It's Your Choice 2016
IYC Access Health PlanAdministered by WPS Health Insurance
What’s New for 2016
Visit the Health Center at wpsic.com/healthcenter, a continually updated online resource designed to help you make good health decisions, whether you’re looking for advice on treating a chronic condition or for tips on leading a healthy lifestyle.
The It's Your Choice Access Health Plan (formerly Standard Plan) is a comprehensive health plan that provides you with freedom of choice among hospitals and physicians in Wisconsin and nationwide. A higher level of benefits is available by using preferred or in-network providers, which are available nationwide. See the Comparison of Benefit Options section of this guide for benefit differences and view the Health Care Benefit Plan booklet for more complete details at etf.wi.gov/publications/et2112.pdf.
Go to www.wpsic.com/state and click “Find a Doctor.” Choose your plan to search for a provider in your network. To request a printed directory be mailed to you, call 1-800-634-6448.
To avoid a $100 inpatient benefit reduction, you, a family member or a provider must notify WPS of any inpatient hospitalization to request pre-certification.
Referrals, Prior Authorizations, Out-of- Network Care
Referrals are not required for this plan.
Members or providers may request prior authorization for services when concerned if WPS will pay and at what rate. Without an approved prior authorization, WPS may deny payment. Visit wpsic.com/state and follow the “Member Materials” link to obtain a copy of a Medical Preauthorization Request Form or call member services. You will receive written notification of the approval or denial for the prior authorization.
Prior authorization is required for low back surgery and high-tech radiology services.
Bariatric surgery requires prior authorization, and members must meet the eligibility criteria as outlined in the Standard Plan (ET-2112) booklet.
Emergency and Urgent Care Outside Service Area
For emergency and urgent care, in-network hospital emergency rooms or urgent care facilities should be used if possible. If you are unable to reach an in-network provider, go to the nearest appropriate medical facility. Contact 1-800-634-6448 or your primary care physician if assistance is needed to determine the appropriate level of care.
Mental, Behavioral Health and Substance Abuse
Medically necessary services are available when performed by licensed mental health professionals practicing within the scope of their licenses and processed based on the provider’s network status.
This page was last modified on: 9/11/2015 7:53:08 PM