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Benefits

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
$1,000 per family

$1,500 per member
$3,000 per family

Out-of-pocket maximum (excludes deductible and mental health expenses)

$1,500 per member
$3,000 per family

$1,500 per member
$3,000 per family

$4,500 per member
$9,000 per family

Lifetime Maximum Benefit

 

Unlimited

Unlimited

Unlimited

Preventive Care

 

 

 

 

Routine immunizations (through age 18)
Routine mammogram and Pap smears
Routine child care (through age 18)
Routine adult physical exam (19 years and above, one per plan year) Routine outpatient lab tests and X-rays

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
Outpatient surgery and diagnostic tests

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)
Outpatient surgery
Outpatient nonsurgical care
Outpatient tests, lab and X-ray
Ancillary services
Organ transplants

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)
Home health care (up to 100 visits per plan year);
Durable medical equipment
Hospice services

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)
Outpatient (up to 20 visits per plan year)

80% after deductible

80% after deductible

50% after deductible

* - You may search for UK HealthCare providers online at www.humana.com.


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