Retiree - UK-PPO High
At a glance: UK-PPO High offers care through a broader network, including UK HealthCare facilities
(such as Chandler Hospital, Good Samaritan Hospital and Kentucky Clinics), UK HealthCare physicians, and Humana/ChoiceCare networks.
Lower deductible than UK-PPO, but UK-PPO High has a higher premium. Click here for full plan details.
The Humana/ChoiceCare networks may be accessed on Humana's website at: www.humana.com.
UK-PPO High Factors to Consider
- Lower out-of-pocket expenses than the UK-PPO.
- Highest PPO premium.
- 90% benefit after meeting your deductible (when applicable) when using an in-network provider.
- 60% benefit after meeting your deductible when using an out-of-network provider.
- Lower copayments for office visits (both primary care and specialist) than UK-PPO.
- Lower copayments when using UK HealthCare providers for certain procedures.
Prior authorization is required for the following services: inpatient hospital services, skilled nursing facility services and all mental health, alcohol and/or chemical dependency services. Failure to obtain prior authorization will result in a 50% benefit penalty. This penalty does not accrue toward the maximum out-of- pocket limit.
UK-PPO High Option Summary of Health Plan Benefits
2008-2009 |
UK PPO High Major Plan Benefits |
UK Healthcare Providers* | In-Network |
Out-of-Network |
Out-of-Pocket Amount
|
Annual Deductible
|
$250 per member $500 per family |
$250 per member |
$750 per member |
Out-of-pocket maximum (excludes deductible and mental health expenses) |
$750 per member $1,500 per family |
$750 per member |
$2,250 per member |
|
Lifetime Maximum Benefit |
|
Unlimited | Unlimited |
Unlimited |
Preventive Care
|
Routine immunizations (through age 18) |
100% after $5 copay per visit | 100% after $10 copay per visit |
60% after deductible |
Physician Services |
Office visits (excludes diagnostic lab and X-ray) |
100% after $5 copay per visit per primary care visit or $15 copay per specialist visit | 100% after $10 copay per visit per primary visit or $20 copay per specialist visit |
60% after deductible
|
Lab tests and X-rays |
100% after office visit copay | 100% after office visit copay |
60% after deductible |
|
Allergy injections |
100% | 100% after $5 office visit copay |
60% after deductible |
|
Inpatient services |
90% after deductible | 90% after deductible |
60% after deductible |
|
Physician visits to emergency room |
90% after deductible | 90% after deductible |
60% after deductible |
|
Hospital Services
|
Inpatient care (semi-private room and board, nursing care, ICU) |
90% after deductible | 90% after deductible |
60% after deductible |
Emergency room
|
90% after $50 copay per visit (waived if admitted) | 90% after $50 copay per visit (waived if admitted) |
60% after deductible |
|
Other Medical Services
|
Skilled nursing facility (up to 100 days) |
90% after deductible | 90% after deductible
|
60% after deductible
|
Ambulance |
90% after deductible | 90% after deductible |
90% after deductible |
|
Physical, speech, hydrotherapy, occupational, and acupuncture therapy (limited to 30 visits per condition per plan year, combined) |
100% after $10 copay per visit | 100% after $15 copay per visit |
60% after deductible |
|
Mental Health and Substance Abuse (mental disorders, chemical and/or alcohol dependence) |
Inpatient (up to 31 days per plan year) |
90% after deductible | 90% after deductible |
60% after deductible |
* - You may search for UK HealthCare providers online at www.humana.com.