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HumanaMedicareEmployerPlanPlansthatgotheextramile
Y0040_GHHHWTDEN_19_NMRHCA_M
DedicatedtocommuniFesaroundthecountryformorethan30years
Over8.3millionMedicaremembersjustlikeyou,acrossall50states1
ProvidingMedicareplanstobeneficiariessince1987
EasilyfindaproviderwithournaFonwidenetworkofproviders
1HumanaInc.2016AnnualReport,February2017
“IhavebeenontheHumanaMAPPOsince2010,anditisthebestinsuranceI’vehad.Theircustomerserviceissecondtonone.”
–EdwinC.Louisville,KYHumanaMAPPOplan
HumanaMedicareAdvantageAtHumana,wehelpyouunderstandthemanyaspectsofMedicareandtrytomakeyouropFonseasytoselect,enrollinanduse.
AboutHumana:
Medicare MedicareAdvantage*
• MemberswithOriginalMedicareo[enchoosetogetaMedicareSupplementplanandastand-aloneprescripFondrugplantogetaddiFonalcoverage
• Possibilitytohaveupto3differentcards
• OnecardandoneplacetocallwithquesFons
*PartDisnotincludedonallMAplans.
MedicareandMedicareAdvantage
Humana’sPreferredProviderOrganizaFon(PPO)
NoCopaymentforcertainPrevenFveCare
Out-Of-PocketMaximum
WorldwideEmergencyCoverage
PPOPlanI–SeeanyproviderthatacceptsMedicareandagreestobillHumana.PPOPlanII-youmaypaymoreforcarefromout-of-networkproviders
A Preferred Provider Organization (PPO) allows members to go to any provider that accepts Medicare that also agrees to Humana’s terms and conditions – in other words, they agree to bill Humana
WhatisaPPO?
Understand Your Plan: Your PPO plan op2ons
PPO Plan I PPO Plan II In-network Out-of-Network
Annual Deductible $0 $0 $0
Hospital Care
Outpatient Hospital Visits $0 - $200 or 20% of the cost
$0-$100 or 20% of the cost $30 copay or 30%
Inpatient Hospital $150 (days 1-5) $150 per admit 30%
Physician and Facility Services
Primary Care Physician $10 $5 30%
Specialist $30 $30 30%
Outpatient Ambulatory Surgical Center $200 $100 30%
Durable Medical Equipment 20% 0% - 20% 20% - 30%
Emergency Services
Emergency Room Care $50 $65 $65
Urgent Care $10 - $30 $5 - $30 $10 or 30%
OtherBenefits:HearingServicesVisionServicesChiropracFcAcupuncturePodiatry
Humana’sPartDcoverageisspreadbetweenfourgroupingsbasedonthedrugtype–alsocalled“Fers.”
ItcoverseverydrugthatiscoveredthroughMedicare.
YourPartDBenefitsMILE
2
Tiers StandardRetailCost-Sharing
(30daysupply)
StandardMailOrderCost-Sharing
(90daysupply) Tier1
(Generic/PreferredGeneric)
$4 $0
Tier2(PreferredBrand)
$40 $80
Tier3(Non-Preferred
Drug)$90 $180
Tier4(Specialty) 33% N/A
IniFalCoverage:
Generic to Specialty Drug Coverage Open Formulary Out-Of-Pocket Protection Receive a 90-day supply of Tier 1 prescriptions at no cost to you when you use mail order
Stage1:DeducPble
Stage2:IniPal
Coverage
Stage3:Coveragegap
Stage4:CatastrophicCoverage
Yourplangivesyoucoverageforyourdrugs,uptothecoveragegap.
ThisonlyappliestoPlanII.
Beginsa[erthetotalyearlydrugcost(includingwhatyourplanhaspaidandwhatyouhavepaid)reaches$3,820.
OnceyearlyTrueOut-Of-Pocket(TrOOP)costsreach$5,100youwillpay:
YoupaythefullcostofyourdrugsunFlyoumeetthededucFble.ThereisnoPartDdeducPbleoneitherPPOplan.
$3.40copay-generic$8.50copay-allotheror5%coinsurance
YourRXDrugPhasesHumana’sPartDcoverageisdesignedtohelpyoumanageyourout-of-pocketcosts.
ExtraBenefitsandResources
HumanaAtHomeSM
Go365[and/or]SilverSneakers
HumanaFirst®
VirtualVisits
MyDirecFves®
HumanaWellDine®mealprogram
HealthCoaching
AtotalhealthandphysicalacFvityprogramatnoextracost.
AwellnessprogramjustforHumanamembersatnoextracost.
