humana's retiree medical solution

21
University of Ky Medicare Presenter Reno Altschul Date August 26, 2005

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Page 1: Humana's Retiree Medical Solution

University of Ky Medicare

Presenter Reno Altschul

Date August 26, 2005

Page 2: Humana's Retiree Medical Solution

2

Benefit Comparisons

UK Medicare Carve Out In-Network

Humana Gold Choice In-Network

Page 3: Humana's Retiree Medical Solution

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Max Out Of Pocket

$1500 individual $3000 Family Does not include

deductible No maximum lifetime

$5000 Does not include

deductible No maximum lifetime

Page 4: Humana's Retiree Medical Solution

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How Physicians Are Selected

Any provider Any Medicare Participating Provider

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Physician Visits

20% coinsurance after $500 deductible

Primary Care 100% after $10 co-payment

Specialist Care 100% after $20 co-payment

Primary Care includes diagnostic procedures, lab tests and x-rays, routine physical, medical supplies, and physical, speech, occupational therapy received during an office visit

Specialist Care includes diagnostic procedures, lab test, x-rays, medical supplies, physical, speech, occupational therapy, and Medicare covered services for chiropractic and podiatry, received during an office visit

Page 6: Humana's Retiree Medical Solution

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Preventive Care

20% coinsurance after deductible

100% with $0 co-payment (if other services are billed as routine preventive, the appropriate co-payment/coinsurance will apply based on the type of service and place of treatment)

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Preventive Services

Bone Mass Measurement(1 per year) Colorectal Screening (1 per year) Diabetes Self-Management (1 per year) Nutritional Therapy (Diabetic or ESRD Patients) Pap Smears and Pelvic Exam Screening (1 per year) Prostate Cancer Screening (I per year) Mammography Screening (1 per year) Immunization (1per year)

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Urgent Treatment Center

20% coinsurance after deductible

100% after $20 co-payment per visit

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Ambulance

20% coinsurance after deductible

100% after $50 co-payment per date of service

Page 10: Humana's Retiree Medical Solution

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Skilled Nursing Facility

20% coinsurance after deductible, 100 day limit per plan year

100% covered from days 1-100 per benefit period

Page 11: Humana's Retiree Medical Solution

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Emergency Room

20% coinsurance after deductible

100% after $50 co-payment per visit 9not waived for admission)

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Outpatient (non-surgical)

20% coinsurance after deductible

100% after $20-$50 co-payment per visit, based on where services received

Page 13: Humana's Retiree Medical Solution

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Outpatient (surgical)

20% coinsurance after deductible

100% after $25-50 co-payment per visit, based on where services received

Page 14: Humana's Retiree Medical Solution

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Hospital Services Inpatient

20% coinsurance after deductible

100% after $100 co-payment per day (days 1-5) per admission

Page 15: Humana's Retiree Medical Solution

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Outpatient Therapy

20% coinsurance after deductible, 30 visit limit per plan year on physical therapy

$20 co-payment all settings, includes cardiac, occupational, physical, and speech therapies. No visit limitations as long as medically necessary.

Page 16: Humana's Retiree Medical Solution

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Prescription Drug Coverage

$8.00 Generic $20.00 Preferred $40.00 Non-Preferred

$10.00 Level One $20 Level Two $40 Level Three 25% coinsurance Level

Four Once the member’s true

out of pocket cost for levels 1-4 reaches $3600, the member pays the greater of $2.00 for a generic or a preferred drug that is a multiple source drug, and $5.00 for all other drugs, or 5% coinsurance. Rx coverage is unlimited.

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Mental/Nervous (Outpatient)

20% coinsurance after deductible, 20 day limit per plan year (in combination with Substance Abuse)

100% after $20 co-payment per visit (not in combination with Substance Abuse, which is 100% after $10-$50 co-payment based on place of treatment)

Page 18: Humana's Retiree Medical Solution

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Mental/Nervous Inpatient

20% coinsurance after deductible, 31 day limit per plan year (in combination with Substance Abuse)

100% after $100 co-payment per admission (days 1-5) 190 day lifetime limit (not in combination with Substance Abuse)

Page 19: Humana's Retiree Medical Solution

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Durable Medical Equipment/Prosthetics

20% coinsurance after deductible, 100 day limit per plan year

20% coinsurance (Medicare fee schedule)

Page 20: Humana's Retiree Medical Solution

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Home Health Care

20% coinsurance after deductible, 100 day limit per plan year

100% covered

Page 21: Humana's Retiree Medical Solution