MEDICARE ADVANTAGE PLANS VIRGINIA MA/MAPD PLANS. Select the market(s) below to view their Market Highlights

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1 MEDICARE ADVANTAGE PLANS VIRGINIA Select the market(s) below to view their Market Highlights Humana offers a wide range of affordable plans and a broad network of healthcare providers nationwide to meet the unique needs of your clients. Many plans come with low or no monthly plan premium, plus health-boosting benefits that aim to help your clients achieve their best health. VAHK7GUEN

2 DSNP AND VALUE PLUS PLANS VIRGINIA DSNP AND VALUE PLUS PLANS

3 PRESCRIPTION DRUG PLANS VIRGINIA PDP PLANS Humana offers affordable prescription drug plans that meet the unique needs of your clients. Our vast network includes mail-order pharmacies like Humana, which offers mailorder copays as low as $0 on generic drugs in many regions. In-store copays as low as $1 on certain generic drugs at Walmart, Sam s Club, and Walmart Neighborhood Markets, which are preferred cost sharing pharmacies.

4 LOCAL SUPPORT VIRGINIA LOCAL SUPPORT Humana now offers two new resources, Broker Relationship Managers (BRM) and Broker Relationship Executives (BRE), in addition to your local market offices. BRMs have been deployed in markets across the country to offer on-the-ground assistance, BREs to provide sales support telephonically and electronically. We encourage you to contact these resources or simply contact Humana Agent Support at

5 MEDICARE ADVANTAGE PLANS VIRGINIA CENTRAL VIRGINIA MARKET HIGHLIGHTS New LPPO with $0 plan premium available in Central VA: Lynchburg, Martinsville, and selected surrounding counties New Value Plus LPPO plan designed with dual eligibles in mind, available in Lynchburg and selected surrounding counties Improved Charlottesville HMO plan: Reduced plan premium, PCP copay, and Rx deductible No referrals needed All MAPD plans offer preferred mail order 90- day Rx Tier 1, 2 for $0 copay through Humana NETWORK HIGHLIGHTS Some in-network hospitals include: Sentara Martha Jefferson Hospital (All Plans), University of Virginia (All Plans) and Centra Health System (PPO & PFFS Plans) Some in-network providers include: Central VA Family Practice; Medical Associates of Central Virginia All PPO plans use Humana s Nationwide ChoiceCare PPO Network MARKET SERVICE AREA Albemarle, Amherst, Appomattox, Bedford City, Campbell, Charlottesville City, Danville City, Henry, Lynchburg City, Martinsville City, Pittsylvania

6 VIRGINIA CENTRAL VIRGINIA NEW Plan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (Regional PPO) Plan Number H H R $29 plan premium; $5 PCP copay; $215 Rx deductible (Charlottesville HMO) $0 plan premium; newly available in select counties in Central VA $74 plan premium; $0 OON deductible; IN & OON cost share are equal (available in all VA counties) Premium $29 $0 $74 PCP $5 $0 $15 Specialist $45 $45 $50 Referrals Required No No No Inpatient Hospital $345 per day Days 1-5 $345 per day Days 1-4 $360 per day Days 1-5 Max Out-of-Pocket $6,700 In-network $6,700 In-network $6,700 In-network Rx Deductible $215 tiers 4-5 $265 tiers 4-5 $360 tiers 4-5 Rx Preferred $2/$8/$45/$95/29%; $0 copay $4/$12/$47/$100/28%; $0 copay $5/$15/$47/$99/26%; $0 copay Key Extra Benefits Hearing, Fitness, OTC allowance $30/Quarter Hearing, Fitness, OTC allowance $30/Quarter allowance $25/Quarter Market Service Area Albemarle, Charlottesville City Amherst, Appomattox, Campbell, Danville City, Henry, Lynchburg City, Martinsville City, Pittsylvania Statewide in North Carolina, Virginia

7 VIRGINIA CENTRAL VIRGINIA NEW Plan Name Humana Gold Choice (PFFS) Humana Gold Choice (PFFS) HumanaChoice (PPO) Plan Number H H H $66 plan premium; $15 PCP copay, $45 Spec copay (see service areas for counties) $77 plan premium; $15 PCP copay; $45 Spec copay (see service areas for counties) $0 plan premium; $3,400 MOOP; $500 copay inpatient hospital; Niche plan for those not needing Rx benefits Premium $66 $77 $0 PCP $15 $15 $10 Specialist $45 $45 $35 Referrals Required No No No Inpatient Hospital $345 per day Days 1-5 $345 per day Days 1-5 $500 per admission Max Out-of-Pocket $6,700 In-network $6,700 In-network $3,400 In-network Rx Deductible $160 tiers 3-5 $160 tiers 3-5 No Coverage Rx Preferred $5/$15/$47/$99/30%; $0 copay $5/$15/$47/$99/30%; $0 copay No Coverage Key Extra Benefits Hearing, Fitness Hearing, Fitness Market Service Area Amherst, Appomattox Pittsylvania Hearing, Fitness, OTC allowance $30/Quarter Amherst, Appomattox, Campbell, Danville City, Henry, Lynchburg City, Martinsville City, Pittsylvania

8 VIRGINIA CENTRAL VIRGINIA Plan Name Plan Number HumanaChoice (Regional PPO) R $0 plan premium, $3400 MOOP, $695 IP copay, Niche plan for those not needing Rx benefits (available in all VA counties) Premium $0 PCP $10 Specialist $35 Referrals Required Inpatient Hospital Max Out-of-Pocket Rx Deductible Rx Preferred Key Extra Benefits No $695 per admission $3,400 In-network No Coverage No Coverage allowance $30/Quarter Market Service Area Statewide in North Carolina, Virginia

