MEDICARE ADVANTAGE PLANS Select the market(s) below to view their Market Highlights MA/MAPD PLANS 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. KYHK7GUEN
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PRESCRIPTION DRUG PLANS 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 mail order 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. PDP
LOCAL SUPPORT 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-theground assistance, BREs to provide sales support telephonically and electronically. We encourage you to contact these resources or simply contact Humana Agent Support at 1-800-309-3163. LOCAL SUPPORT
MEDICARE ADVANTAGE PLANS GREATER LOUISVILLE MARKET HIGHLIGHTS Full suite of products starting with $0 HMOs up to high dollar rich PPO plans; designed to meet a variety of consumer needs Rich $0 HMO benefit with broad network Dual-eligible plans available; see KY Duals Plans snapshot New $15 premium LPPO with access to national PPO network ($0 premium for 100% LIS) Many plans include enhanced additional benefits such as dental, vision, hearing, transportation, OTC allowance and fitness benefits $0 copay for tiers 1 & 2 when utilizing Humana mail order pharmacy for 90-day supply No RX deductibles on many of the plans No referrals on any plans NETWORK HIGHLIGHTS Humana has two HMO networks & a national PPO network in Greater Louisville The Humana Community HMO provides access to JenCare and Norton PCPs in Louisville The Gold Plus HMO and Gold Choice PPO networks are broad networks that include all major Louisville Metro health systems Participating health systems in the broad HMO and PPO networks include Norton, Baptist, University of Louisville, Kentucky One, Clark Memorial, and Hardin Memorial MARKET SERVICE AREA Anderson, Boyle, Breckinridge, Bullitt, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Mercer, Nelson, Oldham, Shelby, Spencer, Washington
GREATER LOUISVILLE MA/MAPD PLANS Plan Name Humana Community (HMO) Humana Gold Plus (HMO) HumanaChoice (PPO) Plan Number H1036-236-000 H5619-073-000 H5216-107-000 $0 HMO with access to the Community HMO network, $0 PCP and $30 Specialist copays. Rich MSBs. No referrals. Plan premium reduced to $0. Robust Greater Louisville HMO network. Rich MSBs. No referrals. Passive network (same in and out of network benefits), Rich MSBs, Single copay hospital stay. Premium $0 $0 $117 PCP $0 $5 $5 Specialist $30 $40 $30 Referrals Required No No No Inpatient Hospital $250 per day Days 1-7 $275 per day Days 1-7 $350 per admission Max Out-of-Pocket $4,900 In Network $5,400 In Network $6,700 In Network Rx Deductible No Deductible No Deductible No Deductible Rx Preferred $0/$14/$47/$100/33%; $0 copay $3/$15/$47/$100/33%; $0 copay $5/$15/$47/$97/33%; $0 copay Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter, Transportation Dental, Vision, Hearing, Fitness, OTC allowance $45/Quarter, Transportation Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter Market Service Area Jefferson Indiana: Clark, Floyd; Kentucky: Bullitt, Hardin, Jefferson, Oldham Indiana: Clark, Floyd, Harrison; Kentucky: Boyle, Bullitt, Hardin, Henry, Jefferson, Marion, Meade, Nelson, Oldham, Shelby, Spencer
