative of South C
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Health Tradition Health Plan (877)
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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
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: Glossary Preventive Services: Routi
Page 99 and 100: Health Plan Contact Information Ant
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