ExtraBenefitsandResources
silversneakers.com
Go365.com
There are a few things you need to do after moving to your Humana plan.
Remember to switch to Humana simply fill out the application provided to you by NMRHCA and return it to the plan office.
Humana does not require that you complete a separate application.
What do I do with my Medicare card? Provide your Humana card to your provider from now on, but keep your Medicare card in a safe place
What do I need to do after I enroll? Read through the materials Humana sends you and expect to receive a call from Humana within 90 days to discuss your health goals
Use Your Plan: What’s Next
Keep, but don’t use Use this card now
*
Is Financial Assistance Available?
*
*
*
Low Income Subsidy assists with prescription drug costs, including premium, copays and coinsurance. Varies based on income and assets. Medicare Savings Program helps pay Medicare Part a and/or B premium. Call 1-800-MEDICARE to see if you qualify.
Thank You HumanaisaMedicareAdvantageHMO,PPOorganizaFonandastand-aloneprescripFondrugplanwithaMedicarecontract.EnrollmentinanyHumanaplandependsoncontractrenewal.ThisinformaFonisnotacompletedescripFonofbenefits.Call1-866-396-8810(TTY:711)formoreinformaFon.
Out-of-network/non-contractedprovidersareundernoobligaFontotreatPlanmembers,exceptinemergencysituaFons.PleasecallourcustomerservicenumberorseeyourEvidenceofCoverageformoreinformaFon,includingthecost-sharingthatappliestoout-of-networkservices.
Discrim
ination
is Agai
nst the
Law
Huma
na Inc
. and it
s subsi
diaries
comp
ly with
applic
able F
ederal
civil
rights l
aws a
nd do
not d
iscrim
inate
on the
basis
of race
, color
, nation
al orig
in, age
, disab
ility, se
x, sexu
al orien
tation
, gend
er iden
tity, or
religio
n. Hu
mana
Inc. an
d its su
bsidia
ries do
not e
xclud
e peop
le or tr
eat th
em
differe
ntly b
ecause
of rac
e, colo
r, natio
nal or
igin, ag
e, disa
bility,
sex,
sexual
orien
tation
, gend
er iden
tity, or
religio
n.Hu
mana
Inc. an
d its su
bsidia
ries pro
vide: (
1) fre
e auxi
liary a
ids an
d ser
vices,
such
as qua
lified s
ign lan
guage
interp
reters
, video
remote
int
erpret
ation, a
nd wr
itten in
forma
tion in
other f
ormats
to pe
ople
with d
isabili
ties wh
en suc
h auxi
liary a
ids an
d serv
ices a
re nece
ssary
to ens
ure an
equal
oppor
tunity
to par
ticipat
e; and
, (2) fr
ee lan
guage
servic
es to
people
whose
prima
ry lang
uage is
not En
glish w
hen th
ose
servic
es are
neces
sary to
provid
e mean
ingful
access
, such
as tra
nslate
d doc
ument
s or o
ral int
erpret
ation.
If you
need t
hese s
ervice
s, call
1-XXX-
XXX-X
XXX
or if y
ou use
a TTY,
cal
l 711.
If you
believ
e that
Huma
na Inc
. and it
s subsi
diaries
have
failed
to pro
vide t
hese s
ervice
s or d
iscrim
inated
in ano
ther w
ay on
the ba
sis of r
ace, co
lor, na
tional o
rigin, a
ge, dis
ability
, sex, s
exual o
rientat
ion,
gender
identi
ty, or
religio
n, you
can file
a griev
ance w
ith Dis
crimina
tion
Grieva
nces, P
.O. Bo
x 1461
8, Lexi
ngton,
KY 40
512-46
18.If y
ou nee
d help
filing
a griev
ance, c
all 1-X
XX-XX
X-XXX
X or
if you
use
a TTY,
call 7
11.You
can a
lso file
a civil
rights
comp
laint w
ith th
e U.S.
Depart
ment
of Heal
th and
Huma
n Serv
ices, O
ffice fo
r Civil
Rights
electr
onical
ly thr
ough t
he Offi
ce for
Civil R
ights C
ompla
int Po
rtal, a
vailab
le at
https:
//ocrp
ortal.h
hs.gov
/ocr/p
ortal/l
obby.js
f, or by
or pho
ne at
U.S. De
partm
ent of
Health
and H
uman
Servic
es, 20
0 Ind
epend
ence
Avenu
e, SW,
Room
509F,
HHH B
uilding
, Wash
ington
, DC 20
201,
1-800-
368-10
19, 80
0-537-
7697 (T
DD).
Compla
int for
ms are
availa
ble at
https:
//www
.hhs.g
ov/ocr
/office
/file/
index.
html.
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