GREATER LOUISVILLE MA/MAPD PLANS NEW NEW Plan Name HumanaChoice (PPO) HumanaChoice (PPO) HumanaChoice (PPO) Plan Number H5216-188-000 H5216-187-000 H5216-018-000 New $15 premium LPPO with access to national PPO network ($0 premium for 100% LIS). Rich LPPO; includes $0 hospital, PCP and Specialist copays. Rich MSBs. Passive network (same in and out of network benefits). Plan premium reduced from $67 to $39, access to national PPO network. No Rx deductible. Premium $15 $195 $39 PCP $15 $0 $10 Specialist $45 $0 $45 Referrals Required No No No Inpatient Hospital $360 per day Days 1-5 $0 per admission $350 per day Days 1-5 Max Out-of-Pocket $6,700 In Network $4,000 In Network $6,700 In Network Rx Deductible $195 tiers 4-5 $195 tiers 3-5 No Deductible Rx Preferred $7/$17/$47/$100/29%; $0 copay $2/$8/$47/$100/29%; $0 copay $5/$15/$47/$100/33%; $0 copay Key Extra Benefits Dental, Fitness, OTC allowance $45/Quarter Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter Dental, Vision, Hearing, Fitness, OTC allowance $45/Quarter Market Service Area Indiana: Clark, Floyd, Harrison; Kentucky: Boyle, Bullitt, Hardin, Henry, Jefferson, Marion, Meade, Nelson, Oldham, Shelby, Spencer Jefferson Indiana: Clark, Floyd, Harrison; Kentucky: Bullitt, Hardin, Henry, Jefferson, Marion, Nelson, Oldham, Shelby, Spencer
GREATER LOUISVILLE MA/MAPD PLANS Plan Name Plan Number HumanaChoice (PPO) H5216-105-000 $0 LPPO with access to national PPO network, No Rx coverage, Good fit for military veterans who have VA Rx coverage Premium $0 PCP $10 Specialist $35 Referrals Required No Inpatient Hospital $295 per day Days 1-6 Max Out-of-Pocket Rx Deductible Rx Preferred Key Extra Benefits Market Service Area $4,500 In Network No Coverage No Coverage Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter Boyle, Bullitt, Hardin, Henry, Jefferson, Marion, Meade, Nelson, Oldham, Shelby, Spencer
MEDICARE ADVANTAGE PLANS LEXINGTON - SOUTH CENTRAL KY MARKET HIGHLIGHTS Full suite of products starting with $0 HMO up to high dollar rich PPO plans New $15 premium LPPO with access to national PPO network ($0 premium for 100% LIS) Dual-eligible plans available; see KY Duals Plans snapshot Full PPO suite of products designed to meet a variety of consumer needs Many plans include enhanced additional benefits such as dental, vision, hearing, transportation, OTC allowance and fitness benefits $0 copay for tiers 1 & 2 when utilizing Humana mail-order pharmacy for 90-day supply No Rx deductibles on many of the plans No Referrals on any plans NETWORK HIGHLIGHTS Humana has a HMO network & our national PPO network comprehensively covering Lexington and Central KY The Humana HMO provides access to Lexington Clinic, St. Joe and Central Baptist The Gold Plus HMO and Gold Choice PPO networks are broad networks that include most major Lexington and Central KY health systems Participating health systems in the broad HMO and PPO networks include Lexington Clinic, St. Joes and Central Baptist MARKET SERVICE AREA Bath, Bell, Bourbon, Breathitt, Casey, Clark, Clay, Clinton, Cumberland, Edmonson, Estill, Fayette, Floyd, Franklin, Garrard, Harlan, Jackson, Jessamine, Johnson, Knott, Knox, Laurel, Lee, Leslie, Letcher, Lincoln, Madison, Magoffin, Martin, Mccreary, Menifee, Monroe, Montgomery, Owsley, Perry, Pike, Powell, Pulaski, Rockcastle, Russell, Scott, Wayne, Whitley, Wolfe, Woodford
