Retiree - 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 selection of network providers, including UK HealthCare facilities, (such as Chandler Hospital, Good Samaritan Hospital, Kentucky Clinics), UK HealthCare physicians and the Humana/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
|
|
UK HealthCare Providers* | Benefits for Covered Services Provided at Participating Providers |
Lifetime Maximum Benefit |
|
Unlimited |
Unlimited |
| Copayment Limits | Individual and Family | N/A | N/A |
Preventive Care
|
Routine immunizations (through age 18) |
100% after $15 copay per primary care visit, |
100% after $25 copay per primary care visit, |
Physician Services
|
Office visits (excludes certain diagnostic lab and X-ray) |
100% after $15 copay per primary care visit, |
100% after $25 copay per primary care visit, |
Lab tests, X-rays and diagnostic tests |
100% after office visit copay |
100% after office visit copay |
|
Allergy injections |
100% |
100% after $5 copay per visit |
|
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 year) |
100% after $500 copay per admission (limited to two copays per plan year) |
Outpatient surgery |
100% after $100 copay per procedure |
100% after $150 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
|
Skilled nursing facility (up to 100 days per plan year) |
100% |
100% |
Durable medical equipment, orthotics, and prosthetics |
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 condition per plan year, combined) |
100% after $30 copay per visit |
100% after $40 copay per visit |
|
Mental Health and Substance Abuse |
Inpatient (up to 31 days/plan year) |
100% after $300 copay per admission |
100% after $500 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.
