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Employers

Employer Bulletin

State Employers
Vol. 20, State G
October 21, 2003

Errors and Updates in the It's Your Choice Books for 2004

Please be aware there are some updates and minor errors in the 2004 It's Your Choice booklets. Employers should communicate this information to employees who are making health care decisions during the annual Dual-Choice enrollment period. Questions should be directed to the Employer Communication Center at (608) 264-7900.

State of Wisconsin Employees ET-2107:

  • A-5, Columbia and Manitowoc county: Network erroneously appears as a non-qualified plan. It is not available in these counties.
  • A-5, Update, Dean is non-qualified in Adams county.
  • A-6, Dean should appear under Adams county as a non-qualified tier 1 plan.
  • A-13, Winnebago county, CompcareBlue Northeast is a tier 2 plan.
  • A-13, SMP is listed as an out-of-state plan. We have received questions if SMP is available to out-of-state subscribers. Yes, for those who can access providers in the SMP directory. Some providers in Dickinson County Michigan are listed as out-of-state.
  • G-7 and G-11, CompcareBlue customer service number on bottom of page should be 1-888-239-9514. Correct number appears next to plan name on preceding page, and on inside back cover.
  • G-14, Update, Dean has signed a contract with Sauk Prairie Memorial Hospital, this hospital is currently in Dean's network and will continue to be in the network for 2004.
  • G-23 and G-25, Humana Eastern and Western, bottom paragraph, web site for their directory should be http://www.humana.com/misc/ProviderDirectory.asp#WStates. The correct info appears on pages G-22 and G-24 under On-Line Services.
  • G-31, Update, Network Health Plan has providers available in Sheboygan County. Participants should check Network's provider directory for a complete listing.
  • G-50, State SMP:
    • Bottom of 2nd column and top of third column should say "Covered services- subject to deductible". Erroneously states in one spot "no deductible", in another "paid at 80%".
    • Third column, reference to Ambulance should not have the (First $50 paid in full). It is paid subject to deductible only.
    • Middle column, under Plan Features, formal referrals are only needed if a member wants to use a provider not listed in the SMP directory and not in an SMP county.
    • Note that members can choose a primary care clinic rather than only a primary care provider, as in the past.
  • Physicians Plus added two clinics in Sauk County: Plain Medical Clinic and River Valley Medical Center.
  • Humana made an error in its 2004 provider directory affecting the Western Region. Page 101 of the directory lists the PreferredOne terminated physicians. However, many of the physicians on that page are also listed as participating providers in other areas of the directory. The error on the terminated listing incorrectly lists many providers as terminated that are still participating in its network in 2004. Remember that "provider guarantee" applies in 2004 for those providers listed as participating providers in other parts of the directory.

Annuitants/Continuants ET-2108:

  • i. First paragraph, second sentence should read: "To change plans, your applications must be mailed to the DETF and postmarked no later than October 24, 2003."
  • A-3, Columbia and Manitowoc county: Network erroneously appears as a non-qualified plan. It is not available in these counties.
  • A-3, Update, Dean is non-qualified in Adams county.
  • G-7 and G-11, CompcareBlue customer service number on bottom of page should be 1-888-239-9514. Correct number appears next to plan name on preceding page, and on inside back cover.
  • G-13, Update, Dean has signed a contract with Sauk Prairie Memorial Hospital, this hospital is currently in Dean's network and will continue to be the network for 2004.
  • G-23 and G-25, Humana Eastern and Western, bottom paragraph, web site for their directory should be http://www.humana.com/misc/ProviderDirectory.asp#WStates. The correct info appears on pages G-22 and G-24 under On-Line Services.
  • G-31, Update, Network Health Plan has providers available in Sheboygan County. Participants should check Network's provider directory for a complete listing.
  • G-50, State SMP:
    • Bottom of 2nd column and top of third column should say "Covered services- subject to deductible". Erroneously states in one spot "no deductible", in another "paid at 80%".
    • Third column, reference to Ambulance should not have the (First $50 paid in full). It is paid subject to deductible only.
    • Middle column, under Plan Features, formal referrals are only needed if a member wants to use a provider not listed in the SMP directory and not in an SMP county.
  • Note that members can choose a primary care clinic rather than only a primary care provider, as in the past.
  • H-3 Application, box on right, middle - in reference to county of Primary Care Physician, mentions Standard Plan II in error. Standard Plan II is not available in 2004.
  • Physicians Plus added two clinics in Sauk County: Plain Medical Clinic and River Valley Medical Center.
  • Humana made an error in its 2004 provider directory affecting the Western Region. Page 101 of the directory lists the PreferredOne terminated physicians. However, many of the physicians on that page are also listed as participating providers in other areas of the directory. The error on the terminated listing incorrectly lists many providers as terminated that are still participating in its network in 2004. Remember that "provider guarantee" applies in 2004 for those providers listed as participating providers in other parts of the directory.

University of Wisconsin-Graduate Assistants ET-2127:

  • A-5, Columbia and Manitowoc county: Network erroneously appears as a non-qualified plan. It is not available in these counties.
  • A-5, Update, Dean is non-qualified in Adams county.
  • A-6, Dean should appear under Adams county as a non-qualified tier 1 plan.
  • A-13, Winnebago county, CompcareBlue Northeast is a tier 2 plan.
  • A-13, SMP is listed as an out-of-state plan. We have received questions if SMP is available to out-of-state subscribers. Yes, for those who can access providers in the SMP directory. Some providers in Dickinson County Michigan are listed as out-of-state.
  • G-13, Update, Dean has signed a contract with Sauk Prairie Memorial Hospital, this hospital is currently in Dean's network and will continue to be in the network for 2004.
  • G-7 and G-11, CompcareBlue customer service number on bottom of page should be 1-888-239-9514. Correct number appears next to plan name on preceding page, and on inside back cover.
  • G-23 and G-25, Humana Eastern and Western, bottom paragraph, web site for their directory should be http:// www.humana.com/misc/ProviderDirectory.asp#WStates. The correct info appears on pages G-22 and G-24 under On-Line Services.
  • G-31, Update, Network Health Plan has providers available in Sheboygan County. Participants should check Network's provider directory for a complete listing.
  • G-50, State SMP:
    • Bottom of 2nd column and top of third column should say "Covered services- subject to deductible". Erroneously states in one spot "no deductible", in another "paid at 80%".
    • Third column, reference to Ambulance should not have the (First $50 paid in full). It is paid subject to deductible only.
    • Middle column, under Plan Features, formal referrals are only needed if a member wants to use a provider not listed in the SMP directory and not in an SMP county.
    • Note that members can choose a primary care clinic rather than only a primary care provider, as in the past.
  • H-3 Application, box on right, middle - in reference to county of Primary Care Physician, mentions Standard Plan II in error. Standard Plan II is not available in 2004.
  • Physicians Plus added two clinics in Sauk County: Plain Medical Clinic and River Valley Medical Center.
  • Humana made an error in its 2004 provider directory affecting the Western Region. Page 101 of the directory lists the PreferredOne terminated physicians. However, many of the physicians on that page are also listed as participating providers in other areas of the directory. The error on the terminated listing incorrectly lists many providers as terminated that are still participating in its network in 2004. Remember that "provider guarantee" applies in 2004 for those providers listed as participating providers in other parts of the directory.

 

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