CTPF 2027 MEDICARE HEALTH INSURANCE HANDBOOK 16 UnitedHealthcare Group Medicare Advantage PPO with Express Scripts by Evernorth Health Services® (PDP) for CTPF Medicare Advantage plan PLAN FEATURES Use any physician who accepts Medicare. Enhanced Medicare Part D prescription coverage. Pays 100% after plan deductible is met, with the exception of Emergency Room visits. Includes several benefits and programs not covered by Medicare. CONTACT INFORMATION UnitedHealthcare Group Number: 12830 Toll free 1-866-572-9396, TTY 711 8 a.m. – 8 p.m., local time | 7 days a week 1-877-365-7949 NurseLine Retiree.UHC.com/ctpf Express Scripts® Group number: CTPFRX 1-800-864-1416 Customer Service www.Express-Scripts.com/medd/ctpf HOW TO ENROLL Complete CTPF Form 350 (available in the center of this book or online at www.ctpf.org). Return with required documentation to CTPF. SERVICE AREA Nationwide; All 50 states, the District of Columbia and the 5 US Territories. FOREIGN TRAVEL Urgent and emergency benefits available. PHYSICIAN SELECTION Choose any provider who accepts Medicare and agrees to bill UHC. No referrals are needed to see a specialist. LIFETIME MAXIMUM No lifetime maximum OUT-OF-POCKET MAXIMUM $1,500 (Includes $175 deductible) Annual Medical Out-of-Pocket Maximum combined for IN and OUT of network. ANNUAL PLAN YEAR DEDUCTIBLE $175 SPECIAL DEDUCTIBLES None HOSPITAL SERVICES Inpatient 100% after deductible Skilled Nursing Facility (non-custodial) 100% after deductible 0% coinsurance per day, days 1-20; 100% days 21-100 after deductible Humana Group Medicare HMO with Part D Pharmacy Medicare Advantage plan PLAN FEATURES Traditional HMO with network, referrals and prior authorization required. Includes Humana Group Medicare prescription coverage. CONTACT INFORMATION Group Number: 303611 for Chicago plans Humana Customer Care is available at 1-866-396-8810 7 a.m. – 8 p.m. CST | Monday through Friday www.humana.com HOW TO ENROLL Complete CTPF Form 350 (available in the center of this book or online at www.ctpf.org) Return with required documentation to CTPF. SERVICE AREA Chicago (Cook, DuPage, Kane, Kankakee, Kendall, Lake, McHenry & Will counties) FOREIGN TRAVEL Foreign travel emergency benefits available. Limited to emergency Medicare-covered services. PHYSICIAN SELECTION Select a PCP from the listing at https://findcare.humana.com/ LIFETIME MAXIMUM No lifetime maximum except inpatient mental health (see behavioral health services). OUT-OF-POCKET MAXIMUM $2,500 per individual, per calendar year. Excludes Part D pharmacy, extra services, & the plan premium. ANNUAL PLAN YEAR DEDUCTIBLE None SPECIAL DEDUCTIBLES None HOSPITAL SERVICES Inpatient $150 copay, per day, for first five days of each admission, authorized services only Skilled Nursing Facility (non-custodial) No copay days 1-20, no 3-day hospital stay required; $25 copay per day, days 21-100, per benefit period. Plan Comparisons: Medicare-Eligible Members 16
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