LEXINGTON - SOUTH CENTRAL KY MA/MAPD PLANS NEW Plan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (PPO) Plan Number H5619-071-000 H5216-107-000 H5216-188-000 $0 HMO in Lexington and several Central KY counties. Low copays. No Rx deductible. No referrals. Passive network (same in and out of network benefits), Rich MSBs, Single copay hospital stay. New $15 plan premium LPPO with access to national PPO network. ($0 premium for 100% LIS). Premium $0 $117 $15 PCP $5 $5 $15 Specialist $30 $30 $45 Referrals Required No No No Inpatient Hospital $295 per day Days 1-6 $350 per admission $360 per day Days 1-5 Max Out-of-Pocket $5,900 In Network $6,700 In Network $6,700 In Network Rx Deductible No Deductible No Deductible $195 tiers 4-5 Rx Preferred $3/$15/$47/$100/33%; $0 copay $5/$15/$47/$97/33%; $0 copay $7/$17/$47/$100/29%; $0 copay Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $45/Quarter, Transportation Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter Dental, Fitness, OTC allowance $45/Quarter Market Service Area Bourbon, Clark, Fayette, Jessamine, Madison, Montgomery, Scott, Woodford Fayette, Pike, Madison, Franklin, Floyd, Jessamine, Whitley, Clark, Scott, Harlan, Perry, Letcher, Johnson, Lincoln, Montgomery, Woodford, Clay, Bourbon, Knott, Casey, among others Fayette, Pike, Madison, Franklin, Floyd, Jessamine, Whitley, Clark, Scott, Harlan, Perry, Letcher, Johnson, Lincoln, Montgomery, Woodford, Clay, Bourbon, Knott, Casey, among others
LEXINGTON - SOUTH CENTRAL KY MA/MAPD PLANS NEW Plan Name HumanaChoice (PPO) HumanaChoice (PPO) HumanaChoice (PPO) Plan Number H5216-187-000 H5216-019-000 H5216-105-000 Rich LPPO; includes $0 hospital, PCP and Specialist copays. Rich MSBs. Passive network (same in and out of network benefits). LPPO $29 plan premium with access to the national PPO network; includes University of Kentucky in-network. No Rx deductible. Premium $195 $29 $0 PCP $0 $10 $10 Specialist $0 $40 $35 Referrals Required No No No $0 LPPO with access to national PPO network, No Rx coverage, Good fit for military veterans who have VA Rx coverage. Inpatient Hospital $0 per admission $350 per day Days 1-5 $295 per day Days 1-6 Max Out-of-Pocket $4,000 In Network $6,700 In Network $4,500 In Network Rx Deductible $195 tiers 3-5 No Deductible No Coverage Rx Preferred $2/$8/$47/$100/29%; $0 copay $5/$15/$47/$100/33%; $0 copay No Coverage Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter Dental, Vision, Hearing, Fitness, OTC allowance $45/Quarter Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter Market Service Area Fayette Bath, Bourbon, Clark, Fayette, Franklin, Jackson, Jessamine, Lincoln, Madison, Menifee, Montgomery, Powell, Scott, Woodford Fayette, Pike, Madison, Franklin, Floyd, Jessamine, Whitley, Clark, Scott, Harlan, Perry, Letcher, Johnson, Lincoln, Montgomery, Woodford, Clay, Bourbon, Knott, Casey, among others
MEDICARE ADVANTAGE PLANS NORTHERN MARKET HIGHLIGHTS Products include HMOs and PPOs with plan premiums from $0 to above $100 Two new HMO plans offered for 2019 that are specific to Northern Kentucky; both include unlimited transportation & other supplemental benefits Dual-eligible plans available; see KY Duals Plans snapshot Full PPO suite of products designed with range of benefit levels to attract a wide array of consumers Many plans include enhanced additional benefits such as dental, vision, hearing, transportation, OTC allowance and fitness benefits $0 copay for tiers 1 & 2 when utilizing Humana mail-order pharmacy for 90-day supply No RX deductibles on many of the Northern Kentucky plans NETWORK HIGHLIGHTS Humana has two HMO networks & a national PPO network in Northern Kentucky The Humana