Market Service AreaAleutians East, Aleutians West, Anchorage, Bethel, Bristol Bay,Denali, Dillingham, Fairbanks North Star, Haines, Juneau, KenaiPeninsula, Ketchikan Gateway, Kodiak Island, Lake AndPeninsula, Matanuska Susitna, Nome, North Slope, NorthwestArctic, Prince of Wales-Outer Ketchikan, Prince WalesKetchikan, Sitka, Skagway Hoonah Angoon, Skagway-Hoonah-Angoon, Southeast Fairbanks, Valdez Cordova, Wade Hampton,Wrangell Petersburg, Wrangell-Petersburg, Yakutat, YukonKoyukuk

Alaska Alaska

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/35%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Aleutians East, Aleutians West, Anchorage,Bethel, Bristol Bay, Denali, Dillingham,Fairbanks North Star, Haines, Juneau, KenaiPeninsula, Ketchikan Gateway, Kodiak Island,Lake And Peninsula, Matanuska Susitna,Nome, North Slope, Northwest Arctic, Princeof Wales-Outer Ketchikan, Sitka, Skagway-Hoonah-Angoon, Southeast Fairbanks, ValdezCordova, Wade Hampton, Wrangell-Petersburg, Yakutat, Yukon Koyukuk

Aleutians East, Aleutians West, Anchorage,Bethel, Bristol Bay, Denali, Dillingham,Fairbanks North Star, Haines, Juneau, KenaiPeninsula, Ketchikan Gateway, Kodiak Island,Lake And Peninsula, Matanuska Susitna,Nome, North Slope, Northwest Arctic, Princeof Wales-Outer Ketchikan, Sitka, Skagway-Hoonah-Angoon, Southeast Fairbanks, ValdezCordova, Wade Hampton, Wrangell-Petersburg, Yakutat, Yukon Koyukuk

Aleutians East, Aleutians West, Anchorage,Bethel, Bristol Bay, Denali, Dillingham,Fairbanks North Star, Haines, Juneau, KenaiPeninsula, Ketchikan Gateway, Kodiak Island,Lake And Peninsula, Matanuska Susitna,Nome, North Slope, Northwest Arctic, Princeof Wales-Outer Ketchikan, Sitka, Skagway-Hoonah-Angoon, Southeast Fairbanks, ValdezCordova, Wade Hampton, Wrangell-Petersburg, Yakutat, Yukon Koyukuk

Alaska Alaska

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Plan Name Plan Number Plan Category

Alaska Alaska

FOR AGENT USE ONLY

Local Support

Local Support - AlaskaLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Alaska Alaska

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana Pharmacy

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderIn-network HMO hospitals and provider systems include,but are not limited to, the following:

Market Service AreaAlameda, Alpine, Amador, Butte, Calaveras, Colusa, Del Norte,El Dorado, Glenn, Humboldt, Inyo, Lake, Lassen, Marin,Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa,Nevada, Placer, Plumas, Sacramento, San Benito, SanFrancisco, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra,Siskiyou, Solano, Sonoma, Sutter, Tehama, Trinity, Tuolumne,Yolo, Yuba

California California Outstate

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/35%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area California Outstate Market-wide California Outstate Market-wide California Outstate Market-wide

California California Outstate

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

California California Outstate

FOR AGENT USE ONLY

Local Support

Local Support - CaliforniaShirley Todd Broker Relationship Manager805-952-3823stodd3@humana.com

CA - Northern

Jared Larson Broker Relationship Executive855-305-4952jlarson1@humana.com

CA- Northern & Los Angeles

Local Market Office 925-255-0910

California California Outstate

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGo365® by Humana is a wellness program that rewardsyour clients for doing healthy activities. Many HumanaMedicare Advantage plans include Go365.Good hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.Many Humana plans include a Well Dine benefit, whichcan provide packaged, precooked meals right tomember's doors during recovery. Optional Supplemental Benefits that include Dental &Vision

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderIn-network HMO hospitals and provider systems include,but are not limited to, the following: Hill PhysiciansMedical Group, John Muir Physician Network and SutterEast Bay Medical Foundation

Market Service AreaContra Costa

California Contra Costa

FOR AGENT USE ONLY

MAPDPlan Name Humana Gold Plus (HMO)

Plan Number H5619-029-000

Plan Highlights High Plan Premium HMO MAPD Plan withthe option to purchase supplementalbenefits

Premium $91

PCP $0

Specialist $12

Referrals Required Yes

Inpatient Hospital $370 per day Days 1-4

Max Out-of-Pocket $5900 In-Network

Rx Deductible $400 tiers 3-5

Rx Preferred $5/$12/$47/$100/25%

Key Extra Benefits Hearing

Market Service Area Contra Costa Market-wide

California Contra Costa

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/35%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Contra Costa Market-wide Contra Costa Market-wide Contra Costa Market-wide

California Contra Costa

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

California Contra Costa

FOR AGENT USE ONLY

Local Support

Local Support - CaliforniaShirley Todd Broker Relationship Manager805-952-3823stodd3@humana.com

CA - Northern

Jared Larson Broker Relationship Executive855-305-4952jlarson1@humana.com

CA- Northern & Los Angeles

Local Market Office 925-255-0910

Local Sales ManagerCharlene Miskimen Local Sales Manager415-590-9087cmiskimen@humana.comContra Costa

California Contra Costa

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGo365® by Humana is a wellness program that rewardsyour clients for doing healthy activities. Many HumanaMedicare Advantage plans include Go365.Multiple selling opportunities with Dual Special NeedsPlansOptional Supplemental Benefits that include Dental &VisionYour plan may include a monthly or quarterly allowancefor over-the-counter(OTC) items such as: Vitamins, PainRelievers, and Cough and cold medicines

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderIn-network HMO hospitals and provider systems include,but are not limited to, the following: Central ValleyMedical Providers, Choice Physicians Network

Market Service AreaFresno, Madera

California Fresno - Madera

FOR AGENT USE ONLY

MAPDPlan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO)

Plan Number H5619-012-000 H5619-013-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withthe option to purchase supplementalbenefits

$0 Plan Premium HMO MAPD Plan withthe option to purchase supplementalbenefits

Premium $0 $0

PCP $0 $0

Specialist $10 $10

Referrals Required Yes Yes

Inpatient Hospital $250 per day Days 1-5 $295 per day Days 1-6

Max Out-of-Pocket $3100 In-Network $5900 In-Network

Rx Deductible No Deductible No Deductible

Rx Preferred $5/$15/$47/$100/33% $5/$15/$47/$100/33%

Key Extra Benefits Hearing, OTC $25/Quarter for selecthealth and wellness products

Hearing, OTC $25/Quarter for selecthealth and wellness products

Market Service Area Fresno Madera

California Fresno - Madera

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-038-000

Plan Highlights Dual Eligible Special Needs plan forFBDE,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $1000 annually; $0 copayments covers:exams, x-rays, cleanings, fillings, crowns,extractions, dentures

Healthy Foods Card $25 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing Annual exam, fitting and $2000 credit forhearing aids.

