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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2017 Local Health Plan Insurance Program
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2017 It's Your Choice - Local Health Plan Insurance for Employees and Retirees
Wisconsin Department Of Employee Trust Funds It's Your Choice 2017


Local Health Plan
Insurance for Employees
and Retirees
(PO6, PO16)


IYC Access Health Plan

Administered by WPS Health Insurance
1-800-634-6448 wpsic.com/state

What’s New for 2017

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.

General Information

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.

Provider Directory

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.

Pre-Certification

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. Please contact WPS for specific eligibility criteria.

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. Please refer to the IYC Access Plan booklet (ET-2112) for details.

24-Hour Nurseline

Not available.

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: 8/17/2016 4:09:22 PM