Community HMO provides access to St. Elizabeth providers and facilities, as well as key specialists in Northern Kentucky The Gold Plus HMO and Gold Choice PPO networks are broad networks that include all major Northern Kentucky and Cincinnati health systems Participating health systems in the broad HMO and PPO networks include St. Elizabeth, Mercy Health, TriHealth, The Christ Hospital & UCHealth MARKET SERVICE AREA Boone, Boyd, Bracken, Campbell, Carroll, Carter, Elliott, Fleming, Gallatin, Grant, Greenup, Harrison, Kenton, Lawrence, Lewis, Mason, Morgan, Nicholas, Owen, Pendleton, Robertson, Rowan, Trimble
NORTHERN MA/MAPD PLANS NEW NEW Plan Name Humana Community (HMO) Humana Gold Plus (HMO) Humana Gold Plus (HMO) Plan Number H0292-001-000 H6622-021-001 H0292-002-000 New HMO in Northern Kentucky built around St. Elizabeth Healthcare system HMO with $0 plan premium that includes access to both St. Elizabeth and Cincinnati health systems Premium $0 $0 $15 PCP $0 $5 $0 Specialist $40 $45 $25 Referrals Required No No No NEW premium HMO in Northern Kentucky with access to both St. Elizabeth and Cincinnati health systems Inpatient Hospital $295 per day Days 1-5 $325 per day Days 1-5 $295 per day Days 1-5 Max Out-of-Pocket $4,500 In Network $5,900 In Network $3,400 In Network Rx Deductible No Deductible No Deductible No Deductible Rx Preferred $2/$8/$47/$100/33%; $0 copay $2/$10/$47/$97/33%; $0 copay $0/$5/$47/$97/33%; $0 copay Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $50/Quarter, Transportation Vision, Hearing, Fitness, OTC allowance $30/Quarter Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter, Transportation Market Service Area Boone, Campbell, Grant, Kenton, Pendleton Boone, Campbell, Grant, Kenton, Pendleton Boone, Campbell, Grant, Kenton, Pendleton
NORTHERN MA/MAPD PLANS Plan Name HumanaChoice (PPO) HumanaChoice (PPO) HumanaChoice (PPO) Plan Number H5216-107-000 H5216-109-000 H5216-105-000 LPPO with passive network cost shares (same in and out of network copays) $19 plan premium LPPO ($0 plan premium for 100% LIS) expanded to additional counties for 2019 Premium $117 $19 $0 PCP $5 $15 $10 Specialist $30 $45 $35 Referrals Required No No No $0 LPPO with access to national PPO network, No Rx coverage, Good fit for military veterans who have VA Rx coverage Inpatient Hospital $350 per admission $415 per day Days 1-4 $295 per day Days 1-6 Max Out-of-Pocket $6,700 In Network $5,500 In Network $4,500 In Network Rx Deductible No Deductible $150 tiers 3-5 No Coverage Rx Preferred $5/$15/$47/$97/33%; $0 copay $2/$8/$47/$100/30%; $0 copay No Coverage Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter Hearing, Fitness, OTC allowance $15/Month Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter Market Service Area Boone, Boyd, Campbell, Carroll, Carter, Gallatin, Grant, Greenup, Kenton, Morgan, Owen, Pendleton, Trimble Boone, Bracken, Campbell, Grant, Kenton, Pendleton Boone, Boyd, Campbell, Carroll, Carter, Gallatin, Grant, Greenup, Kenton, Morgan, Owen, Pendleton, Trimble