OTC Allowance $150 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto 36 one-way trip(s) per year by car, van,wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Fresno - Madera Market-wide

California Fresno - Madera

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/35%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Fresno - Madera Market-wide Fresno - Madera Market-wide Fresno - Madera Market-wide

California Fresno - Madera

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

California Fresno - Madera

FOR AGENT USE ONLY

Local Support

Local Support - CaliforniaShirley Todd Broker Relationship Manager805-952-3823stodd3@humana.com

CA - Northern

Jared Larson Broker Relationship Executive855-305-4952jlarson1@humana.com

CA- Northern & Los Angeles

Local Market Office 559-221-2522

Local Sales ManagerRichard Duran Local Sales Manager559-696-7676rduran1@humana.comFresno, Madera County

California Fresno - Madera

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGo365® by Humana is a wellness program that rewardsyour clients for doing healthy activities. Many HumanaMedicare Advantage plans include Go365.Multiple selling opportunities with Dual Special NeedsPlansNew MA-Only plan available with Comprehensive Dentaland a $75 Part B Giveback for customers that get theirdrug coverage elsewhere, such as Veterans. Your plan may include a monthly or quarterly allowancefor over-the-counter(OTC) items such as: Vitamins, PainRelievers, and Cough and cold medicines

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderIn-network HMO hospitals and provider systems include,but are not limited to, the following: Bakersfield FamilyMedical Center, QualCare and Hispanic Physicians IPA. Most major hospital facilities within the market are in-network

Market Service AreaKern

California Kern County

FOR AGENT USE ONLY

MA / MAPDNEW

Plan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO)

Plan Number H5619-116-000 H5619-121-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withrich benefits and additional ancillaries

MA Only plan with a $75 Part B PremiumGiveback, designed for individuals that donot need additional drug coverage. Greatfit for Veterans using the VA for drugcoverage.

Premium $0 $0

PCP $0 $20

Specialist $0 $50

Referrals Required Yes Yes

Inpatient Hospital $0 per admission $1860 per admission

Max Out-of-Pocket $2500 In-Network $6700 In-Network

Rx Deductible No Deductible No Coverage

Rx Preferred $0/$9/$47/$100/33% No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$25/Quarter for select health andwellness products

Dental

Market Service Area Kern County Market-wide Kern County Market-wide

California Kern County

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-038-000

Plan Highlights Dual Eligible Special Needs plan forFBDE,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $1000 annually; $0 copayments covers:exams, x-rays, cleanings, fillings, crowns,extractions, dentures

Healthy Foods Card $25 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing Annual exam, fitting and $2000 credit forhearing aids.

OTC Allowance $150 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto 36 one-way trip(s) per year by car, van,wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Kern County Market-wide

California Kern County

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/35%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Kern County Market-wide Kern County Market-wide Kern County Market-wide

California Kern County

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

California Kern County

FOR AGENT USE ONLY

Local Support

Local Support - CaliforniaEdward Martin Broker Relationship Manager661-481-8189emartin5@humana.com

CA - Los Angeles

Jared Larson Broker Relationship Executive855-305-4952jlarson1@humana.com

CA- Northern & Los Angeles

Local Market Office 424-246-4834

Local Sales ManagerDaralynn King Local Sales Manager818-257-0559dking36@humana.comKern County

California Kern County

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGo365® by Humana is a wellness program that rewardsyour clients for doing healthy activities. Many HumanaMedicare Advantage plans include Go365.New MA-Only plan with Comprehensive Dental and a$90 Part B giveback available for customers that gettheir drug coverage elsewhere, such as Veterans. Plan available with Transportation BenefitPlans may include Comprehensive Dental coverage Your plan may include a monthly or quarterly allowancefor over-the-counter(OTC) items such as: Vitamins, PainRelievers, and Cough and cold medicines

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderIn-network HMO hospitals and provider systems include,but are not limited to, the following: Regal-Lakesive MG,HealthCare Partners, Facey MG, THIPA, Prospect MG,High Desert MG and Heritage-Sierra MG Most major hospital facilities within the market are in-network

Market Service AreaLos Angeles

California Los Angeles

FOR AGENT USE ONLY

MA / MAPDNEW

Plan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO)

Plan Number H5619-021-000 H5619-120-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withrich benefits and additional ancillariesincluding Comprehensive Dental

MA Only plan with a $90 Part B PremiumGiveback, designed for individuals that donot need additional drug coverage. Greatfit for Veterans using the VA for drugcoverage.

Premium $0 $0

PCP $0 $20

Specialist $0 $50

Referrals Required Yes Yes

Inpatient Hospital $0 per admission $1860 per admission

Max Out-of-Pocket $990 In-Network $6700 In-Network

Rx Deductible No Deductible No Coverage

Rx Preferred $0/$0/$35/$100/33% No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$125/Quarter for select health andwellness products

Dental

Market Service Area Los Angeles Market-wide Los Angeles Market-wide

California Los Angeles

FOR AGENT USE ONLY

Plan Name Humana Value Plus (HMO)

Plan Number H5619-037-000

Plan Highlights Lean medical and pharmacy benefits, withrich supplemental benefits

Dental $1000 annually; $0 copayments covers:exams, x-rays, cleanings, fillings, crowns,extractions, dentures

Vision Annual exam and $200 credit every year foreyewear or contact lenses including fittings.

Hearing Annual exam and fitting. $1000 credit forhearing aids once every 3 years.

OTC Allowance $100 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto 36 one-way trip(s) per year by car, van,wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Los Angeles Market-wide

California Los Angeles

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/35%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Los Angeles Market-wide Los Angeles Market-wide Los Angeles Market-wide

California Los Angeles

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

California Los Angeles

FOR AGENT USE ONLY

Local Support

Local Support - CaliforniaEdward Martin Broker Relationship Manager661-481-8189emartin5@humana.com

CA - Los Angeles

Jared Larson Broker Relationship Executive855-305-4952jlarson1@humana.com

CA- Northern & Los Angeles

Local Market Office 424-246-4834

Local Sales ManagerDaralynn King Local Sales Manager818-257-0559dking36@humana.comSan Fernando Valley

Keisha Smith Local Sales Manager951-348-0854ksmith46@humana.comSan Gabriel Valley

Ronald Morales Local Sales Manager951-218-1321rmorales4@humana.comSouth Los Angeles, Los Angeles County

California Los Angeles

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGo365® by Humana is a wellness program that rewardsyour clients for doing healthy activities. Many HumanaMedicare Advantage plans include Go365.Many Plans include Dental, Vision, Hearing, OTC andSilverSneakers® Fitness BenefitsNew MA-Only plan with Comprehensive Dental and a$75 Part B giveback available for customers that gettheir drug coverage elsewhere, such as Veterans. Some Humana Plans include Routine non-emergentmedical transportation at no additional cost

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderIn-network HMO hospitals and provider systems include,but are not limited to, the following: Heritage VictorValley MG, Regal MG, PrimeCare MG, Upland MG

Market Service AreaSan Bernardino

California San Bernardino

FOR AGENT USE ONLY

MA / MAPDNEW

Plan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO)

Plan Number H5619-039-002 H5619-121-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withrich benefits and additional ancillaries

MA Only plan with a $75 Part B PremiumGiveback, designed for individuals that donot need additional drug coverage. Greatfit for Veterans using the VA for drugcoverage.

Premium $0 $0

PCP $0 $20

Specialist $0 $50

Referrals Required Yes Yes

Inpatient Hospital $0 per admission $1860 per admission

Max Out-of-Pocket $1499 In-Network $6700 In-Network

Rx Deductible No Deductible No Coverage

Rx Preferred $0/$5/$47/$100/33% No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$30/Quarter for select health andwellness products

Dental

Market Service Area San Bernardino Market-wide San Bernardino Market-wide

California San Bernardino

FOR AGENT USE ONLY

Plan Name Humana Value Plus (HMO)

Plan Number H5619-037-000

Plan Highlights Lean medical and pharmacy benefits, withrich supplemental benefits

Dental $1000 annually; $0 copayments covers:exams, x-rays, cleanings, fillings, crowns,extractions, dentures

Vision Annual exam and $200 credit every year foreyewear or contact lenses including fittings.

Hearing Annual exam and fitting. $1000 credit forhearing aids once every 3 years.

