Columbia Part B Giveback HMO H5619-081 Key Selling Points $52 - - PDF document

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Columbia Part B Giveback HMO H5619-081

Supplemental Benefits

• TruHearing
• SilverSneakers
• HumanaFirst Nursing Hotline
• Go365 Rewards

Key Selling Points

• $52 Part B Giveback
• Strong Network
• No Referrals

Benefits

2017 2018

Premium $0 MOOP: $6,700 Plan Deductible: N/A Inpatient Cost Share $450/Day for Days 1 thru 4 SNF $0 (days 1-20); $167/day (days 21-100) PCP Copay $15 Spec Copay $45 Outpatient Surgery $400 at ASC or $450 Outpatient Hospital Advanced Imaging $400 at Free-Standing or $450 Outpatient Hospital Part D Benefit $300 Ded on Tier 3, 4 & 5 $5/$15/$47/$100/27%

***For Agent Use Only. Not for Public Distribution. Humana Confidential***

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Charleston $0 HMO H5619-084

Supplemental Benefits

• SilverSneakers
• HumanaFirst Nursing Hotline
• Go365 Rewards
• Vision – Exam & $100 Eyewear

allowance

• Enhanced Nutrition Therapy

Key Selling Points

• $0 Premium
• Strong Network
• No Referrals
• SilverSneakers

***For Agent Use Only. Not for Public Distribution. Humana Confidential***

Benefits

2017 2018

Premium $0 MOOP: $6,700 Plan Deductible: N/A Inpatient Cost Share $450/Day for Days 1 thru 4 SNF $0 (days 1-20); $167/day (days 21-100) PCP Copay $15 Spec Copay $50 Outpatient Surgery $400 at ASC or $450 Outpatient Hospital Setting Advanced Imaging $400 at ASC or $450 Outpatient Hospital Setting Part D Benefit $250 Ded on Tier 3, 4 & 5 $6/$15/$47/$100/28%

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Upstate HMO H5619-086 (formerly H2012-100)

Supplemental Benefits

• Dental
• Vision – Exam & $100

Eyewear

• TruHearing
• OTC - $50/Quarter
• WellDine Meal Program
• SilverSneakers
• HumanaFirst Nursing Hotline
• Go365 Rewards

Key Selling Points

• No referrals
• Strong Network
• $5 PCP Copay
• Rich Supplemental

Benefits

• York County expansion
• Combined Segments

***For Agent Use Only. Not for Public Distribution. Humana Confidential***

Benefits

2017 2018

Premium $0 $0 MOOP: $6,700 $5,900 Plan Deductible: N/A N/A Inpatient Cost Share $345/day for Days 1-5 $360/day for Days 1-5 SNF $0 (days 1-20); $160/day (days 21-100) $0 (days 1-20); $167/day (days 21-100) PCP Copay $5 / $15 $5 Spec Copay $45 $45 Outpatient Surgery $295 at ASC or $345 Outpatient Hospital $310 at ASC or $360 Outpatient Hospital Advanced Imaging $295 at Free-Standing or $345 Outpatient Hospital $310 at Free-Standing or $360 Outpatient Hospital Part D Benefit $400 Ded on Tier 4 & 5 $7/$17/$47/$97/25% $195 Ded on Tier 3, 4 & 5 $4/$12/$47/$100/29%

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Preferred PDP S5884-134

Key Selling Points

• Low monthly premium
• $0 copay on Tier 1 & 2 for

90 day supply through Humana Pharmacy after meeting deductible

• Retail Preferred Cost-

Sharing at Walmart, Walgreens & Sam’s Club

***For Agent Use Only. Not for Public Distribution. Humana Confidential***

Plan Premium $26.60 (Full LIS - $3.60)

Deductible $405* Initial Coverage Limit $3,750 Preferred Standard Tier 1 $0 $2 Tier 2 $1 $3 Tier 3 20% 25% Tier 4 35% 37% Tier 5 25% 25% Coverage Gap Generic 44% Co-Insurance Brand 35% Co-Insurance True Out of Pocket $5,000 Catastrophic Coverage Member pays the greater of $3.35 for Generic/Preferred multi-source drugs and $8.35 for all other drugs; or 5% co-insurance *Deductible applies to all tiers. Please refer to the Summary of Benefits and EOC for full explanation of benefits.