9 MEDICARE ADVANTAGE PLANS VIRGINIA NORTHERN VIRGINIA MARKET HIGHLIGHTS Two new LPPO plans with $0 plan premium (Winchester and Fredericksburg, and some surrounding counties) No referrals needed All MAPD plans offer preferred mail order 90-day Rx Tier 1, 2 for $0 copay through Humana $0 deductible out-of-network on LPPO MAPD plans $160 Rx deductible on HMO plan; $265 Rx deductible Tier 4 & 5 on LPPO MAPD plan NETWORK HIGHLIGHTS Privia Medical Group: $0 PCP copay on HMO Some in-network providers include: Valley Health, Mary Washington Healthcare, Virginia Hospital Center, UVA/Novant, Reston Hospital Center and Sentara Northern VA Medical Center All PPO plans use Humana s Nationwide ChoiceCare PPO Network MARKET SERVICE AREA Accomack, Alexandria City, Arlington, Clarke, Culpeper, Essex, Falls Church City, Fauquier, Frederick, Fredericksburg City, King George, Loudoun, Manassas City, Manassas Park City, Northampton, Northumberland, Page, Prince William, Rappahannock, Richmond, Shenandoah, Spotsylvania, Stafford, Warren, Westmoreland, Winchester City

10 VIRGINIA NORTHERN VIRGINIA NEW NEW Plan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (PPO) Plan Number H H H $0 plan premium; $0-$15 PCP copay ($0 copay for Privia-affiliated PCPs); $160 Rx deductible Tier 4&5 only $0 plan premium; $265 Rx deductible Tier 4&5 only $0 plan premium; $265 Rx deductible Tier 4&5 only Premium $0 $0 $0 PCP $15 $15 $15 Specialist $40 $45 $45 Referrals Required No No No Inpatient Hospital $295 per day Days 1-6 $345 per day Days 1-4 $345 per day Days 1-4 Max Out-of-Pocket $6,700 In-network $6,700 In-network $6,700 In-network Rx Deductible $160 tiers 4-5 $265 tiers 4-5 $265 tiers 4-5 Rx Preferred $2/$8/$45/$95/30%; $0 copay $4/$12/$47/$100/28%; $0 copay $4/$12/$47/$100/28%; $0 copay Key Extra Benefits Dental, allowance $30/Quarter Hearing, Fitness, OTC allowance $30/Quarter Hearing, Fitness, OTC allowance $30/Quarter Market Service Area Alexandria City, Arlington, Falls Church City, Fauquier, Loudoun, Manassas City, Manassas Park City, Prince William Frederick, Shenandoah, Winchester City Fredericksburg City, Spotsylvania, Stafford

11 VIRGINIA NORTHERN VIRGINIA Plan Name HumanaChoice (PPO) HumanaChoice (PPO) HumanaChoice (Regional PPO) Plan Number H H R $49 plan premium; $0 OON deductible; $265 Rx deductible Tier 4&5 only; $699-$999 copays on hearing aids $69 plan premium; $0 OON deductible; $265 Rx deductible Tier 4&5 only; $699-$999 copays on hearing aids $74 plan premium; $0 OON deductible; IN & OON cost share are equal Premium $49 $69 $74 PCP $15 $15 $15 Specialist $45 $45 $50 Referrals Required No No No Inpatient Hospital $345 per day Days 1-5 $345 per day Days 1-5 $360 per day Days 1-5 Max Out-of-Pocket $6,700 In-network $6,700 In-network $6,700 In-network Rx Deductible $265 tiers 4-5 $265 tiers 4-5 $360 tiers 4-5 Rx Preferred $4/$12/$47/$100/28%; $0 copay $4/$12/$47/$100/28%; $0 copay $5/$15/$47/$99/26%; $0 copay Key Extra Benefits Hearing, Fitness, OTC allowance $30/Quarter Hearing, Fitness, OTC allowance $30/Quarter allowance $25/Quarter Market Service Area Alexandria City, Arlington, Clarke, Falls Church City, Loudoun, Manassas City, Manassas Park City, Prince William Accomack, Essex, Fauquier, Fredericksburg City, King George, Northampton, Northumberland, Page, Rappahannock, Richmond, Spotsylvania, Stafford, Warren, Westmoreland Statewide in North Carolina, Virginia

12 VIRGINIA NORTHERN VIRGINIA NEW Plan Name Humana Gold Choice (PFFS) Humana Gold Choice (PFFS) HumanaChoice (PPO) Plan Number H H H $66 plan premium; $15 PCP copay, $45 Spec copay (see service areas for counties) $77 plan premium; $15 PCP copay; $45 Spec copay (see service areas for counties) $0 plan premium; $3,400 MOOP; $500 copay inpatient hospital; Niche plan for those not needing Rx benefits Premium $66 $77 $0 PCP $15 $15 $10 Specialist $45 $45 $35 Referrals Required No No No Inpatient Hospital $345 per day Days 1-5 $345 per day Days 1-5 $500 per admission Max Out-of-Pocket $6,700 In-network $6,700 In-network $3,400 In-network Rx Deductible $160 tiers 3-5 $160 tiers 3-5 No Coverage Rx Preferred $5/$15/$47/$99/30%; $0 copay Key Extra Benefits Hearing, Fitness Hearing, Fitness Market Service Area Essex, Northumberland, Richmond $5/$15/$47/$99/30%; $0 copay Alexandria City, Falls Church City, Fredericksburg City, King George, Loudoun, Northampton, Page, Rappahannock, Spotsylvania, Stafford, Westmoreland No Coverage Hearing, Fitness, OTC allowance $30/Quarter Prince William, Loudoun, Arlington, Spotsylvania, Alexandria City, Stafford, Frederick, Fauquier, Shenandoah, Accomack, Warren, Page, Winchester City, Westmoreland, among others

