Health Plans - UK-PPO
At a glance: UK-PPO provides care through a broader network, including UK HealthCare facilities and physicians, Humana/ChoiceCare networks. Out-of-network coverage is available, slightly higher premium than UK-HMO. Click here for full plan details.
The Humana/ChoiceCare networks may be accessed on Humana's website at: www.humana.com.
UK-PPO Summary of Benefits
With the PPO option, participating providers agree to accept
Humana’s determination of reasonable allowable charges as payment
in full. The PPO plan provides a large number of providers,
including UK HealthCare facilities (such as Chandler Hospital, Good Samaritan Hospital, and Kentucky Clinics), UK HealthCare physicians and
Humana/ChoiceCare networks.
Under either PPO: copayments,
deductibles and expenses for mental health and substance abuse do
NOT accrue toward the maximum out-of-pocket limit.
UK-PPO Factors to Consider:
- Lower copayments when using UK Healthcare providers for certain procedures.
- 50% benefit after meeting your deductible when using an out-of-network provider.
- Lowest PPO premium; slightly higher premium than HMO.
- Covered transplants include kidney, liver, pancreas, kidney/pancreas, heart, lung, heart/lung, bone marrow and cornea transplants.
- Deductible does not apply to in-network preventive services.
Prior authorization is required for the following services: durable medical equipment (over $750), home health care and hospice services and other services as listed in the certificate of coverage.
UK-PPO Option Summary of Health Plan Benefits
2012-2013
|
Major Plan Benefits
|
UK Healthcare Providers |
In-Network Benefits |
Out-of-Network Benefits &nebsp; |
Lifetime Maximum Benefit |
|
Unlimited |
Unlimited |
Unlimited |
Out-of-pocket Amount |
Annual Deductible |
$500/member; $1,000/family |
$500/member; $1,000/family |
$1,500/member; $3,000/family |
Preventive Care
|
Routine child care and immunizations (through age 18) |
100% |
100%
|
50% after deductible |
Physician Services
|
Office visits (excludes diagnostic lab and X-ray) |
100% after $15 copay per primary care visit or $40 copay per specialist visit |
100% after $25 copay per primary care visit or $50 copay per specialist visit |
50% after deductible |
Lab tests, X-rays and diagnostic tests |
100% after office visit copay |
100% after office visit copay |
50% after deductible |
|
Allergy injections |
100% after $10 copay per visit |
100% after $10 copay per visit |
50% after deductible |
|
Inpatient services |
80% after deductible |
80% after deductible |
50% after deductible |
|
Physician visits to emergency room |
80% |
80% |
50% after deductible |
|
Hospital Services
|
Inpatient care (semi-private room and board, nursing care, ICU) |
80% after deductible |
80% after deductible |
50% after deductible |
Emergency Room |
80% after $100 copay per visit (waived if admitted) |
80% after $100 copay per visit (waived if admitted) |
50% after deductible |
|
| Urgent Treatment Center | N/A | 100% after $50 copay per visit | 50% after deductible | |
Other Medical Services
|
Skilled nursing facility (up to 100 days per plan year) |
80% after deductible; up to $500 member cost per year |
80% after deductible;up to $500 member cost per year |
50% after deductible |
Ambulance |
80% after deductible |
80% after deductible |
50% after deductible |
|
Physical, speech, hydrotherapy, occupational and acupuncture therapy (limited to 30 visits per plan year, combined)
|
100% after $40 copay per visit |
100% after $50 copay per visit |
50% after deductible |
|
Mental Health and Substance Abuse |
Inpatient |
80% after deductible |
80% after deductible |
50% after deductible |
| Outpatient | 100% after $40 copay per visit | 100% after $50 copay per visit | 50% after deductible |
* - You may search for UK HealthCare providers online at www.humana.com.