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 and UK-PPO High Summary of Benefits
In each of the PPO options, participating providers agree to accept
Humana’s determination of reasonable allowable charges as payment
in full. Each PPO is similar in providing 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
2008-2009 |
Major Plan Benefits |
UK Healthcare Providers* | In-Network |
Out-of-Network |
Out-of-Pocket Amount
|
Annual Deductible
|
$500 per member $1,000 per family |
$500 per member |
$1,500 per member |
Out-of-pocket maximum (excludes deductible and mental health expenses) |
$1,500 per member $3,000 per family |
$1,500 per member |
$4,500 per member |
|
Lifetime Maximum Benefit |
|
Unlimited | Unlimited |
Unlimited |
Preventive Care
|
Routine immunizations (through age 18) |
100% after $10 copay per visit | 100% after $15 copay per visit
|
50% after deductible |
Physician Services |
Office visits (excludes diagnostic lab and X-ray)
|
100% after $10 copay per visit per primary care visit or $20 copay per specialist visit | 100% after $15 copay per visit per primary care visit or $25 copay per specialist visit |
50% after deductible
|
Lab tests and X-rays |
100% after office visit copay | 100% after office visit copay |
50% after deductible |
|
Allergy injections |
100% | 100% after $5 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 $50 copay per visit (waived if admitted) | 80% after $50 copay per visit (waived if admitted) |
50% after deductible |
|
Other Medical Services
|
Skilled nursing facility (up to 100 days) |
80% after deductible | 80% after deductible |
50% after deductible
|
Ambulance |
80% after deductible | 80% after deductible |
80% after deductible |
|
Physical, speech, hydrotherapy, occupational and acupuncture therapy (limited to 30 visits per condition, per plan year, combined) |
100% after $20copay per visit | 100% after $25 copay per visit |
50% after deductible |
|
Mental Health and Substance Abuse |
Inpatient (up to 31 days per plan year) |
80% after deductible | 80% after deductible |
50% after deductible |
* - You may search for UK HealthCare providers online at www.humana.com.