13 VIRGINIA NORTHERN VIRGINIA Plan Name HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Plan Number R H $0 plan premium; $3,400 MOOP; $695 copay inpatient hospital; Niche plan for those not needing Rx benefits Premium $0 $29 PCP $10 $15 Specialist $35 $45 Referrals Required No No $29 plan premium; can be paired with stand alone PDP plan Inpatient Hospital $695 per admission $345 per day Days 1-5 Max Out-of-Pocket $3,400 In-network $6,700 In-network Rx Deductible No Coverage No Coverage Rx Preferred No Coverage No Coverage Key Extra Benefits allowance $30/Quarter Hearing, Fitness, OTC allowance $30/Quarter Market Service Area Statewide in North Carolina, Virginia Essex, Northumberland, Richmond

14 MEDICARE ADVANTAGE PLANS VIRGINIA RICHMOND MARKET HIGHLIGHTS $0 plan premium; $0 PCP copay; $3,400 MOOP on Core HMO plan Transportation benefit included on most HMO plans Year round selling opportunity CSNP (Diabetes, Cardiovascular Disease and Chronic Heart Condition) New supplemental benefit for food insecurity on Value Plus Plan in Henrico County and Richmond City All MAPD plans offer preferred mail order 90- day Rx Tier 1,2 for $0 copay through Humana No referrals needed NETWORK HIGHLIGHTS Some in-network hospitals include: Bon Secours and HCA Health Systems 4 JenCare locations: Downtown Richmond, Mechanicsville, Southside-Hull St, and Petersburg-Colonial Heights Some in-network providers include: OrthoVirginia, Commonwealth Primary Care and Virginia Physicians, Inc. All PPO plans use Humana s Nationwide ChoiceCare PPO Network MARKET SERVICE AREA Amelia, Caroline, Chesterfield, Colonial Heights City, Cumberland, Dinwiddie, Goochland, Hanover, Henrico, Hopewell City, King And Queen, Louisa, New Kent, Petersburg City, Powhatan, Prince George, Richmond City, Sussex

15 VIRGINIA RICHMOND Plan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) Humana Gold Plus - Diabetes and Heart (HMO SNP) Plan Number H H H $0 plan premium, $3400 MOOP, $0 PCP copay, $30 Spec copay, $100 Rx deductible Tier 4 & 5 only, $99- $399 copay on hearing aids $13 plan premium; $10 PCP copay; $40 Spec copay; $265 Rx deductible Tier 4 & 5 only; $699- $999 copays on hearing aids $0 plan premium; $0 PCP copay; $45 Spec copay; $150 Rx deductible Tier 4 & 5 only; $499 - $799 copay on hearing aids Premium $0 $13 $0 PCP $0 $10 $0 Specialist $30 $40 $45 Referrals Required No No No Inpatient Hospital $275 per day Days 1-6 $295 per day Days 1-6 $275 per day Days 1-6 Max Out-of-Pocket $3,400 In-network $6,700 In-network $6,700 In-network Rx Deductible $100 tiers 4-5 $265 tiers 4-5 $150 tiers 4-5 Rx Preferred $2/$8/$45/$95/31%; $0 copay $4/$12/$47/$100/28%; $0 copay $4/$12/$47/$100/30%; $0 copay Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter, Transportation Hearing, Fitness, OTC allowance $30/Quarter Dental, Vision, Hearing, Fitness, OTC allowance $50/Quarter, Transportation Market Service Area Chesterfield, Colonial Heights City, Dinwiddie, Hanover, Henrico, Hopewell City, Petersburg City, Richmond City Chesterfield, Colonial Heights City, Dinwiddie, Goochland, Hanover, Henrico, Hopewell City, Louisa, Petersburg City, Powhatan, Richmond City Chesterfield, Colonial Heights City, Hanover, Henrico, Hopewell City, Petersburg City, Richmond City

16 VIRGINIA RICHMOND Plan Name HumanaChoice (PPO) HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Plan Number H R H $53 plan premium; $10 PCP copay; $40 Spec copay; $160 Rx deductible Tier 4 & 5 only; $699- $999 copays on hearing aids $74 plan premium; $0 OON deductible; IN & OON cost share are equal $66 plan premium; $15 PCP copay, $45 Spec copay (see service areas for counties) Premium $53 $74 $66 PCP $10 $15 $15 Specialist $40 $50 $45 Referrals Required No No No Inpatient Hospital $295 per day Days 1-6 $360 per day Days 1-5 $345 per day Days 1-5 Max Out-of-Pocket $6,700 In-network $6,700 In-network $6,700 In-network Rx Deductible $160 tiers 4-5 $360 tiers 4-5 $160 tiers 3-5 Rx Preferred Key Extra Benefits Market Service Area $4/$12/$47/$100/30%; $0 copay Hearing, Fitness, OTC allowance $30/Quarter Richmond Marketwide $5/$15/$47/$99/26%; $0 copay allowance $25/Quarter Statewide in North Carolina, Virginia $5/$15/$47/$99/30%; $0 copay Hearing, Fitness Chesterfield, Goochland, Hanover, Henrico, Petersburg City, Powhatan, Richmond City