OTC Allowance $100 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto 36 one-way trip(s) per year by car, van,wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area San Bernardino Market-wide

California San Bernardino

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/35%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area San Bernardino Market-wide San Bernardino Market-wide San Bernardino Market-wide

California San Bernardino

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

California San Bernardino

FOR AGENT USE ONLY

Local Support

Local Support - CaliforniaEdward Martin Broker Relationship Manager661-481-8189emartin5@humana.com

CA - Los Angeles

Jared Larson Broker Relationship Executive855-305-4952jlarson1@humana.com

CA- Northern & Los Angeles

Local Market Office 424-246-4834

Local Sales ManagerKeisha Smith Local Sales Manager951-348-0854ksmith46@humana.comSan Bernardino County

California San Bernardino

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGo365® by Humana is a wellness program that rewardsyour clients for doing healthy activities. Many HumanaMedicare Advantage plans include Go365.Multiple selling opportunities with Dual Special NeedsPlansPartnership with MedCore (Omni) to offer the HumanaCommunity Plan an MAPD HMOYour plan may include a monthly or quarterly allowancefor over-the-counter(OTC) items such as: Vitamins, PainRelievers, and Cough and cold medicines

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderIn-network HMO hospitals and provider systems include,but are not limited to, the following: Stanislaus County -AllCare IPA, San Joaquin County - MedCore (Omni IPA),AllCare IPA, Hill Physicians Medical Group and SutterGould Medical Foundation

Market Service AreaSan Joaquin, Stanislaus

California San Joaquin - Stanislaus

FOR AGENT USE ONLY

MAPDPlan Name Humana Community (HMO) Humana Gold Plus (HMO) Humana Gold Plus (HMO)

Plan Number H7621-003-000 H5619-032-000 H5619-026-000

Plan Highlights Low Plan Premium HMO MAPD Plan, inpartnership with MedCore (Omni) withrich benefits and additional ancillaries

Low Plan Premium HMO MAPD Plan withrich benefits and additional ancillaries

High Plan Premium HMO MAPD Plan withrich benefits and additional ancillaries

Premium $19 $19 $57

PCP $0 $0 $0

Specialist $0 $10 $10

Referrals Required Yes Yes Yes

Inpatient Hospital $200 per day Days 1-5 $200 per day Days 1-5 $250 per day Days 1-6

Max Out-of-Pocket $2900 In-Network $3400 In-Network $3400 In-Network

Rx Deductible No Deductible No Deductible No Deductible

Rx Preferred $2/$10/$47/$100/33% $0/$10/$47/$100/33% $4/$15/$47/$100/33%

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$45/Quarter for select health andwellness products

Dental, Vision, Hearing, Fitness, OTC$30/Quarter for select health andwellness products

Vision, Hearing, Fitness

Market Service Area San Joaquin Stanislaus San Joaquin

California San Joaquin - Stanislaus

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-038-000

Plan Highlights Dual Eligible Special Needs plan forFBDE,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $1000 annually; $0 copayments covers:exams, x-rays, cleanings, fillings, crowns,extractions, dentures

Healthy Foods Card $25 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing Annual exam, fitting and $2000 credit forhearing aids.

OTC Allowance $150 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto 36 one-way trip(s) per year by car, van,wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area San Joaquin - Stanislaus Market-wide

California San Joaquin - Stanislaus

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/35%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area San Joaquin - Stanislaus Market-wide San Joaquin - Stanislaus Market-wide San Joaquin - Stanislaus Market-wide

California San Joaquin - Stanislaus

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

California San Joaquin - Stanislaus

FOR AGENT USE ONLY

Local Support

Local Support - CaliforniaShirley Todd Broker Relationship Manager805-952-3823stodd3@humana.com

CA - Northern

Jared Larson Broker Relationship Executive855-305-4952jlarson1@humana.com

CA- Northern & Los Angeles

Local Market Office 925-255-0910

Local Sales ManagerCharlene Miskimen Local Sales Manager415-590-9087cmiskimen@humana.comSan Joaquin, Stanislaus County

California San Joaquin - Stanislaus

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyExpanding DE-SNP HMO Service Area to include San LuisObispoGo365® by Humana is a wellness program that rewardsyour clients for doing healthy activities. Many HumanaMedicare Advantage plans include Go365.Good hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.Introducing new $0 plan premium HMO in San LuisObispo County Many Plans include Dental, Vision, Hearing, OTC andSilverSneakers® Fitness BenefitsMultiple selling opportunities with Dual Special NeedsPlansYour plan may include a monthly or quarterly allowancefor over-the-counter(OTC) items such as: Vitamins, PainRelievers, and Cough and cold medicines

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderIn-network HMO hospitals and provider systems include,but are not limited to, the following: CoastalCommunities Physician Network (CCPN)

Market Service AreaSan Luis Obispo

California San Luis Obispo

FOR AGENT USE ONLY

MAPDNEW

Plan Name Humana Gold Plus (HMO)

Plan Number H5619-119-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withrich benefits and additional ancillaries.

Premium $0

PCP $0

Specialist $0

Referrals Required Yes

Inpatient Hospital $285 per day Days 1-5

Max Out-of-Pocket $3000 In-Network

Rx Deductible No Deductible

Rx Preferred $3/$12/$47/$100/33%

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Market Service Area San Luis Obispo Market-wide

California San Luis Obispo

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-038-000

Plan Highlights Dual Eligible Special Needs plan forFBDE,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $1000 annually; $0 copayments covers:exams, x-rays, cleanings, fillings, crowns,extractions, dentures

Healthy Foods Card $25 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing Annual exam, fitting and $2000 credit forhearing aids.

OTC Allowance $150 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto 36 one-way trip(s) per year by car, van,wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area San Luis Obispo Market-wide

California San Luis Obispo

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/35%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area San Luis Obispo Market-wide San Luis Obispo Market-wide San Luis Obispo Market-wide

California San Luis Obispo

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

California San Luis Obispo

FOR AGENT USE ONLY

Local Support

Local Support - CaliforniaEdward Martin Broker Relationship Manager661-481-8189emartin5@humana.com

CA - Los Angeles

Jared Larson Broker Relationship Executive855-305-4952jlarson1@humana.com

CA- Northern & Los Angeles

Local Market Office 424-246-4834

Local Sales ManagerDaralynn King Local Sales Manager818-257-0559dking36@humana.comSan Luis Obispo

California San Luis Obispo

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyCompetitive plan premium Go365® by Humana is a wellness program that rewardsyour clients for doing healthy activities. Many HumanaMedicare Advantage plans include Go365.Many Humana plans include a Well Dine benefit, whichcan provide packaged, precooked meals right tomember's doors during recovery. Many Plans include Dental, Vision, Hearing, OTC andSilverSneakers® Fitness BenefitsMultiple selling opportunities with Dual Special NeedsPlansNew MA-Only plan available with Comprehensive Dentaland a $75 Part B Giveback for customers that get theirdrug coverage elsewhere, such as Veterans.

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderIn-network HMO hospitals and provider systems include,but are not limited to, the following: Valley Care IPA,Seaview IPA, Facey-Simi Valley, Regal-Lakeside MedicalGroup and Santa Barbara Select IPA Most major hospital facilities within the market are in-network

Market Service AreaSanta Barbara, Ventura

California Santa Barbara-Ventura

FOR AGENT USE ONLY

MA / MAPDNEW

Plan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO)

Plan Number H5619-023-000 H5619-121-000

Plan Highlights Moderate Plan Premium HMO MAPD Planwith rich benefits and additionalancillaries

MA Only plan with a $75 Part B PremiumGiveback, designed for individuals that donot need additional drug coverage. Greatfit for Veterans using the VA for drugcoverage.

Premium $20 $0

PCP $0 $20

Specialist $10 $50

Referrals Required Yes Yes

Inpatient Hospital $330 per day Days 1-5 $1860 per admission

Max Out-of-Pocket $5900 In-Network $6700 In-Network

Rx Deductible No Deductible No Coverage

Rx Preferred $5/$15/$47/$100/33% No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$25/Quarter for select health andwellness products

Dental

Market Service Area Santa Barbara-Ventura Market-wide Ventura

California Santa Barbara-Ventura

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-038-000

Plan Highlights Dual Eligible Special Needs plan forFBDE,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $1000 annually; $0 copayments covers:exams, x-rays, cleanings, fillings, crowns,extractions, dentures

Healthy Foods Card $25 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing Annual exam, fitting and $2000 credit forhearing aids.

