Retiree - 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.
- 80% benefit after meeting your deductible (when applicable) when using an in-network provider.
- 50% benefit after meeting your deductible when using an out-of-network provider.
- Lowest PPO premium; slightly higher premium than HMO.
- Deductible does not apply to in-network preventive services.
UK-PPO Option Summary of Health Plan Benefits
2009-2010 |
UK-PPO Major Plan Benefits |
UK Healthcare Providers* | In-Network |
Out-of-Network |
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 immunizations (through age 18) |
100% after $15 copay per visit |
100% after $25 copay per visit |
50% after deductible |
Physician Services |
Office visits (excludes diagnostic lab and X-ray)
|
100% after $15 copay per primary care visit or $30 copay per specialist visit |
100% after $25 copay per primary care visit or $40 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 office visit copay |
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 $75 copay per visit (waived if admitted) |
80% after $75 copay per visit (waived if admitted) |
50% after deductible |
|
Other Medical Services
|
Skilled nursing facility (up to 100 days per plan year) |
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 plan year, combined) |
100% after $30 copay per visit |
100% after $40 copay per visit |
50% after deductible |
|
Mental Health and Substance Abuse |
Inpatient (up to 31 days/plan year) |
80% after deductible |
80% after deductible |
50% after deductible |
* - You may search for UK HealthCare providers online at www.humana.com.