MEDICARE ADVANTAGE PLANS WESTERN MARKET HIGHLIGHTS Full suite of PPO products designed to meet a variety of consumer needs New $15 premium LPPO with access to national PPO network ($0 premium for 100% LIS) Expanded dual-eligible look-a-like plans available in PPO counties; see KY Duals Plans snapshot Many plans include enhanced additional benefits such as dental, vision, hearing, transportation, OTC allowance and fitness benefits $0 copay for tiers 1 & 2 when utilizing Humana mail-order pharmacy for 90-day supply No RX deductibles on many of the plans No Referrals on any plans NETWORK HIGHLIGHTS The PPO networks are broad networks that include all major Western Kentucky health systems Robust PPO network includes but is not limited to: Owensboro Health, The Medical Center at Bowling Green, T.J. Samson Community Hospital and Jennie Stuart Health Center MARKET SERVICE AREA Adair, Allen, Ballard, Barren, Butler, Caldwell, Calloway, Carlisle, Christian, Crittenden, Daviess, Fulton, Graves, Green, Hancock, Hart, Henderson, Hickman, Hopkins, Livingston, Logan, Lyon, Marshall, Mccracken, Mclean, Metcalfe, Muhlenberg, Ohio, Simpson, Taylor, Todd, Trigg, Union, Warren, Webster
WESTERN MA/MAPD PLANS NEW Plan Name HumanaChoice (PPO) HumanaChoice (PPO) HumanaChoice (PPO) Plan Number H5216-107-000 H5216-188-000 H5525-022-000 Passive network (same in and out of network benefits). Rich MSBs. Single copay hospital stay. New $15 plan premium LPPO with access to national PPO network. ($0 premium for 100% LIS). Premium $117 $15 $39 PCP $5 $15 $10 Specialist $30 $45 $40 Referrals Required No No No Plan premium reduced from $57 to $39. Expansive national PPO network. Includes pharmacy, vision, hearing and OTC allowance. Inpatient Hospital $350 per admission $360 per day Days 1-5 $350 per day Days 1-5 Max Out-of-Pocket $6,700 In Network $6,700 In Network $6,700 In Network Rx Deductible No Deductible $195 tiers 4-5 No Deductible Rx Preferred $5/$15/$47/$97/33%; $0 copay $7/$17/$47/$100/29%; $0 copay $5/$15/$47/$100/33%; $0 copay Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter Dental, Fitness, OTC allowance $45/Quarter Vision, Hearing, Fitness, OTC allowance $45/Quarter Market Service Area Adair, Allen, Barren, Butler, Crittenden, Fulton, Green, Hickman, Livingston, Logan, Metcalfe, Simpson, Union, Warren Adair, Allen, Barren, Butler, Crittenden, Fulton, Green, Hickman, Livingston, Logan, Metcalfe, Simpson, Union, Warren Adair, Allen, Butler, Crittenden, Fulton, Green, Hickman, Livingston, Logan, Simpson, Union
WESTERN MA/MAPD PLANS Plan Name Plan Number HumanaChoice (PPO) H5216-105-000 $0 LPPO with access to national PPO network, No Rx coverage, Good fit for military veterans who have VA Rx coverage Premium $0 PCP $10 Specialist $35 Referrals Required No Inpatient Hospital $295 per day Days 1-6 Max Out-of-Pocket Rx Deductible Rx Preferred Key Extra Benefits Market Service Area $4,500 In Network No Coverage No Coverage Dental, Vision, Hearing, Fitness, OTC allowance $75/Quarter Adair, Allen, Barren, Butler, Crittenden, Fulton, Green, Hickman, Livingston, Logan, Metcalfe, Simpson, Union, Warren
DSNP AND VALUE PLUS PLANS DUAL-ELIGIBLE SPECIAL NEEDS PLANS (DSNP) Humana s DSNPs offer beneficiaries who qualify for both Medicare and Medicaid with free or low-cost care for most medical and pharmacy services, as well as rich supplemental benefits like dental coverage, eye exams and glasses, over-the-counter items, 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 free or low-cost care for most medical and pharmacy services, as well as rich supplemental benefits like dental coverage, eye exams and glasses, over-the-counter items, 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 and pay higher cost sharing. 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.
DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW Plan Name Plan Number Humana Gold Plus SNP-DE (HMO SNP) H6622-018-000 Dual-eligible HMO SNP plan in Northern Kentucky with improved dental and other supplemental benefits for 2019 Dental $2,000 annually; $0 copay covers: exams, x-rays, cleanings, fillings, crowns, extractions, dentures 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 Unlimited one-way trips to approved locations and fitness centers per year Current Service Area Boone, Campbell, Grant, Kenton, Pendleton
DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW Plan Name Plan Number Humana Gold Plus SNP-DE (HMO SNP) H5619-075-000 Dual-eligible plan with access to the HMO network, rich dental, hearing, vision, OTC allowance and transportation Dental $1,000 annually; $0 copay covers: exams, x-rays, cleanings, fillings, crowns, extractions, dentures Vision Annual exam and $50 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 $150/Quarter for select health and wellness products Transportation Unlimited one-way trips to approved locations and fitness centers per year Current Service Area Bourbon, Bullitt, Clark, Fayette, Hardin, Jefferson, Jessamine, Madison, Montgomery, Oldham, Scott, Woodford
DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW Plan Name Plan Number Dental Vision Hearing OTC Allowance Transportation Meals on Wheels Current Service Area Humana Community HMO SNP-DE (HMO SNP) H1036-235-000 Dual-eligible plan with access to the Community HMO network, rich dental, hearing, vision, OTC allowance and transportation $1,000 annually; $0 copay covers: exams, x-rays, cleanings, fillings, crowns, extractions, dentures Annual exam and $200 credit every year for eyewear or contact lenses including fittings $0 annual exams, fittings and TruHearing advanced level hearing aids plus 48 batteries OTC $200/Quarter for select health and wellness products Unlimited one-way trips to approved locations and fitness centers per year 2 meals per day, 5 days a week up to 130 meals for members referred by a provider for food access Jefferson
DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW Plan Name Plan Number Dental Vision Hearing OTC Allowance Transportation Current Service Area Humana Value Plus (PPO) H5216-115-000 Lean medical and Rx benefits with rich supplemental benefits, designed with dual eligibles in mind yet available to all $1,000 annually; 0% coninsurance on exams, x-rays, cleanings and 50% coinsurance on fillings Annual exam and $200 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 $75/Quarter for select health and wellness products Up to 12 one-way trips to approved locations and fitness centers per year Adair, Allen, Barren, Bath, Boyd, Boyle, Butler, Carroll, Carter, Casey, Clay, Clinton, Crittenden, Cumberland, Edmonson, Floyd, Franklin, Fulton, Gallatin, Green, Greenup, Harlan, Henry, Hickman, Jackson, Johnson, Knott, Leslie, Letcher, Lincoln, Livingston, Logan, Magoffin, Marion, Martin, Meade, Menifee, Metcalfe, Monroe, Morgan, Nelson, Owen, Owsley, Perry, Pike, Powell, Shelby, Simpson, Spencer, Trimble, Union, Warren, Whitley
DSNP AND VALUE PLUS PLANS BENEFIT OVERVIEW NEW Plan Name Plan Number Dental Vision Hearing OTC Allowance Transportation Current Service Area Humana Value Plus (PPO) H5525-040-000 Lean medical and Rx benefits with rich supplemental benefits, designed with dual eligibles in mind yet available to all $1,000 annually; 0% coninsurance on exams, x-rays, cleanings and 50% coinsurance on fillings Annual exam and $200 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 $75/Quarter for select health and wellness products Up to 12 one-way trips to approved locations and fitness centers per year Anderson, Ballard, Bell, Breathitt, Breckinridge, Caldwell, Calloway, Carlisle, Daviess, Elliott, Estill, Fleming, Garrard, Graves, Grayson, Hancock, Harrison, Hart, Hopkins, Knox, Larue, Laurel, Lawrence, Lee, Lewis, Lyon, Marshall, Mason, Mccreary, Mclean, Mercer, Muhlenberg, Nicholas, Ohio, Pulaski, Robertson, Rockcastle, Rowan, Russell, Taylor, Todd, Trigg, Washington, Wayne, Wolfe
PDP PLANS Plan Name Humana Preferred Rx Plan (PDP) Humana Walmart Rx Plan (PDP) Plan Number S5884-138-000 S5884-161-000 Pairs well for members with Extra Help (LIS). Tier 1 & Tier 2 mailorder copays are $0 at Humana for 90-day supply. Retail copays as low as $1. Tier 1 mail-order copays are as low as $0 at Humana for 90-day supply. Premium TBD 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%/39%/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 Statewide in Indiana, Kentucky Statewide in Indiana, Kentucky
LOCAL SUPPORT Jason Hasman Broker Relationship Executive (855) 305-4950 jhasman@humana.com Jay Turner Broker Relationship Manager (502) 649-2543 jturner18@humana.com Local Market Office (800) 941-6172