OTC Allowance $150 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto 36 one-way trip(s) per year by car, van,wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Ventura

California Santa Barbara-Ventura

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/35%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Santa Barbara-Ventura Market-wide Santa Barbara-Ventura Market-wide Santa Barbara-Ventura Market-wide

California Santa Barbara-Ventura

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

California Santa Barbara-Ventura

FOR AGENT USE ONLY

Local Support

Local Support - CaliforniaEdward Martin Broker Relationship Manager661-481-8189emartin5@humana.com

CA - Los Angeles

Jared Larson Broker Relationship Executive855-305-4952jlarson1@humana.com

CA- Northern & Los Angeles

Local Market Office 424-246-4834

Local Sales ManagerDaralynn King Local Sales Manager818-257-0559dking36@humana.comSanta Barbara, Ventura County

California Santa Barbara-Ventura

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

Local Market office and Support Team to help with all ofyour needsMany Plans include Dental, Vision, Hearing, OTC andSilverSneakers® Fitness BenefitsNew MA-Only plan available for customers that get theirdrug coverage elsewhere, such as Veterans. Plan available with Part B premium giveback

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderIn-network hospitals and provider systems include, butare not limited to, the following: HealthCare Partners,Prospect Medical Group, Memorial Care/GNP, MonarchHealthCare, UCI, Regal Medical Group, ADOC, DesertOasis, PrimeCare, HCMG, UC San Diego Health, GreaterTri-Cities Medical Group, Mercy Physicians MedicalGroup, Primecare Associates Medical Group, ScrippsPhysician Medical Group

Market Service AreaImperial, Orange, Riverside, San Diego

California Southern California

FOR AGENT USE ONLY

MA / MAPDPlan Name Humana Gold Plus (HMO) Humana Community (HMO) Humana Gold Plus (HMO)

Plan Number H5619-021-000 H7621-002-000 H5619-016-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withrich benefits and additional ancillariesincluding Comprehensive Dental

$0 Plan Premium HMO MAPD Plan withrich benefits and additional ancillaries toincludes Comprehensive Dental

$0 Plan Premium HMO MAPD Plan withrich benefits and additional ancillaries toinclude Comprehensive Dental

Premium $0 $0 $0

PCP $0 $0 $5

Specialist $0 $0 $15

Referrals Required Yes Yes Yes

Inpatient Hospital $0 per admission $0 per admission $230 per day Days 1-7

Max Out-of-Pocket $990 In-Network $1499 In-Network $2900 In-Network

Rx Deductible No Deductible No Deductible No Deductible

Rx Preferred $0/$0/$35/$100/33% $0/$5/$47/$100/33% $5/$15/$47/$100/33%

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$125/Quarter for select health andwellness products

Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Orange Riverside San Diego

California Southern California

FOR AGENT USE ONLY

NEW NEW

Plan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO)

Plan Number H5619-120-000 H5619-121-000

Plan Highlights MA Only plan with a $90 Part B PremiumGiveback, designed for individuals that donot need additional drug coverage. Greatfit for Veterans using the VA for drugcoverage.

MA Only plan with a $75 Part B PremiumGiveback, designed for individuals that donot need additional drug coverage. Greatfit for Veterans using the VA for drugcoverage.

Premium $0 $0

PCP $20 $20

Specialist $50 $50

Referrals Required Yes Yes

Inpatient Hospital $1860 per admission $1860 per admission

Max Out-of-Pocket $6700 In-Network $6700 In-Network

Rx Deductible No Coverage No Coverage

Rx Preferred No Coverage No Coverage

Key Extra Benefits Dental Dental

Market Service Area Orange, San Diego Riverside

California Southern California

FOR AGENT USE ONLY

Plan Name Humana Value Plus (HMO)

Plan Number H5619-037-000

Plan Highlights Lean medical and pharmacy benefits, withrich supplemental benefits

Dental $1000 annually; $0 copayments covers:exams, x-rays, cleanings, fillings, crowns,extractions, dentures

Vision Annual exam and $200 credit every year foreyewear or contact lenses including fittings.

Hearing Annual exam and fitting. $1000 credit forhearing aids once every 3 years.

OTC Allowance $100 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto 36 one-way trip(s) per year by car, van,wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Orange, Riverside, San Diego

California Southern California

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/35%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Southern California Market-wide Southern California Market-wide Southern California Market-wide

California Southern California

FOR AGENT USE ONLY

Other Plans

Humana Gold Plus (HMO) H5619-039-001 MA-PD

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

California Southern California

FOR AGENT USE ONLY

Local Support

Local Support - CaliforniaDan Nazarek Broker Relationship Manager951-213-7743dnazarek@humana.com

CA - Southern

Nick DeMoe Broker Relationship Executive1-800-903-4934ndemoe@humana.com

NV, CA - Southern

Local Market Office 949-623-1447(Irvine); 951-780-0180(Riverside); 442-287-5150(Carlsbad)

Local Sales ManagerEmilee Contreras Local Sales Manager949-491-5716econtreras1@humana.comOrange County

Jon Kaufman Local Sales Manager858-395-4967jkaufman@humana.comSan Diego County

Terri Bacot Local Sales Manager951-691-9629tbacot@humana.comRiverside County

California Southern California

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGo365® by Humana is a wellness program that rewardsyour clients for doing healthy activities. Many HumanaMedicare Advantage plans include Go365.Multiple selling opportunities with Dual Special NeedsPlansOptional Supplemental Benefits that include Dental &VisionYour plan may include a monthly or quarterly allowancefor over-the-counter(OTC) items such as: Vitamins, PainRelievers, and Cough and cold medicines

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderIn-network HMO hospitals and provider systems include,but are not limited to, the following: Key Medical Groupand Kaweah Delta Health Care District

Market Service AreaKings, Tulare

California Tulare - Kings

FOR AGENT USE ONLY

MAPDPlan Name Humana Gold Plus (HMO)

Plan Number H5619-015-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withrich benefits and additional ancillaries

Premium $0

PCP $5

Specialist $20; $0 preferred

Referrals Required Yes

Inpatient Hospital $250 per day Days 1-5

Max Out-of-Pocket $5900 In-Network

Rx Deductible No Deductible

Rx Preferred $5/$15/$47/$100/33%

Key Extra Benefits Hearing, Fitness, OTC $25/Quarter forselect health and wellness products

Market Service Area Tulare - Kings Market-wide

California Tulare - Kings

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-038-000

Plan Highlights Dual Eligible Special Needs plan forFBDE,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $1000 annually; $0 copayments covers:exams, x-rays, cleanings, fillings, crowns,extractions, dentures

Healthy Foods Card $25 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing Annual exam, fitting and $2000 credit forhearing aids.