17 VIRGINIA RICHMOND NEW Plan Name HumanaChoice (PPO) HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Plan Number H R H $0 plan premium; $3,400 MOOP; $500 copay inpatient hospital; Niche plan for those not needing Rx benefits $0 plan premium; $3,400 MOOP; $695 copay inpatient hospital; Niche plan for those not needing Rx benefits $29 plan premium; can be paired with stand alone PDP plan Premium $0 $0 $29 PCP $10 $10 $15 Specialist $35 $35 $45 Referrals Required No No No Inpatient Hospital $500 per admission $695 per admission $345 per day Days 1-5 Max Out-of-Pocket $3,400 In-network $3,400 In-network $6,700 In-network Rx Deductible No Coverage No Coverage No Coverage Rx Preferred No Coverage No Coverage No Coverage Key Extra Benefits Hearing, Fitness, OTC allowance $30/Quarter allowance $30/Quarter Hearing, Fitness, OTC allowance $30/Quarter Market Service Area Richmond Marketwide Statewide in North Carolina, Virginia Chesterfield, Goochland, Hanover, Henrico, Petersburg City, Powhatan, Richmond City

18 MEDICARE ADVANTAGE PLANS VIRGINIA ROANOKE MARKET HIGHLIGHTS New high benefit HMO plan in Roanoke and surrounding counties. $0 copay for PCP, SPC and IPH HMO with $0 plan premium available in Roanoke and some surrounding counties with $3,400 MOOP and $0 PCP copay Niche MA Only plan is a good fit for veterans All MAPD plans offer preferred mail order 90- day Rx Tier 1, 2 for $0 copay through Humana No referrals needed HMO plan has $160 Rx deductible only on Tiers 4 & 5; LPPO MAPD plan has $215 Rx deductible only on Tiers 4 & 5 NETWORK HIGHLIGHTS Some in-network hospitals include: Carilion and HCA Lewis Gale All PPO plans use Humana s Nationwide ChoiceCare PPO Network MARKET SERVICE AREA Bedford, Bland, Botetourt, Craig, Floyd, Franklin, Montgomery, Pulaski, Radford, Roanoke, Roanoke City, Salem

19 VIRGINIA ROANOKE NEW Plan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) Humana Gold Plus (HMO) Plan Number H H H $0 plan premium; $0 PCP copay; $35 Spec copay; $160 Rx deductible Tier 4 & 5 only; $699- $999 copay on hearing aids $125 plan premium; $0 PCP copay; $0 Spec copay; $190 Rx deductible Tier 3,4,5 $13 plan premium; $0 PCP copay; $45 Spec copay; $160 Rx deductible Tier 4 & 5 only; $699- $999 copay on hearing aids Premium $0 $125 $13 PCP $0 $0 $0 Specialist $35 $0 $45 Referrals Required No No No Inpatient Hospital $275 per day Days 1-6 $0 per admission $275 per day Days 1-6 Max Out-of-Pocket $3,400 In-network $6,700 In-network $6,700 In-network Rx Deductible $160 tiers 4-5 $190 tiers 3-5 $160 tiers 4-5 Rx Preferred $2/$8/$45/$95/30%; $0 copay $4/$12/$47/$99/29%; $0 copay $2/$8/$45/$95/30%; $0 copay Key Extra Benefits allowance $30/Quarter allowance $75/Quarter, Transportation allowance $30/Quarter Market Service Area Franklin, Roanoke, Roanoke City, Salem Botetourt, Craig, Floyd, Franklin, Montgomery, Pulaski, Radford, Roanoke, Roanoke City, Salem Botetourt, Craig, Floyd, Montgomery, Pulaski, Radford

20 VIRGINIA ROANOKE Plan Name HumanaChoice (PPO) HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Plan Number H R H $69 plan premium; $500 OON deductible; $10 PCP copay; $45 Spec copay; $215 Rx deductible Tier 4 & 5 only $74 plan premium; $0 OON deductible; IN & OON cost share are equal $66 plan premium; $15 PCP copay, $45 Spec copay (see service areas for counties) Premium $69 $74 $66 PCP $10 $15 $15 Specialist $45 $50 $45 Referrals Required No No No Inpatient Hospital $345 per day Days 1-5 $360 per day Days 1-5 $345 per day Days 1-5 Max Out-of-Pocket $6,700 In-network $6,700 In-network $6,700 In-network Rx Deductible $215 tiers 4-5 $360 tiers 4-5 $160 tiers 3-5 Rx Preferred $4/$12/$47/$100/29%; $0 copay $5/$15/$47/$99/26%; $0 copay $5/$15/$47/$99/30%; $0 copay Key Extra Benefits Market Service Area allowance $30/Quarter Roanoke Marketwide allowance $25/Quarter Statewide in North Carolina, Virginia Hearing, Fitness Bedford, Bland, Botetourt, Craig, Floyd, Pulaski, Radford, Roanoke, Roanoke City, Salem

