UPHS_Enrollment_Guide_FINAL

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Print this Guide Human Resources/ Benefits Locations Making Changes During the Year Contact Information Search this Document > Welcome What’s New Cost for Coverage Plan Highlights Carewise Health Programs Medical PENNCare PPO Keystone Point-of- Service (POS) Plan Aetna Quality Point-of-Service (QPOS) Plan Behavioral Health Prescription Drug Vision Dental Flexible Spending Accounts (FSAs) Life Insurance AD&D Coverage Disability Legal Notices Welcome > Medical Medical Benefits You can elect the PENNCare PPO, Keystone Point-of-Service (KPOS) or the Aetna Quality Point-of-Service (QPOS) Plans. Your out-of-pocket expenses will be lower when you use a UPHS provider or facility, including CHOP. However, the PPO, KPOS and QPOS plans have large carrier networks. Keep in mind that in the KPOS and QPOS plans, your Primary Care Physician manages all of your in-network care, including referring you to specialists and network facilities (for example, laboratory testing). Click on the boxes to learn more about each plan: PENNCare PPO Plan Keystone Pointof-Service Plan Aetna Quality Point-of-Service Plan Provider Directory PENNCare provider directories and carrier network listings are available online. Click here to access the PENN Provider Directory. • PENNCare PPO • Keystone POS • Aetna QPOS
Print this Guide Human Resources/ Benefits Locations Making Changes During the Year Contact Information Search this Document > Carewise Health Programs Medical PENNCare PPO Keystone POS and Aetna QPOS Behavioral Health Prescription Drug Vision Dental Flexible Spending Accounts (FSAs) Life Insurance AD&D Coverage Disability Legal Notices Welcome What’s New Cost for Coverage Plan Highlights Welcome > Medical > PENNCare PPO PENNCare PPO Below is a summary of the PENNCare PPO plan. For a more detailed list of coverage, click here. How to Access Care PENNCare PPO PENNCare Network Personal Choice Out-of-Network Go to any PENNCare provider Go to any Personal Choice provider Referrals Needed No No No Annual Deductible and Coinsurance Outpatient Office Visit Hospital Inpatient For all plans, Pavilion is covered for an additional fee. Annual Out-of-Pocket Limit None None; 80% coinsurance for other services as noted $10 Primary Care or specialist visit Covered at 100% N/A $20 Primary Care or specialist visit Covered at 100% after copayment ($375 maximum per admission) $2,000/person $4,000/family (coinsurance only) Go to any qualified provider $300/person $600/family Plan pays 70% UCR after deductible Deductibles and coinsurance apply Covered at 70% after deductible $2,500/person $5,000/family More Information Review the PENNCare PPO Chart Contact Provider PENNCare PPO at 215-241-2990 or 800-841-1992
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UPHS_Enrollment_Guide_FINAL

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