Health Plans - UK-EPO
At a glance: provides care through a broader network, including UK HealthCare facilities and physicians and Humana/ChoiceCare networks. No out-of-network coverage. Click here for full plan details.
The Humana/ChoiceCare networks may be accessed on Humana's website at: www.humana.com.
UK-EPO Summary of Health Plan Benefits
The UK-EPO Option is very similar to an HMO in the way
benefits are applied. If you choose the UK-EPO, you must receive
treatment from an in-network provider. Only emergency services,
or urgent services received while out of the service area, are covered
when provided by out-of-network providers or facilities. When you
use in-network providers, you will have a $20 copayment for
primary care visits and a $30 copayment for specialist visits.
UK-EPO Factors to Consider:
- Large provider network, including UK HealthCare facilities (such as Chandler Hospital, Good Samaritan Hospital, Kentucky Clinics), UK HealthCare physicians and the Humana and ChoiceCare networks.
- No referrals required for specialty care services.
- No coverage for out-of-network services, unless it is a life- or limb-threatening emergency.
- No deductibles to meet.
Prior authorization is required for the following services: inpatient hospital services; inpatient mental health, alcohol and/or
chemical dependency services; outpatient mental health, alcohol
and/or chemical dependency services; and skilled nursing facility
services. Failure to obtain prior authorization will result in a 50%
benefit penalty.
UK-EPO Summary of Health Plan Benefits
2008-2009
|
Major Plan Benefits
|
UK HealthCare Providers* | Benefits for Covered Services Provided at Participating Providers |
Copayment Limits |
Individual and Family |
N/A | N/A |
Lifetime Maximum Benefit |
|
Unlimited | Unlimited |
Preventive Care
|
Routine immunizations (through age 18) |
100% after $15 copay per primary care visit or $25 copay per specialist visit | 100% after $20 copay per primary care visit or $30 copay per specialist visit
|
Physician Services
|
Office visits (excludes diagnostic lab and X-ray)
|
100% after $15 copay per primary care visit or $25 copay per specialist visit | 100% after $20 copay per primary care visit or $30 copay per specialist visit |
Lab tests and X-rays |
100% after office visit copay | 100% after office visit copay |
|
Allergy injections |
100% | 100% after $5 copay |
|
Inpatient services |
100% | 100% |
|
Hospital Services
|
Inpatient care (semi-private room and board, nursing care, ICU) |
100% after $300 copay per admission (limited to two copays per plan per year) | 100% after $400 copay per admission (limited to two copays per plan per year) |
Outpatient surgery |
100% after $100 copay per procedure | 100% after $100 copay per procedure |
|
Outpatient nonsurgical care |
100% | 100% |
|
Emergency room |
100% after $75 copay (waived if admitted) | 100% after $75 copay (waived if admitted) |
|
Organ transplants |
100% | 100% |
|
Other Medical Services
|
Hospice services |
100% | 100% |
Durable medical equipment |
80% up to $400 member cost per year | 80% up to $400 member cost per year |
|
Physical, speech, hydrotherapy, occupational and acupuncture therapy (limited to 30 visits per plan year combined) |
100% after $20 copay per visit | 100% after $25 copay per visit
|
|
Mental Health and Substance Abuse (mental disorders, chemical and/or alcohol dependence) |
Inpatient (up to 31 days per plan year) |
100% after $300 copay per admission | 100% after $400 copay per admission |
Outpatient (up to 20 visits per plan year) |
70% | 70% |
* - You may search for UK HealthCare Providers online at www.humana.com.