21 VIRGINIA ROANOKE NEW Plan Name HumanaChoice (PPO) HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Plan Number H R H $0 plan premium; $3,400 MOOP; $500 copay inpatient hospital; Niche plan for those not needing Rx benefits $0 plan premium; $3,400 MOOP; $695 copay inpatient hospital; Niche plan for those not needing Rx benefits $29 plan premium; can be paired with stand alone PDP plan Premium $0 $0 $29 PCP $10 $10 $15 Specialist $35 $35 $45 Referrals Required No No No Inpatient Hospital $500 per admission $695 per admission $345 per day Days 1-5 Max Out-of-Pocket $3,400 In-network $3,400 In-network $6,700 In-network Rx Deductible No Coverage No Coverage No Coverage Rx Preferred No Coverage No Coverage No Coverage Key Extra Benefits Hearing, Fitness, OTC allowance $30/Quarter allowance $30/Quarter Hearing, Fitness, OTC allowance $30/Quarter Market Service Area Roanoke Marketwide Statewide in North Carolina, Virginia Bedford, Bland, Botetourt, Craig, Floyd, Radford, Roanoke, Roanoke City, Salem

22 MEDICARE ADVANTAGE PLANS VIRGINIA SOUTHWEST VIRGINIA MARKET HIGHLIGHTS $0 Rx deductible on HMO plans with $29 plan premium and $95 plan premium No referrals needed All MAPD plans offer preferred mail order 90- day Rx Tier 1, 2 for $0 copay through Humana $0 PCP copay on HMO plans with $29 plan premium and $95 plan premium HMO available with $0 plan premium, $5 PCP copay and $50 Rx deductible on Tiers 4 and 5 NETWORK HIGHLIGHTS Some in-network providers include: Holston Medical Group Some in-network hospitals include: Ballad Health (Wellmont and Mountain States), LifePoint All PPO plans use Humana s Nationwide ChoiceCare PPO Network MARKET SERVICE AREA Bristol, Buchanan, Dickenson, Grayson, Lee, Norton City, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe

23 VIRGINIA SOUTHWEST VIRGINIA Plan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) Humana Gold Plus (HMO) Plan Number H H H $0 plan premium; $5 PCP copay; $45 Spec copay; $50 Rx deductible Tier 4&5 only; $399-$699 copay on hearing aids $29 plan premium; $0 PCP copay; $35 Spec copay; $0 Rx deductible; $399-$699 copay on hearing aids $95 plan premium; $0 PCP copay; $35 Spec copay; $0 copay inpatient hospital; $0 Rx deductible; $399- $699 copay on hearing aids Premium $0 $29 $95 PCP $5 $0 $0 Specialist $45 $35 $35 Referrals Required No No No Inpatient Hospital $295 per day Days 1-6 $245 per day Days 1-6 $0 per admission Max Out-of-Pocket $6,700 In-network $5,900 In-network $5,400 In-network Rx Deductible $50 tiers 4-5 No Deductible No Deductible Rx Preferred $7/$17/$47/$100/32%; $0 copay $5/$15/$47/$97/33%; $0 copay $3/$10/$47/$97/33%; $0 copay Key Extra Benefits allowance $25/Quarter Dental, allowance $25/Quarter Dental, allowance $30/Quarter Market Service Area Southwest Virginia Marketwide Southwest Virginia Marketwide Southwest Virginia Marketwide

24 VIRGINIA SOUTHWEST VIRGINIA Plan Name HumanaChoice (PPO) HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Plan Number H R H $59 plan premium; $15 PCP copay; $35 Spec copay; $0 Rx deductible; $399-$699 copay on hearing aids $74 plan premium; $0 OON deductible; IN & OON cost share are equal $90 plan premium; $15 PCP copay, $40 Spec copay; $415 Rx deductible Premium $59 $74 $90 PCP $15 $15 $15 Specialist $35 $50 $40 Referrals Required No No No Inpatient Hospital $265 per day Days 1-7 $360 per day Days 1-5 $295 per day Days 1-6 Max Out-of-Pocket $6,700 In-network $6,700 In-network $6,700 In-network Rx Deductible No Deductible $360 tiers 4-5 $415 tiers 4-5 Rx Preferred $7/$17/$47/$97/33%; $0 copay $5/$15/$47/$99/26%; $0 copay $7/$17/$47/$100/25%; $0 copay Key Extra Benefits allowance $25/Quarter allowance $25/Quarter Vision, Hearing, OTC allowance $10/Month Market Service Area Southwest Virginia Marketwide Statewide in North Carolina, Virginia Bristol, Buchanan, Dickenson, Grayson, Lee, Russell, Smyth, Tazewell, Washington, Wise, Wythe

25 VIRGINIA SOUTHWEST VIRGINIA Plan Name HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Plan Number R H $0 plan premium; $3,400 MOOP; $695 copay inpatient hospital; Niche plan for those not needing Rx benefits Premium $0 $0 PCP $10 $15 Specialist $35 $40 Referrals Required No No $0 plan premium; $15 PCP copay, $40 Spec copay; may be paired with stand alone PDP plan Inpatient Hospital $695 per admission $295 per day Days 1-6 Max Out-of-Pocket $3,400 In-network $6,700 In-network Rx Deductible No Coverage No Coverage Rx Preferred No Coverage No Coverage Key Extra Benefits Market Service Area allowance $30/Quarter Statewide in North Carolina, Virginia Vision, Fitness, OTC allowance $25/Quarter Bristol, Buchanan, Dickenson, Grayson, Lee, Russell, Smyth, Tazewell, Washington, Wise, Wythe