OTC Allowance $150 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto 36 one-way trip(s) per year by car, van,wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Tulare - Kings Market-wide

California Tulare - Kings

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/35%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Tulare - Kings Market-wide Tulare - Kings Market-wide Tulare - Kings Market-wide

California Tulare - Kings

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

California Tulare - Kings

FOR AGENT USE ONLY

Local Support

Local Support - CaliforniaShirley Todd Broker Relationship Manager805-952-3823stodd3@humana.com

CA - Northern

Jared Larson Broker Relationship Executive855-305-4952jlarson1@humana.com

CA- Northern & Los Angeles

Local Market Office 559-221-2522

Local Sales ManagerRichard Duran Local Sales Manager559-696-7676rduran1@humana.comTulare, King County

California Tulare - Kings

FOR AGENT USE ONLY

Market Service AreaHawaii, Kalawao

Hawaii Hawaii Outstate

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/44%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Hawaii Outstate Market-wide Hawaii Outstate Market-wide Hawaii Outstate Market-wide

Hawaii Hawaii Outstate

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F (HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Plan Name Plan Number Plan Category

Hawaii Hawaii Outstate

FOR AGENT USE ONLY

Local Support

Local Support - HawaiiNohemy Been Broker Relationship Manager303-408-6912nbeen@humana.com

AZ, HI

Brian John Broker Relationship Executive855-305 4949bjohn@humana.com

AZ, HI

Local Market Office 808-540-8570

Hawaii Hawaii Outstate

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyFull PPO and HMO suite of products designed to meet avariety of consumer needsGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.Humana Pharmacy provides value, experience, safety,accuracy, convenience and service to your clientsMany Plans include Dental, Vision, Hearing, OTC andSilverSneakers® Fitness BenefitsMost of Humana’s Medicare Advantage plans include theSilverSneakers® fitness program at no extra cost. Plan available with Transportation BenefitYour plan may include a monthly or quarterly allowancefor over-the-counter(OTC) items such as: Vitamins, PainRelievers, and Cough and cold medicines

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network servicesMost major hospital facilities within the market are in-network

Market Service AreaHonolulu

Hawaii Honolulu

FOR AGENT USE ONLY

MAPDPlan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H0028-004-000 H5216-041-000 H5216-040-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withlow cost shares and additional ancillaries

$0 Plan Premium LPPO MAPD Plan withmoderate cost shares and additionalancillaries

LPPO MAPD Plan with low cost shares andadditional ancillaries at no additional cost

Premium $0 $0 $54

PCP $0 $10 $0

Specialist $45 $50 $35

Referrals Required Yes No No

Inpatient Hospital $350 per day Days 1-5 $430 per day Days 1-4 $325 per day Days 1-5

Max Out-of-Pocket $5850 In-Network $6700 In-Network $5350 In-Network

Rx Deductible $275 tiers 3-5 $325 tiers 3-5 $200 tiers 3-5

Rx Preferred $5/$15/$47/$100/28% $5/$15/$47/$100/27% $3/$12/$45/$100/29%

Key Extra Benefits Dental, Hearing, Fitness, OTC $45/Quarterfor select health and wellness products

Vision, Hearing, Fitness, OTC $25/Quarterfor select health and wellness products

Dental, Hearing, Fitness, OTC $50/Quarterfor select health and wellness products

Market Service Area Honolulu Market-wide Honolulu Market-wide Honolulu Market-wide

Hawaii Honolulu

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/44%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Honolulu Market-wide Honolulu Market-wide Honolulu Market-wide

Hawaii Honolulu

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F (HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Plan Name Plan Number Plan Category

Hawaii Honolulu

FOR AGENT USE ONLY

Local Support

Local Support - HawaiiNohemy Been Broker Relationship Manager303-408-6912nbeen@humana.com

AZ, HI

Brian John Broker Relationship Executive855-305-4949bjohn@humana.com

AZ, HI

Local Market Office 808-540-8570

Local Sales ManagerAnastassia Hale Local Sales Manager808-219-9361ahale14@humana.com Hawaii (Oahu, Maui, Kauai)

Jose Cabrera, Sales Director Local Sales Manager757-775-0309jcabrerajr@humana.comHawaii (Oahu, Maui, Kauai)

Hawaii Honolulu

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyFull PPO and HMO suite of products designed to meet avariety of consumer needsGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.Humana Pharmacy provides value, experience, safety,accuracy, convenience and service to your clientsMany Plans include Dental, Vision, Hearing, OTC andSilverSneakers® Fitness BenefitsMost of Humana’s Medicare Advantage plans include theSilverSneakers® fitness program at no extra cost. Plan available with Transportation BenefitYour plan may include a monthly or quarterly allowancefor over-the-counter(OTC) items such as: Vitamins, PainRelievers, and Cough and cold medicines

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network servicesMost major hospital facilities within the market are in-network

Market Service AreaKauai

Hawaii Kauai

FOR AGENT USE ONLY

MAPDPlan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H0028-004-000 H5216-041-000 H5216-040-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withlow cost shares and additional ancillaries

$0 Plan Premium LPPO MAPD Plan withmoderate cost shares and additionalancillaries

LPPO MAPD Plan with low cost shares andadditional ancillaries at no additional cost

Premium $0 $0 $54

PCP $0 $10 $0

Specialist $45 $50 $35

Referrals Required Yes No No

Inpatient Hospital $350 per day Days 1-5 $430 per day Days 1-4 $325 per day Days 1-5

Max Out-of-Pocket $5850 In-Network $6700 In-Network $5350 In-Network

Rx Deductible $275 tiers 3-5 $325 tiers 3-5 $200 tiers 3-5

Rx Preferred $5/$15/$47/$100/28% $5/$15/$47/$100/27% $3/$12/$45/$100/29%

Key Extra Benefits Dental, Hearing, Fitness, OTC $45/Quarterfor select health and wellness products

Vision, Hearing, Fitness, OTC $25/Quarterfor select health and wellness products

Dental, Hearing, Fitness, OTC $50/Quarterfor select health and wellness products

Market Service Area Kauai Market-wide Kauai Market-wide Kauai Market-wide

Hawaii Kauai

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/44%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Kauai Market-wide Kauai Market-wide Kauai Market-wide

Hawaii Kauai

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F (HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Plan Name Plan Number Plan Category

Hawaii Kauai

FOR AGENT USE ONLY

Local Support

Local Support - HawaiiNohemy Been Broker Relationship Manager303-408-6912nbeen@humana.com

AZ, HI

Brian John Broker Relationship Executive855-305-4949bjohn@humana.com

AZ, HI

Local Market Office 808-540-8570

Local Sales ManagerAnastassia Hale Local Sales Manager808-219-9361ahale14@humana.com Hawaii (Oahu, Maui, Kauai)

Jose Cabrera, Sales Director Local Sales Manager757-775-0309jcabrerajr@humana.comHawaii (Oahu, Maui, Kauai)

Hawaii Kauai

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyFull PPO and HMO suite of products designed to meet avariety of consumer needsGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.Humana Pharmacy provides value, experience, safety,accuracy, convenience and service to your clientsMany Plans include Dental, Vision, Hearing, OTC andSilverSneakers® Fitness BenefitsMost of Humana’s Medicare Advantage plans include theSilverSneakers® fitness program at no extra cost. Plan available with Transportation BenefitYour plan may include a monthly or quarterly allowancefor over-the-counter(OTC) items such as: Vitamins, PainRelievers, and Cough and cold medicines

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network servicesMost major hospital facilities within the market are in-network

Market Service AreaMaui

Hawaii Maui

FOR AGENT USE ONLY

MAPDPlan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H0028-004-000 H5216-041-000 H5216-040-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withlow cost shares and additional ancillaries

$0 Plan Premium LPPO MAPD Plan withmoderate cost shares and additionalancillaries

LPPO MAPD Plan with low cost shares andadditional ancillaries at no additional cost

Premium $0 $0 $54

PCP $0 $10 $0

Specialist $45 $50 $35

Referrals Required Yes No No

Inpatient Hospital $350 per day Days 1-5 $430 per day Days 1-4 $325 per day Days 1-5

Max Out-of-Pocket $5850 In-Network $6700 In-Network $5350 In-Network

Rx Deductible $275 tiers 3-5 $325 tiers 3-5 $200 tiers 3-5

Rx Preferred $5/$15/$47/$100/28% $5/$15/$47/$100/27% $3/$12/$45/$100/29%

Key Extra Benefits Dental, Hearing, Fitness, OTC $45/Quarterfor select health and wellness products

Vision, Hearing, Fitness, OTC $25/Quarterfor select health and wellness products

Dental, Hearing, Fitness, OTC $50/Quarterfor select health and wellness products

Market Service Area Maui Market-wide Maui Market-wide Maui Market-wide

Hawaii Maui

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/44%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Maui Market-wide Maui Market-wide Maui Market-wide

Hawaii Maui

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F (HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Plan Name Plan Number Plan Category

