Retiree - UK-PPO
At a glance: UK-PPO provides care through a broader network, including UK HealthCare facilities and physicians, Humana or 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, UK HealthCare physicians, and Humana or 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:
- New for 2007: Acupuncture therapy is included as a covered service.
- 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.
- 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.
UK-PPO Option Summary of Health Plan Benefits
2007-2008 |
UK-PPO Major Plan Benefits |
In-Network |
Out-of-Network |
Out-of-Pocket Amount
|
Annual Deductible
|
$500 per member |
$1,500 per member |
Out-of-pocket maximum (excludes deductible and mental health expenses) |
$1,500 per member |
$4,500 per member |
|
Lifetime Maximum Benefit |
|
Unlimited |
Unlimited |
Preventive Care
|
Routine immunizations (through age 18) |
100% after $15 copayment per visit |
50% after deductible |
Routine outpatient laboratory tests and X-rays |
100% after office visit copayment |
50% after deductible |
|
Physician Services |
Office visits (excludes diagnostic lab and X-ray)
|
100% after $15 copayment per visit to primary care physician or $25 copayment per visit to specialist |
50% after deductible
|
Lab tests and X-rays |
100% after office visit copayment |
50% after deductible |
|
Allergy injections |
100% after $5 copayment per visit |
50% after deductible |
|
Inpatient services |
80% after deductible |
50% after deductible |
|
Physician visits to emergency room |
80% |
50% after deductible |
|
Hospital Services
|
Inpatient care (semi-private room and board, nursing care, ICU) |
80% after deductible |
50% after deductible |
Emergency room |
80% after $50 copayment per visit (waived if admitted) |
50% after deductible |
|
Other Medical Services
|
Skilled nursing facility (up to 100 days) |
80% after deductible |
50% after deductible
|
Ambulance |
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 $25 copayment per visit |
50% after deductible |
|
Mental Health and Substance Abuse (mental disorders, chemical and/or alcohol dependence) |
Inpatient (up to 31 days per plan year) |
80% after deductible |
50% after deductible |