26 MEDICARE ADVANTAGE PLANS VIRGINIA TIDEWATER MARKET HIGHLIGHTS $0 plan premium; $0 PCP copay; $3,400 MOOP on Core HMO plan Transportation benefit included on most HMO plans Year round selling opportunity CSNP (Diabetes, Cardiovascular Disease and Chronic Heart Condition) All MAPD plans offer preferred mail order 90- day Rx Tier 1, 2 for $0 copay through Humana No referrals needed NETWORK HIGHLIGHTS Some in-network hospitals include: Sentara, Riverside, Bon Secours and Chesapeake Regional 4 JenCare locations: Virginia Beach, Norfolk, Portsmouth and Newport News Some in-network providers include: TPMG and FirstCare All PPO plans use Humana s Nationwide ChoiceCare PPO Network MARKET SERVICE AREA Chesapeake City, Franklin City, Gloucester, Hampton City, Isle Of Wight, James City, Newport News City, Norfolk City, Poquoson City, Portsmouth City, Southampton, Suffolk City, Surry, Virginia Beach City, Williamsburg City, York

27 VIRGINIA TIDEWATER Plan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) Humana Gold Plus - Diabetes and Heart (HMO SNP) Plan Number H H H $0 plan premium; $0 PCP copay; $40 Spec copay; $160 Rx deductible Tier 4 & 5 only; $699- $999 copays on hearing aids $0 plan premium, $3400 MOOP, $0 PCP copay, $30 Spec copay, $100 RX deductible Tier 4 & 5 only, $99- $399 copay on hearing aids $0 plan premium; $0 PCP copay; $45 Spec copay; $150 Rx deductible Tier 4 & 5 only; $499 - $799 copay on hearing aids Premium $0 $0 $0 PCP $0 $0 $0 Specialist $40 $30 $45 Referrals Required No No No Inpatient Hospital $295 per day Days 1-6 $275 per day Days 1-6 $275 per day Days 1-6 Max Out-of-Pocket $6,700 In-network $3,400 In-network $6,700 In-network Rx Deductible $160 tiers 4-5 $100 tiers 4-5 $150 tiers 4-5 Rx Preferred $4/$12/$47/$100/30%; $0 copay $2/$8/$45/$95/31%; $0 copay $4/$12/$47/$100/30%; $0 copay Key Extra Benefits Dental, Hearing, Fitness, OTC allowance $30/Quarter Dental, Vision, Hearing, Fitness, OTC allowance $200/Quarter, Transportation Dental, Vision, Hearing, Fitness, OTC allowance $50/Quarter, Transportation Market Service Area Chesapeake City, Hampton City, Isle Of Wight, James City, Newport News City, Norfolk City, Poquoson City, Portsmouth City, Suffolk City, Virginia Beach City, Williamsburg City, York Chesapeake City, Hampton City, Newport News City, Norfolk City, Portsmouth City, Suffolk City, Virginia Beach City Chesapeake City, Hampton City, Newport News City, Norfolk City, Portsmouth City, Virginia Beach City

28 VIRGINIA TIDEWATER Plan Name HumanaChoice (PPO) HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Plan Number H R H $55 plan premium; $10 PCP copay; $40 Spec copay; $265 Rx deductible Tier 4 & 5 only; $699- $999 copays on hearing aids $74 plan premium; $0 OON deductible; IN & OON cost share are equal $66 plan premium; $15 PCP copay, $45 Spec copay (see service areas for counties) Premium $55 $74 $66 PCP $10 $15 $15 Specialist $40 $50 $45 Referrals Required No No No Inpatient Hospital $295 per day Days 1-6 $360 per day Days 1-5 $345 per day Days 1-5 Max Out-of-Pocket $6,700 In-network $6,700 In-network $6,700 In-network Rx Deductible $265 tiers 4-5 $360 tiers 4-5 $160 tiers 3-5 Rx Preferred $4/$12/$47/$100/28%; $0 copay $5/$15/$47/$99/26%; $0 copay $5/$15/$47/$99/30%; $0 copay Key Extra Benefits Market Service Area allowance $30/Quarter Tidewater Marketwide allowance $25/Quarter Statewide in North Carolina, Virginia Hearing, Fitness Chesapeake City, Gloucester, Hampton City, Isle Of Wight, Newport News City, Norfolk City, Portsmouth City, Southampton, Suffolk City, Virginia Beach City, Williamsburg City, York

29 VIRGINIA TIDEWATER NEW Plan Name HumanaChoice (PPO) HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Plan Number H R H $0 plan premium; $3,400 MOOP; $500 copay inpatient hospital; Niche plan for those not needing Rx benefits $0 plan premium; $3,400 MOOP; $695 copay inpatient hospital; Niche plan for those not needing Rx benefits $29 plan premium; can be paired with stand alone PDP plan Premium $0 $0 $29 PCP $10 $10 $15 Specialist $35 $35 $45 Referrals Required No No No Inpatient Hospital $500 per admission $695 per admission $345 per day Days 1-5 Max Out-of-Pocket $3,400 In-network $3,400 In-network $6,700 In-network Rx Deductible No Coverage No Coverage No Coverage Rx Preferred No Coverage No Coverage No Coverage Key Extra Benefits Hearing, Fitness, OTC allowance $30/Quarter allowance $30/Quarter Hearing, Fitness, OTC allowance $30/Quarter Market Service Area Tidewater Marketwide Statewide in North Carolina, Virginia Chesapeake City, Gloucester, Hampton City, Isle Of Wight, Newport News City, Norfolk City, Portsmouth City, Southampton, Suffolk City, Virginia Beach City, Williamsburg City, York