Hawaii Maui

FOR AGENT USE ONLY

Local Support

Local Support - HawaiiNohemy Been Broker Relationship Manager303-408-6912nbeen@humana.com

AZ, HI

Brian John Broker Relationship Executive855-305-4949bjohn@humana.com

AZ, HI

Local Market Office 808-540-8570

Local Sales ManagerAnastassia Hale Local Sales Manager808-219-9361ahale14@humana.com Hawaii (Oahu, Maui, Kauai)

Jose Cabrera, Sales Director Local Sales Manager757-775-0309jcabrerajr@humana.comHawaii (Oahu, Maui, Kauai)

Hawaii Maui

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

Full PPO and HMO suite of products designed to meet avariety of consumer needsLocal market office and support team to assist withbroker and member needsMultiple selling opportunities with Chronic Special NeedsPlanNew MA-Only plan available with Comprehensive Dentaland a $100 Part B Giveback for customers that get theirdrug coverage elsewhere, such as Veterans. Plans available with Part B premium giveback Your plan may include a monthly or quarterly allowancefor over-the-counter(OTC) items such as: Vitamins, PainRelievers, and Cough and cold medicines

Network Highlights

All major hospital facilities within the market are in-networkFor a complete list of in-network providers, visitwww.Humana.com/PhysicianFinder

Market Service AreaClark, Nye

Nevada Las Vegas

FOR AGENT USE ONLY

MA / MAPDPlan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) Humana Gold Plus - Diabetes and Heart

(HMO C-SNP)

Plan Number H6622-056-000 H6622-028-000 H6622-029-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withrich benefits and additional ancillariesincluding Comprehensive Dental

$0 Plan Premium HMO MAPD Plan withrich benefits and additional ancillaries

Chronic Special Needs plan designed forindividuals with Cardiovascular Disorders,Chronic Heart Failure, and DiabetesMellitus

Premium $0 $0 $0

PCP $0 $0 $0

Specialist $0 $10 $0

Referrals Required Yes Yes Yes

Inpatient Hospital $0 per admission $0 per day Days 1-3, $50 per day Days 4-7 $0 per day Days 1-3, $50 per day Days 4-7

Max Out-of-Pocket $1500 In-Network $1900 In-Network $2500 In-Network

Rx Deductible No Deductible No Deductible No Deductible

Rx Preferred $0/$0/$47/$100/33% $2/$8/$47/$100/33% $5/$6/$40/$80/33%

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Market Service Area Las Vegas Market-wide Las Vegas Market-wide Las Vegas Market-wide

Nevada Las Vegas

FOR AGENT USE ONLY

Plan Name Humana Gold Plus Lung (HMO C-SNP) Humana Kidney Care (HMO C-SNP) HumanaChoice (PPO)

Plan Number H6622-030-000 H6622-031-000 H5216-141-000

Plan Highlights Chronic Special Needs plan designed forindividuals with Chronic Lung Disorders

Chronic Special Needs plan designed forindividuals with End-stage renal diseaserequiring dialysis (any mode of dialysis)

$0 Plan Premium with $50 Part B PremiumGiveback LPPO MAPD Plan with leanbenefits and additional ancillaries

Premium $0 $27 $0

PCP $0 $0 $5

Specialist $0 $10 $45

Referrals Required Yes Yes No

Inpatient Hospital $0 per day Days 1-3, $50 per day Days 4-7 $1364 Deductible, $0 per day Days 1-60,$341 per day Days 61-90, $682 per dayDays 91-150

$450 per day Days 1-4

Max Out-of-Pocket $2500 In-Network $6700 In-Network $6700 In-Network

Rx Deductible No Deductible No Deductible $365 tiers 3-5

Rx Preferred $1/$2/$40/$80/33% $5/$6/$47/$100/33% $5/$13/$47/$100/26%

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Dental, Vision, Hearing, OTC $25/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness

Market Service Area Las Vegas Market-wide Las Vegas Market-wide Las Vegas Market-wide

Nevada Las Vegas

FOR AGENT USE ONLY

NEW

Plan Name HumanaChoice (PPO) HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H5216-037-000 H5216-036-000 H5216-216-000

Plan Highlights Moderate Plan Premium LPPO MAPD Planwith moderate cost shares and additionalancillaries

High Plan Premium LPPO MAPD Plan withlow cost shares and additional ancillaries

MA Only plan with a $100 Part B PremiumGiveback, designed for individuals that donot need additional drug coverage. Greatfit for Veterans using the VA for drugcoverage.

Premium $34 $151 $0

PCP $5 $5 $0

Specialist $40 $40 20%

Referrals Required No No No

Inpatient Hospital $315 per day Days 1-6 $295 per day Days 1-5 $480 per day Days 1-3

Max Out-of-Pocket $6700 In-Network $6700 In-Network $6700 In-Network

Rx Deductible $225 tiers 3-5 $225 tiers 3-5 No Coverage

Rx Preferred $2/$5/$47/$100/29% $4/$7/$47/$100/29% No Coverage

Key Extra Benefits Vision, Hearing, Fitness, OTC $25/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Dental

Market Service Area Las Vegas Market-wide Las Vegas Market-wide Las Vegas Market-wide

Nevada Las Vegas

FOR AGENT USE ONLY

NEW

Plan Name Humana Value Plus (HMO)

Plan Number H6622-064-000

Plan Highlights Lean medical and pharmacy benefits, withrich supplemental benefits

Dental $1000 annually; $0 copayments covers:exams, x-rays, cleanings, fillings, crowns,extractions, dentures

Vision Annual exam and $200 credit every year foreyewear or contact lenses including fittings.

Hearing $0 annual exams, fittings and TruHearingadvanced level hearing aids, plus 48batteries.

OTC Allowance $175 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto 50 one-way trip(s) per year by car, van,wheelchair access vehicle.

Current Service Area Las Vegas Market-wide

Nevada Las Vegas

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/36%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Las Vegas Market-wide Las Vegas Market-wide Las Vegas Market-wide

Nevada Las Vegas

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Nevada Las Vegas

FOR AGENT USE ONLY

Local Support

Local Support - NevadaMary Granger Broker Relationship Manager702-719-9325mgranger@humana.com

Nick DeMoe Broker Relationship Executive1-800-903-4934ndemoe@humana.com

NV, CA - Southern

Local Market Office 702-837-4401

Local Sales ManagerRachel Townsend Local Sales Manager702-956-0860rtownsend1@Humana.comNevada

Nevada Las Vegas

FOR AGENT USE ONLY

Market Service AreaCarson City, Churchill, Douglas, Elko, Esmeralda, Eureka,Humboldt, Lander, Lincoln, Lyon, Mineral, Pershing, Storey,White Pine

Nevada Nevada Outstate

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/36%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Nevada Outstate Market-wide Nevada Outstate Market-wide Nevada Outstate Market-wide

Nevada Nevada Outstate

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Nevada Nevada Outstate

FOR AGENT USE ONLY

Local Support

Local Support - NevadaMary Granger Broker Relationship Manager702-719-9325mgranger@humana.com

Nick DeMoe Broker Relationship Executive1-800-903-4934ndemoe@humana.com

NV, CA - Southern

Local Market Office 702-837-4401

Nevada Nevada Outstate

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

New MA-Only plan available with Comprehensive Dentaland a $100 Part B GivebackOptional Supplemental Benefits that include Dental &VisionPlans available with Part B premium giveback

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderMost major hospital facilities within the market are in-network

Market Service AreaWashoe

Nevada Reno

FOR AGENT USE ONLY

MA / MAPDNEW

Plan Name HumanaChoice (PPO) HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H5216-194-000 H5216-039-000 H5216-216-000

Plan Highlights $0 Plan Premium with $50 Part B PremiumGiveback LPPO MAPD Plan with leanbenefits and additional ancillaries

Low Plan Premium LPPO MAPD Plan withlean benefits and additional ancillaries

MA Only plan with a $100 Part B PremiumGiveback, designed for individuals that donot need additional drug coverage. Greatfit for Veterans using the VA for drugcoverage.

