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Employers Health/ Humana is one of the largest and finest small group health insurers in
the Midwest. They offer top quality products to groups of two or more employees. Multiple plan options with indivudal employee choice of HMO or PPO. Outstanding customer service. Husband and wife groups
are eligible for coverage.
Experience
Humana of Illinois and Northern Indiana is a federally qualified managed care company with 25
years of experience, providing health care coverage and services to more than 600,000 members primarily in Cook, DuPage, Kane, Lake, McHenry and Will counties in Illinois and Lake, Porter and LaPorte counties in
Indiana. The company offers comprehensive, affordable health care plans through more than 3,000 employer groups ranging in size from 2 to 60,000 employees. Coverage also is offered to individuals.
Stability
Humana Inc. is fiscally sound, receiving solid financial reviews from
independent rating agencies. Total assets, company-wide, are in excess of $3.1 billion with membership of more than 6.2 million primarily in 18 states.
Good Doctors and Hospitals Close to Home
Humana members choose doctors, and use those
hospitals and other health care providers who meet the professional standards Humana sets through its credentialing system. Audits of these participating providers are ongoing to promote the quality of care and
service on which our members depend. We contract with more than 9,200 quality primary care physicians and specialists, and 73 highly-regarded hospitals close to where our members live or work.
National Committee for Quality Assurance (NCQA) Accreditation
Since Humana Health Plan,
Inc. of Illinois and Northern Indiana opened in 1972, we have maintained a standard practice of monitoring the quality of care and service our members receive. These quality standards are exemplified in our full
(three-year) accreditation status from the National Committee for Quality Assurance (NCQA), one of the highest honors a health plan can receive. As of July 31, 1997, only 50 percent of all health plans reviewed by
NCQA nationally had received full accreditation, and Humana is proud to be one of them. Humana is the first HMO in Chicago to receive full NCQA accreditation.
Humana products which have received NCQA accreditation are:
- Classic staff-model HMO
- Staff-network model HMO
- Premier mixed-model HMO
- Individual HMO
- Medicaid HMO
- Medicare Risk HMO
Broad Product Portfolio
- Humana offers a spectrum of managed care plans
tailored to the needs of our customers.
- A full range of group medical plans, including health maintenance
organization plans (HMOs), point-of-service (POS or exclusive provider organization), preferred provider organizations (PPOs), and traditional health insurance.
- Group and Individual Medicare programs, Medicare HMO
and POS plans and Medicare supplemental coverage.
- Medically underwritten non-group HMO plan for
individuals under age 65.
- Administrative-service-only (ASO) program for
self-funded health and dental plans.
- Dental plans, including network-based plans and
traditional dental insurance.
- Member-directed health care financial services,
including flexible spending plans.
- Group term life and employee-funded term life insurance.
- Long and short-term disability insurance.
Benefit Plan Flexibility
A full range of Humana HMO plans provide more coverage than
traditional insurance, including many preventive care benefits to maintain good health. Most services are covered 100 percent or , in some plans, coverage begins after a small copayment. There are no deductible
amounts to pay or claim forms to file. Humana contracts with group practice physicians, hospitals and other community-based health care professionals.To receive benefits under an HMO plan, members must choose a
primary care physician from the Plan's provider directory who will provide or arrange all health care services.
Humana POS and PPO plans each offer two levels of coverage. The plans allow members to decide at
any time whether to use Humana participating providers or non-participating providers. Humana contracts with large networks of POS and PPO physicians, hospitals and other health care professionals. When members
choose in-network (participating) providers, benefits are higher and out-of-pocket costs are lower. Use of out-of-network providers will result in lower benefits and there are claim forms to file. Under PPO and POS
plans there are deductibles and coinsurance amounts which must be met before benefits begin.
Specialty products such as dental, long and short-term disability, group term life and MSAs can be
purchased by groups to complement Humana medical products, or can be bought as stand-alone plans.
Humana also offers plans for individuals who are not part of a group. Our Individual HMO Plan is a
medically underwritten plan which provides broad coverage, including prescription drugs. This plan is for individuals who are under age 65 and not eligible for Medicare.
Our Humana Gold Plus Plan is an HMO offered to Medicare-eligible individuals. Nationwide more than
365,000 members are enrolled in our Medicare HMO plans.
Provider Networks
The Plan offers several types of provider networks to support its
managed care products:
- Classic staff-model HMO. This cost-efficient network is comprised
of 23 conveniently located centers of excellence, 19 of which are owned and operated by Humana. There are 170 primary care physicians (PCP), supported by 750 participating specialists and 15 hospitals.
- Staff network-model HMO. This expanded provider network combines
Humana's Classic HMO centers of excellence with over 1000 additional affiliated physicians contracted primarily through physician hospital organizations (PHOs). More than 3,000 specialists and 39 hospitals are
affiliated with the Humana Staff HMO network.
- Premier mixed-model HMO. The Premier network includes more than
2,400 PCPs (most of whom practice in large group settings), 60 hospitals and 4,000 specialists.
- IPA-model HMO. More than 2,500 PCPs, 4,100 specialists and 66
affiliated hospitals are contracted under the IPA network. The IPA network supports both HMO and POS products.
- Point-of-Service (POS). Humana's POS plans offer the flexibility of
in-network and out-of-network benefits. More than 1,600 PCPs, 3,000 specialists and 46 hospitals participate with our POS plans.
- Participating Provider Organization (PPO). More than 2,000 primary
care physicians, 4,200 specialists and 73 hospitals are contracted to provide in-network services to PPO members.
Quality Care
Quality care means taking an active approach to the prevention of illness
and disease as well as early detection and treatment. Outreach programs are an important part of quality care. Among our many outreach and disease state management programs are:
- Senior influenza vaccination
- Child immunizations
- Diabetes management
- Cervical cancer detection
- Hypertension screening
- Cesarean section reduction
- Congestive heart failure
- Asthma management
- Mammography screening
- Behavioral health access
Special programs
Congestive Heart Failure (CHF)--the number one cause of hospital
admissions among our Medicare members. A CHF outreach program, involving in-home care for selected high-risk patients focuses on helping members with CHF once they leave the hospital. These home visits are designed
to educate the member and his or her family about diet, fluid intake and medication, and monitor the patient's compliance on a regular basis.
Asthma--we have developed a team to help asthmatic patients improve their quality of life
and decrease emergency room visits. Follow-up calls are made within 48 working hours to any member who visits an emergency room, urgent care or after hours center, or who is hospitalized for asthma. Letters are also
sent to all members who receive asthma medication encouraging them to follow their treatment plans and to attend Humana health education classes.
Behavioral Health Access Center--a major advance in mental health and addictions care. The
Access Center allows members to call an 800 number for telephone evaluation, thus assuring appropriate, rapid access to care based on the patient's needs. All treatment programs are designed to assist members in
gaining an understanding of their concerns and in striving for a healthier and more productive lifestyle. Emergency and crisis intervention services are available 24 hours a day by calling the Access Center.
Breast Care Management System--Award-winning program. Humana Chicago proudly accepted the
1997 American Association of Health Plans (AAHP) National Exemplary Practice Program Award for our breast care program. The Breast Care Management System program was created to manage the identification and
treatment of women with breast cancer. This program has increased the chances that a woman with breast cancer will find out at the earliest stages of the disease and has decreased the time between identifying the
presence of cancer and initiating treatment The program has also increased the screening rate and reduced the number of days from detection of breast cancer to surgery. Humana's brand of managed care has shown its
ability to aggressively detect and fight this deadly disease. The result is lives saved.
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