30 MEDICARE ADVANTAGE PLANS VIRGINIA VIRGINIA OUTSTATE MARKET HIGHLIGHTS Select rural counties offering PFFS and/or RPPO plans RPPO MAPD and MA Only plans in all VA counties PFFS MAPD and MA Only plans available in select VA counties LPPO MA Only plan available in most VA counties Only the PFFS MA Only plan can be paired with a stand-alone PDP plan NETWORK HIGHLIGHTS RPPO and LPPO plans in this area are passive in design having no OON deductibles or coinsurance PFFS plans are networked, have $750 OON deductible, but are passive after deductible (IN = OON cost share) All PPO plans use Humana s Nationwide ChoiceCare PPO Network MARKET SERVICE AREA Alleghany, Augusta, Bath, Brunswick, Buckingham, Buena Vista City, Carroll, Charles City, Charlotte, Covington City, Emporia City, Fairfax, Fairfax City, Fluvanna, Galax City, Giles, Greene, Greensville, Halifax, Harrisonburg City, Highland, King William, Lancaster, Lexington City, Lunenburg, Madison, Mathews, Mecklenburg, Middlesex, Nelson, Nottoway, Orange, Patrick, Prince Edward, Rockbridge, Rockingham, Staunton City, Waynesboro City

31 VIRGINIA VIRGINIA OUTSTATE Plan Name HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Humana Gold Choice (PFFS) Plan Number R H H $74 plan premium; $0 OON deductible; IN & OON cost share are equal $66 plan premium; $15 PCP copay, $45 Spec copay (see service areas for counties) $77 plan premium; $15 PCP copay; $45 Spec copay (see service areas for counties) Premium $74 $66 $77 PCP $15 $15 $15 Specialist $50 $45 $45 Referrals Required No No No Inpatient Hospital $360 per day Days 1-5 $345 per day Days 1-5 $345 per day Days 1-5 Max Out-of-Pocket $6,700 In-network $6,700 In-network $6,700 In-network Rx Deductible $360 tiers 4-5 $160 tiers 3-5 $160 tiers 3-5 Rx Preferred $5/$15/$47/$99/26%; $0 copay $5/$15/$47/$99/30%; $0 copay $5/$15/$47/$99/30%; $0 copay Key Extra Benefits Market Service Area allowance $25/Quarter Statewide in North Carolina, Virginia Hearing, Fitness Halifax, Lancaster, Middlesex, Nottoway, Prince Edward Hearing, Fitness Bath, Brunswick, Carroll, Emporia City, Galax City, Greensville, Harrisonburg City, Highland, Mecklenburg, Patrick, Rockingham

32 VIRGINIA VIRGINIA OUTSTATE Plan Name HumanaChoice (Regional PPO) Humana Gold Choice (PFFS) Plan Number R H $0 plan premium; $3,400 MOOP; $695 copay inpatient hospital; Niche plan for those not needing Rx benefits Premium $0 $29 PCP $10 $15 Specialist $35 $45 Referrals Required No No $29 plan premium; can be paired with stand alone PDP plan Inpatient Hospital $695 per admission $345 per day Days 1-5 Max Out-of-Pocket $3,400 In-network $6,700 In-network Rx Deductible No Coverage No Coverage Rx Preferred No Coverage No Coverage Key Extra Benefits Market Service Area allowance $30/Quarter Statewide in North Carolina, Virginia Hearing, Fitness, OTC allowance $30/Quarter Brunswick, Buckingham, Carroll, Emporia City, Galax City, Giles, Greensville, Lancaster, Middlesex, Nottoway, Orange, Patrick, Prince Edward

33 DSNP AND VALUE PLUS PLANS VIRGINIA DUAL-ELIGIBLE SPECIAL NEEDS PLANS (DSNP) Humana s DSNPs offer beneficiaries who qualify for both Medicare and Medicaid with $0 or low cost copays for many medical and pharmacy services, as well as rich supplemental benefits like dental coverage, eye exams and glasses, over-the-counter allowance, hearing aids, and more. DSNPs allow year-round enrollment. Eligible members must meet Medicaid requirements to enroll in these plans. VALUE PLUS PLANS A Value Plus Plan is a Medicare Advantage plan offered by Humana with those eligible for both Medicare and Medicaid in mind, but since it s a Medicare Advantage plan, it s available to anyone with Medicare. Dual-Eligible Medicare and Medicaid beneficiaries will receive $0 or low cost copays for many medical and pharmacy services, as well as rich supplemental benefits like dental coverage, eye exams and glasses, over-the-counter allowance, hearing aids, and more. Dual eligibles may enroll in this plan year-round. Unlike a DSNP, if a beneficiary loses Medicaid status, they are not required to change health plans they will keep this plan, but will lose their Medicaid benefits. Value Plus Plans also appeal to Medicare beneficiaries who are familiar with Original Medicare benefits and cost sharing, who also desire pharmacy coverage and rich supplemental benefits.