Premium $0 $19 $0

PCP $5 $10 $0

Specialist $45 $50 20%

Referrals Required No No No

Inpatient Hospital $450 per day Days 1-4 $335 per day Days 1-5 $480 per day Days 1-3

Max Out-of-Pocket $6700 In-Network $6700 In-Network $6700 In-Network

Rx Deductible $365 tiers 3-5 $400 tiers 3-5 No Coverage

Rx Preferred $5/$13/$47/$100/26% $6/$14/$47/$100/25% No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness Vision, Hearing, Fitness, OTC $25/Quarterfor select health and wellness products

Dental

Market Service Area Reno Market-wide Reno Market-wide Reno Market-wide

Nevada Reno

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/36%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Reno Market-wide Reno Market-wide Reno Market-wide

Nevada Reno

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Nevada Reno

FOR AGENT USE ONLY

Local Support

Local Support - NevadaMary Granger Broker Relationship Manager702-719-9325mgranger@humana.com

Nick DeMoe Broker Relationship Executive1-800-903-4934ndemoe@humana.com

NV, CA - Southern

Local Market Office 702-837-4401

Local Sales ManagerRachel Townsend Local Sales Manager702-956-0860rtownsend1@Humana.comNevada

Nevada Reno

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.Many Plans include Acupuncture, Vision, Hearing, OTCand SilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans. Optional Supplemental Benefits that include DentalReduced PPO plan premium to $39, and reduced HMOplan premium to $59

Network Highlights

HMO and PPO plans within the market do not requirereferralsHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network servicesIn-network hospitals and provider systems include, butare not limited to, the following: Bend Memorial Clinic,St. Charles, Mosaic, and High Lakes Health

Market Service AreaCrook, Deschutes, Jefferson

Oregon Central OR

FOR AGENT USE ONLY

MA / MAPDPlan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H1036-219-000 H5216-044-000 H5216-047-000

Plan Highlights Reduced Plan Premium $59 HMO MAPDPlan with low cost shares and additionalancillaries

Reduced Plan Premium $39 LPPO MAPDPlan with moderate cost shares andadditional ancillaries

High Plan Premium LPPO MAPD Plan withmoderate cost shares and additionalancillaries

Premium $59 $39 $102

PCP $0 $10 $10

Specialist $40 $40 $45

Referrals Required No No No

Inpatient Hospital $395 per day Days 1-4 $360 per day Days 1-5 $300 per day Days 1-5

Max Out-of-Pocket $5500 In-Network $6000 In-Network $6700 In-Network

Rx Deductible $100 tiers 3-5 $200 tiers 3-5 $320 tiers 3-5

Rx Preferred $4/$15/$47/$100/31% $4/$15/$47/$100/29% $4/$15/$47/$100/27%

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Vision, Hearing, Fitness, OTC $30/Quarterfor select health and wellness products

Vision, Hearing, Fitness, OTC $30/Quarterfor select health and wellness products

Market Service Area Deschutes, Jefferson Central OR Market-wide Central OR Market-wide

Oregon Central OR

FOR AGENT USE ONLY

Plan Name HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H5216-048-000 H5216-046-000

Plan Highlights High Plan Premium LPPO MAPD Plan withlow cost shares and additional ancillaries

MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $201 $0

PCP $0 $0

Specialist $30 $35

Referrals Required No No

Inpatient Hospital $325 per day Days 1-4 $360 per day Days 1-5

Max Out-of-Pocket $6700 In-Network $3600 In-Network

Rx Deductible $435 tiers 2-5 No Coverage

Rx Preferred $16/$18/$47/$100/25% No Coverage

Key Extra Benefits Dental, Vision, Fitness, OTC $30/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Central OR Market-wide Central OR Market-wide

Oregon Central OR

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Central OR Market-wide Central OR Market-wide Central OR Market-wide

Oregon Central OR

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Oregon Central OR

FOR AGENT USE ONLY

Local Support

Local Support - OregonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerTom Thorpe Local Sales Manager360-487-9348tthorpe@humana.comMarket Manager SW WA/OR

Oregon Central OR

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyMany Plans include Vision, Hearing, OTC andSilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans. PPO plans within the market do not require referrals

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network services

Market Service AreaBaker, Benton, Clatsop, Columbia, Coos, Curry, Douglas,Gilliam, Grant, Harney, Hood River, Jackson, Josephine,Klamath, Lake, Lane, Lincoln, Linn, Marion, Morrow, Polk,Sherman, Tillamook, Umatilla, Union, Wallowa, Wasco,Wheeler, Yamhill

Oregon Oregon Outstate

FOR AGENT USE ONLY

MA / MAPDPlan Name HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H5216-048-000 H5216-046-000

Plan Highlights High Plan Premium LPPO MAPD Plan withlow cost shares and additional ancillaries

MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $201 $0

PCP $0 $0

Specialist $30 $35

Referrals Required No No

Inpatient Hospital $325 per day Days 1-4 $360 per day Days 1-5

Max Out-of-Pocket $6700 In-Network $3600 In-Network

Rx Deductible $435 tiers 2-5 No Coverage

Rx Preferred $16/$18/$47/$100/25% No Coverage

Key Extra Benefits Dental, Vision, Fitness, OTC $30/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Columbia, Hood River, Lincoln, Linn Columbia, Hood River, Lincoln, Linn

Oregon Oregon Outstate

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Oregon Outstate Market-wide Oregon Outstate Market-wide Oregon Outstate Market-wide

Oregon Oregon Outstate

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Oregon Oregon Outstate

FOR AGENT USE ONLY

Local Support

Local Support - OregonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerTom Thorpe Local Sales Manager360-487-9348tthorpe@humana.comMarket Manager SW WA/OR

Oregon Oregon Outstate

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.HMO plan includes Dental coverage at no additional costMany Plans include Acupuncture, Vision, Hearing, OTCand SilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans.

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network servicesIn-network hospitals and provider systems include, butare not limited to, the following: OHSU, Legacy,Adventist, NW Primary Care, and Tuality

Market Service AreaClackamas, Multnomah, Washington

Oregon Portland Tri County Area

FOR AGENT USE ONLY

MA / MAPDPlan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H1036-153-000 H5216-048-000 H5216-046-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withlow cost shares and additional ancillaries

High Plan Premium LPPO MAPD Plan withlow cost shares and additional ancillaries

MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $0 $201 $0

PCP $0 $0 $0

Specialist $40 $30 $35

Referrals Required Yes No No

Inpatient Hospital $450 per day Days 1-4 $325 per day Days 1-4 $360 per day Days 1-5

Max Out-of-Pocket $5700 In-Network $6700 In-Network $3600 In-Network

Rx Deductible $150 tiers 3-5 $435 tiers 2-5 No Coverage

Rx Preferred $2/$8/$47/$100/30% $16/$18/$47/$100/25% No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$25/Quarter for select health andwellness products

Dental, Vision, Fitness, OTC $30/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Portland Tri County Area Market-wide Portland Tri County Area Market-wide Portland Tri County Area Market-wide

Oregon Portland Tri County Area

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Portland Tri County Area Market-wide Portland Tri County Area Market-wide Portland Tri County Area Market-wide

Oregon Portland Tri County Area

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Oregon Portland Tri County Area

FOR AGENT USE ONLY

Local Support

Local Support - OregonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerTom Thorpe Local Sales Manager360-487-9348tthorpe@humana.comMarket Manager SW WA/OR

Oregon Portland Tri County Area

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyExpanding $0 plan premium PPO in Ada, Canyon, Gem,Payette, Boise, Owyhee, Washington and Elmore.Expanding PPO Service Area to include Owyhee,Washington and Elmore CountiesGo365® by Humana is a wellness program that rewardsyour clients for doing healthy activities. Many HumanaMedicare Advantage plans include Go365.Good hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.Many Plans include Dental, Vision, Hearing, OTC andSilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans. Your plan may include a monthly or quarterly allowancefor over-the-counter(OTC) items such as: Vitamins, PainRelievers, and Cough and cold medicines

