Individual MAPD HMO. Member/Provider Service: If you use a TTY, call 711
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1 Individual MAPD HMO 1 HUMANA GOLD PLUS (HMO) A Medicare Health Plan with Prescription Drug Coverage RxBIN: XXXXXX RxPCN: XXXXXXXX RxGRP: XXXXX IPA/Center Name: XXXXXXX Telephone: 3 <Claims Address> <Optional Second Claims Line> 4 EyeMed Vision: 1. This is where the name of the member s plan is displayed MAPD HMO cards can have the following plan names: HUMANA GOLD PLUS (HMO) HUMANA COMMUNITY (HMO) HUMANA GOLD PLUS (HMO SNP) HUMANA COMMUNITY (HMO SNP) HUMANA KIDNEY CARE (HMO SNP) HUMANA GOLD PLUS CLD (HMO SNP) HUMANA KIDNEY CARE (HMO POS SNP) HUMANA TOTAL CARE ADVANTAGE (HMO) HUMANA GOLD PLUS DIABETES (HMO SNP) HUMANA GOLD PLUS DIABETES AND HEART (HMO SNP) HUMANA COMMUNITY DIABETES AND HEART (HMO SNP). will appear on cards where copays are the preferred form of payment (Coinsurance will not be displayed 3. Claims addresses are variable based on market, IPA, or PCP affiliations. Specific markets may have dual claims which will indicate two claims addresses labeled be an "A" and "B" claims address.
2 Individual MA HMO 1 HUMANA GOLD PLUS (HMO) A Medicare Health Plan IPA/Center Name: XXXXXXX Telephone: 3<Claims Address> <Optional Second Claims Line> 4EyeMed Vision: 1. MA HMO plans all share the same Plan name.. will appear on cards where copays are the preferred form of payment (Coinsurance will not be displayed 3. Claims addresses are variable based on market, IPA, or PCP affiliations. Specific markets may have dual claims which will indicate two claims addresses labeled be an "A" and "B" claims address.
3 Individual MAPD PPO 1 HUMANACHOICE (PPO) A Medicare Health Plan with Prescription Drug Coverage RxBIN: XXXXXX RxPCN: XXXXXXXX RxGRP: XXXXX Claims, PO Box 14601, Lexington, KY EyeMed Vision: 1. This is where the name of the member s plan is displayed MAPD PPO cards can have the following plan names: HUMANACHOICE (PPO) HUMANACHOICE (REGIONAL PPO) HUMANACHOICE FLORIDA (PPO) HUMANACHOICE TEXAS (PPO). will appear on cards where copays are the preferred form of payment (Coinsurance will not be displayed 3. EyeMed Vision phone number will appear on the card for members who have enrolled in plans with the EyeMed
4 Individual MA PPO 1 HUMANACHOICE (PPO) A Medicare Health Plan HumanaFirst 4-hr Nurse Advice Line: Claims, PO Box 14601, Lexington, KY EyeMed Vision: 1. This is where the name of the member s plan is displayed MAPD PPO cards can have the following plan names: HUMANACHOICE (PPO) HUMANACHOICE (REGIONAL PPO). will appear on cards where copays are the preferred form of payment (Coinsurance will not be displayed 3. EyeMed Vision phone number will appear on the card for members who have enrolled in plans with the EyeMed
5 Individual MAPD PFFS 1 HUMANA GOLD CHOICE (PFFS) A Medicare Health Plan with Prescription Drug Coverage 3 RxBIN: XXXXXX RxPCN: XXXXXXXX RxGRP: XXXXX Network: XXXXX For Payment Terms and Conditions: PROVIDERS: DO NOT BILL MEDICARE. Claims, PO Box 14601, Lexington, KY EyeMed Vision: 1. PFFS plans all share the same Plan name.. The network name will appear depending on the network benefit the member has chosen: Network: Full Network: Partial Network: None 3. will appear on cards where copays are the preferred form of payment (Coinsurance will not be displayed
6 Individual MA PFFS 1 HUMANA GOLD CHOICE (PFFS) A Medicare Health Plan Network: XXXXX 3 For Payment Terms and Conditions: PROVIDERS: DO NOT BILL MEDICARE. Claims, PO Box 14601, Lexington, KY EyeMed Vision: 1. PFFS plans all share the same Plan name.. The network name will appear depending on the network benefit the member has chosen: Network: Full Network: Partial Network: None 3. will appear on cards where copays are the preferred form of payment (Coinsurance will not be displayed
7 Individual PDP 1 HUMANA ENHANCED (PDP) Prescription Drug Plan RxBIN: RxPCN: RxGRP: XXXXXX XXXXXXXX XXXXX CUSTOMER SERVICE: Mail Delivery Pharmacy: Submit Rx Claims only to: Humana Claims, PO Box 14140, Lexington, KY See pharmacy and drug list at Humana.com 1. This is where the name of the member s plan is displayed (this is the only variable on the card) HUMANA ENHANCED (PDP) PREFERRED RX PLAN (PDP) HUMANA RX PLAN (PDP)
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