34 VIRGINIA DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW Plan Name Plan Number Vision Humana Value Plus (HMO) H Lean medical and Rx benefits with rich supplemental benefits, designed with dual eligibles in mind yet available to all Annual exam and $200 credit every year for eyewear or contact lenses including fittings Hearing $0 annual exams, fittings and TruHearing advanced level hearing aids plus 48 batteries OTC Allowance OTC $300/Quarter for select health and wellness products Transportation Up to 36 one-way trips to approved locations and fitness centers per year Current Service Area Accomack, Albemarle, Alexandria City, Alleghany, Amelia, Appomattox, Arlington, Augusta, Bath, Bland, Botetourt, Brunswick, Buckingham, Buena Vista City, Caroline, Carroll, Charles City, Charlotte, Charlottesville City, Clarke, Covington City, Craig, Cumberland, Danville City, Emporia City, Essex, Falls Church City, Fauquier, Floyd, Fluvanna, Franklin, Franklin City, Fredericksburg City, Galax City, Giles, Gloucester, Goochland, Greene, Greensville, Halifax, Harrisonburg City, Henry, Highland, Isle Of Wight, James City, King And Queen, King George, King William, Lancaster, Lexington City, Loudoun, Louisa, Lunenburg, Madison, Manassas City, Manassas Park City, Martinsville City, Mathews, Mecklenburg, Middlesex, Montgomery, Nelson, New Kent, Northampton, Northumberland, Nottoway, Orange, Page, Patrick, Pittsylvania, Powhatan, Prince George, Prince William, Pulaski, Radford, Rappahannock, Richmond, Roanoke, Roanoke City, Rockbridge, Rockingham, Salem, Southampton, Spotsylvania, Stafford, Staunton City, Surry, Sussex, Warren, Waynesboro City, Westmoreland, Williamsburg City, Wythe, York

35 VIRGINIA DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW Plan Name Plan Number Dental Humana Value Plus (HMO) H Lean medical and Rx benefits with rich supplemental benefits, designed with dual eligibles in mind yet available to all $0 copayment covers: exams, x-rays, cleanings, fillings, and extractions Vision Annual exam and $200 credit every year for eyewear or contact lenses including fittings Hearing $0 annual exams, fittings and TruHearing advanced level hearing aids plus 48 batteries OTC Allowance OTC $300/Quarter for select health and wellness products Transportation Up to 36 one-way trips to approved locations and fitness centers per year Meals on Wheels 2 meals per day, 5 days a week up to 130 meals for members referred by a provider for food access Current Service Area Henrico, Richmond City

36 VIRGINIA DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW Plan Name Plan Number Dental Humana Value Plus (HMO) H Lean medical and Rx benefits with rich supplemental benefits, designed with dual eligibles in mind yet available to all $0 copayment covers: exams, x-rays, cleanings, fillings, and extractions Vision Annual exam and $200 credit every year for eyewear or contact lenses including fittings Hearing $0 annual exams, fittings and TruHearing advanced level hearing aids plus 48 batteries OTC Allowance OTC $300/Quarter for select health and wellness products Transportation Up to 36 one-way trips to approved locations and fitness centers per year Current Service Area Chesapeake City, Chesterfield, Colonial Heights City, Dinwiddie, Hampton City, Hanover, Hopewell City, Newport News City, Norfolk City, Petersburg City, Poquoson City, Portsmouth City, Suffolk City, Virginia Beach City

37 VIRGINIA DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW NEW Plan Name Plan Number Vision Hearing Humana Value Plus (PPO) H Lean medical and Rx benefits with rich supplemental benefits, designed with dual eligibles in mind yet available to all Annual exam and $100 credit every year for eyeglasses or contact lenses. OON coverage available. Some restrictions apply if benefits received Out-of-Network $0 annual exam, fittings and TruHearing advanced level hearing aids plus 48 batteries OTC Allowance OTC $300/Quarter for select health and wellness products Transportation Up to 12 one-way trips to approved locations and fitness centers per year Current Service Area Amherst, Appomattox, Bedford, Campbell, Frederick, Lynchburg City, Shenandoah, Winchester City

38 VIRGINIA DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW NEW Plan Name Plan Number Dental Humana Value Plus (PPO) H Lean medical and Rx benefits with rich supplemental benefits, designed with dual eligibles in mind yet available to all $2,000 annually; $0 copayment covers: exams, x-rays, cleanings, fillings, crowns, extractions, dentures Vision $40 maximum benefit coverage for routine exam Hearing $0 annual exam, fittings and TruHearing advanced level hearing aids plus 48 batteries OTC Allowance OTC $100/Month for select health and wellness products Transportation Up to 12 one-way trips to approved locations and fitness centers per year Current Service Area Bristol, Buchanan, Dickenson, Grayson, Lee, Norton City, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe

39 VIRGINIA PDP PLANS Plan Name Humana Preferred Rx Plan (PDP) Humana Walmart Rx Plan (PDP) Plan Number S S Premium Pairs well for members with Extra Help (LIS). Tier 1 & Tier 2 mailorder copays are $0 at Humana for 90-day supply. TBD Retail copays as low as $1. Tier 1 mail-order copays are as low as $0 at Humana for 90-day supply. TBD Rx Deductible $415 all tiers $415 tiers 3-5 Preferred Retail 30-day Supply No Coverage $1/$4/20%/35%/25% Standard Retail 30-day Supply $0/$1/25%/37%/25% $10/$20/25%/50%/25% Preferred Mail 90-day Supply $0 copay for tiers 1 & 2 $0 copay for tier 1, $8 copay for tier 2 Market Service Area Virginia Statewide Virginia Statewide

40 LOCAL SUPPORT VIRGINIA Christopher Rosa Bieser Broker Relationship Executive (800) Jennifer Meyer Broker Relationship Manager (540) Local Market Office (800)