b'Plan Comparisons: Medicare-Eligible MembersUnitedHealthcare Group Medicare AdvantageHumana Group Medicare HMOPPO with Express Scripts Medicare (PDP) for CTPFwith Part D Pharmacy Medicare Advantage planMedicare Advantage plan PLAN FEATURES PLAN FEATURESUse any physician who accepts Medicare. EnhancedTraditional HMO with network, referrals and prior Medicare Part D prescription coverage. Pays 100% afterauthorization required. Includes Humana Group plan deductible is met, with the exception of EmergencyMedicare prescription coverage. Room visits. Includes several benefits and programs notCONTACT INFORMATIONcovered by Medicare.CONTACT INFORMATION Group number 303611 for Chicago plansUnitedHealthcare Group Number: 12830 For other service areas, group number is listed on Toll free 1-866-572-9396, TTY 711 insurance card1-866-396-8810 Customer Service8 a.m.8 p.m., local time | 7 days a week www.humana.com1-877-365-7949 NurseLineHOW TO ENROLLRetiree.UHC.com/ctpf | uhcvirtualretiree.com/ctpfExpress Scripts Group number: CTPFRX Contact CTPF Member Services at 1-312-641-4464 and 1-800-864-1416 Customer Service request an enrollment packet. Return the completed www.Express-Scripts.com/medd/ctpf packet and CTPF Form 350 (available in the center of this HOW TO ENROLL book or online at www.ctpf.org), to CTPF.Complete CTPF Form 350 (available in the center of thisSERVICE AREAbook or online at www.ctpf.org). Return with requiredChicago (Cook, DuPage, Kane, Kankakee, Kendall, Lake, documentation to CTPF. McHenry & Will counties) and some areas in AL, AZ, CA, CO, FL, IN, KS, LA, MO, MS, NC, NM, NV, PR, TN, TX, UT, SERVICE AREA call for more info. Nationwide; All 50 states, the District of Columbia and theFOREIGN TRAVEL5 US Territories. Foreign travel emergency benefits available. Limited to FOREIGN TRAVEL emergency Medicare-covered services.Urgent and emergency benefits available. PHYSICIAN SELECTIONPHYSICIAN SELECTION Select a PCP from the listing at www.humana.comChoose any provider who accepts Medicare. LIFETIME MAXIMUM LIFETIME MAXIMUMNo lifetime maximum except inpatient mental health (see No lifetime maximum behavioral health services).OUT-OF-POCKET MAXIMUMOUT-OF-POCKET MAXIMUM $1,500 (Includes $175 deductible) $2,500 per individual, per calendar year. Excludes Part D Annual Medical Out-of-Pocket Maximum combined forpharmacy, extra services, & the plan premium.IN and OUT of network. ANNUAL PLAN YEAR DEDUCTIBLE ANNUAL PLAN YEAR DEDUCTIBLENone$175 SPECIAL DEDUCTIBLES SPECIAL DEDUCTIBLESNoneNoneHOSPITAL SERVICES HOSPITAL SERVICESInpatientInpatient$150 Copay, per day, for first five days of each 100% after deductible admission, authorized services onlySkilled Nursing Facility (non-custodial)Skilled Nursing Facility (non-custodial)No copay days 100% after deductible 1-20, no 3-day hospital stay required; $25 Copay per day, 0% coinsurance per day, days 1-20; days 21-100, per benefit period.100% days 21-100 after deductible1616 CTPF 2024 MEDICARE HEALTH INSURANCE HANDBOOK CTPF 2024 MEDICARE HEALTH INSURANCE HANDBOOK'