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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2016 State of Wisconsin Group Health Insurance Program
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Wisconsin Department Of Employee Trust Funds It's Your Choice 2016


Local Health Plan
Insurance for Employees
and Retirees
(PO6)


Humana – Eastern

1-855-STOFWIH or 1-855-786-3944
humana.com

What’s New for 2016

The Humana Eastern service area will no longer include Green and Kewaunee counties. Humana continues to offer HumanaVitality, a health and wellness program that rewards healthy lifestyle choices for members and their families.
Visit humana.com/Vitality for more information.

Humana’s robust online tools help you choose a provider, see claim status and more. For additional information, go to our.humana.com/stateofwi.

Humana continues to offer a dedicated team trained specifically on the State of Wisconsin health insurance program.

For Members on Medicare: Medicare Advantage

If you retire and are currently a Humana member enrolled in Medicare Parts A and B, you will automatically be enrolled in Humana’s Medicare Advantage PPO plan. Retirees enrolled in Medicare Parts A and B and enrolled in another Medicare plan may choose to switch to Humana’s Medicare Advantage plan. This plan is available if you live anywhere in the United States or Puerto Rico and if you use providers that have accepted the terms of the Medicare Advantage plan.

For 2016, Humana’s Medicare Advantage will provide the same Uniform Benefits for in-network and out-of-network services. Additional benefits and services are also available, such as enhanced preventive benefits which covers 22 services at 100% including bone mass measurement and depression screening, Humana’s 24-hour nurse helpline, HumanaVitality and the Silver Sneakers fitness program. To get more information, including an enrollment kit with a provider directory, call Humana Group Medicare Enrollment at 1-855-STOFWIH or 1-855-786-3944. Participants of Humana's Medicare Advantage are not eligible to receive the Well Wisconsin Incentive.

Provider Directory: Non-Medicare Members

You are required to have a Wisconsin based primary care provider. Go to https://our.humana.com/stateofwi to request a provider directory.
To request a printed directory be mailed to you, call 1-855-786-3944.

Referrals, Prior Authorizations, Out-of-Network Care: Non-Medicare Members

Referrals are needed when receiving care from in-network providers for certain services. Please call 1-855-STOFWIH for more details. Prior authorization is required for some services, and for out-of-network providers before you receive care. You will receive written notification of the approval or denial for the prior authorization. If you are unsure if a service, test, or procedure requires prior authorization or a referral, contact 1-855-STOFWIH prior to your appointment.

Service Area: Non-Medicare Members

Qualified: Brown, Dodge, Fond du Lac, Green Lake, Jefferson, Kenosha, Manitowoc, Marinette, Milwaukee, Oconto, Outagamie, Ozaukee, Racine, Sheboygan, Walworth, Washington, Waukesha, Waupaca, Waushara and Winnebago counties.
Non-qualified: Calumet, Door, Rock and Shawano counties.

Emergency and Urgent Care Outside Service Area

If you require emergency or urgent care when outside of the network, seek care at the nearest medical facility. If possible, contact 1-855-STOFWIH within 48 hours of receiving care or if assistance is needed to determine the appropriate level of care. Follow-up care must be received from an in-network provider unless otherwise approved by Humana.

Mental, Behavioral Health and Substance Abuse

Prior to seeking mental, behavioral health or substance abuse services, contact 1-855-STOFWIH or 1-855-786-3944 between 8 a.m. and 5:30 p.m. for assistance from a behavioral health specialist.

24-Hour Nurseline

HumanaFirst Nurse Advice: 1-800-622-9529

Disclaimer:
Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.

This page was last modified on: 9/24/2015 11:58:50 AM