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network servicesMost major hospital facilities within the market are in-network

Market Service AreaMalheur

Oregon Southwest Idaho

FOR AGENT USE ONLY

MA / MAPDPlan Name HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H5216-132-000 H5216-046-000

Plan Highlights $0 Plan Premium LPPO MAPD Plan withlow cost shares and additional ancillaries

MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $0 $0

PCP $0 $0

Specialist $40 $35

Referrals Required No No

Inpatient Hospital $395 per day Days 1-4 $360 per day Days 1-5

Max Out-of-Pocket $5000 In-Network $3600 In-Network

Rx Deductible $200 tiers 3-5 No Coverage

Rx Preferred $4/$15/$47/$100/29% No Coverage

Key Extra Benefits Vision, Hearing, Fitness, OTC $50/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Southwest Idaho Market-wide Southwest Idaho Market-wide

Oregon Southwest Idaho

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Southwest Idaho Market-wide Southwest Idaho Market-wide Southwest Idaho Market-wide

Oregon Southwest Idaho

FOR AGENT USE ONLY

Other Plans

HumanaChoice (PPO) H5216-044-000 MA-PD

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan B Med Supp

Humana Med Supp Plan C Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan K Med Supp

Humana Med Supp Plan L Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Oregon Southwest Idaho

FOR AGENT USE ONLY

Local Support

Local Support - OregonNathan Brown Broker Relationship Manager801-473-3312nbrown@humana.com

UT, ID

Lisa Brewer Broker Relationship Executive855-305-5004lbrewer7@humana.com

UT, ID

Local Market Office 1-800-884-8328

Oregon Southwest Idaho

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.HMO DE-SNP plan includes new $50 food card monthlyallowance, $300 quarterly OTC allowance, unlimitedtransportation and dental coverage with $3000 annualmaximumMany Plans include Acupuncture, Vision, Hearing, OTCand SilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans. Optional Supplemental Benefits that include DentalSome Humana Plans include Routine non-emergentmedical transportation at no additional cost

Network Highlights

All major hospital facilities within the market are in-networkFor a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network services

Market Service AreaClark

Washington Clark

FOR AGENT USE ONLY

MA / MAPDPlan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) HumanaChoice (PPO)

Plan Number H5619-056-000 H5619-101-000 H5216-047-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withlow cost shares and additional ancillaries

Moderate Plan Premium HMO MAPD Planwith low cost shares and additionalancillaries

High Plan Premium LPPO MAPD Plan withmoderate cost shares and additionalancillaries

Premium $0 $33 $102

PCP $5 $0 $10

Specialist $50 $35 $45

Referrals Required Yes Yes No

Inpatient Hospital $440 per day Days 1-4 $345 per day Days 1-5 $300 per day Days 1-5

Max Out-of-Pocket $6500 In-Network $5000 In-Network $6700 In-Network

Rx Deductible $100 tiers 3-5 $50 tiers 3-5 $320 tiers 3-5

Rx Preferred $2/$8/$47/$100/31% $2/$8/$47/$100/32% $4/$15/$47/$100/27%

Key Extra Benefits Vision, Hearing, Fitness, OTC $50/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Vision, Hearing, Fitness, OTC $30/Quarterfor select health and wellness products

Market Service Area Clark Market-wide Clark Market-wide Clark Market-wide

Washington Clark

FOR AGENT USE ONLY

Plan Name HumanaChoice (PPO)

Plan Number H5216-046-000

Plan Highlights MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $0

PCP $0

Specialist $35

Referrals Required No

Inpatient Hospital $360 per day Days 1-5

Max Out-of-Pocket $3600 In-Network

Rx Deductible No Coverage

Rx Preferred No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Clark Market-wide

Washington Clark

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-067-000

Plan Highlights Dual Eligible Special Needs plan forQMB,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $3000 annually; $0 copayments cover: exams,x-rays, cleanings, fluoridetreatment,extractions, fillings, crowns,dentures, denture adjustments, denturereline, deep cleaning, recementation,emergency treatment for pain, oral surgery,periodontal maintenance, and root canals

Healthy Foods Card $50 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing $0 annual exams, fittings and TruHearingadvanced level hearing aids, plus 48batteries.

OTC Allowance $300 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto unlimited one-way trip(s) per year by car,van, wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Clark Market-wide

Washington Clark

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Clark Market-wide Clark Market-wide Clark Market-wide

Washington Clark

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan G Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Washington Clark

FOR AGENT USE ONLY

Local Support

Local Support - WashingtonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerLuan Quach Local Sales Manager206-696-6194lquach@humana.comDE-SNP Manager WA

Tom Thorpe Local Sales Manager360-487-9348tthorpe@humana.comMarket Manager SW WA/OR

Washington Clark

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.HMO DE-SNP plan includes new $50 food card monthlyallowance, $300 quarterly OTC allowance, unlimitedtransportation and dental coverage with $3000 annualmaximumIntroducing new $69 plan premium HMOMany Plans include Acupuncture, Vision, Hearing, OTCand SilverSneakers® Fitness BenefitsOptional Supplemental Benefits that include Dental

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network servicesMost major hospital facilities within the market are in-network

Market Service AreaIsland

Washington Island

FOR AGENT USE ONLY

MA / MAPDNEW

Plan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H5619-129-000 H5216-047-000 H5216-048-000

Plan Highlights New HMO MAPD Plan with moderate costshare and additional ancillaries

High Plan Premium LPPO MAPD Plan withmoderate cost shares and additionalancillaries

High Plan Premium LPPO MAPD Plan withlow cost shares and additional ancillaries

Premium $69 $102 $201

PCP $5 $10 $0

Specialist $45 $45 $30

Referrals Required Yes No No

Inpatient Hospital $450 per day Days 1-4 $300 per day Days 1-5 $325 per day Days 1-4

Max Out-of-Pocket $6000 In-Network $6700 In-Network $6700 In-Network

Rx Deductible $225 tiers 3-5 $320 tiers 3-5 $435 tiers 2-5

Rx Preferred $3/$12/$47/$100/29% $4/$15/$47/$100/27% $16/$18/$47/$100/25%

Key Extra Benefits Vision, Hearing, Fitness, OTC $10/Quarterfor select health and wellness products

Vision, Hearing, Fitness, OTC $30/Quarterfor select health and wellness products

Dental, Vision, Fitness, OTC $30/Quarterfor select health and wellness products

Market Service Area Island Market-wide Island Market-wide Island Market-wide

Washington Island

FOR AGENT USE ONLY

Plan Name HumanaChoice (PPO)

Plan Number H5216-046-000

Plan Highlights MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $0

PCP $0

Specialist $35

Referrals Required No

Inpatient Hospital $360 per day Days 1-5

Max Out-of-Pocket $3600 In-Network

Rx Deductible No Coverage

Rx Preferred No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Island Market-wide

Washington Island

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-067-000

Plan Highlights Dual Eligible Special Needs plan forQMB,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $3000 annually; $0 copayments cover: exams,x-rays, cleanings, fluoridetreatment,extractions, fillings, crowns,dentures, denture adjustments, denturereline, deep cleaning, recementation,emergency treatment for pain, oral surgery,periodontal maintenance, and root canals

Healthy Foods Card $50 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing $0 annual exams, fittings and TruHearingadvanced level hearing aids, plus 48batteries.

OTC Allowance $300 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto unlimited one-way trip(s) per year by car,van, wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Island Market-wide

Washington Island

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Island Market-wide Island Market-wide Island Market-wide

Washington Island

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan G Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Washington Island

FOR AGENT USE ONLY

Local Support

Local Support - WashingtonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerLuan Quach Local Sales Manager206-696-6194lquach@humana.comDE-SNP Manager WA

Samantha George Local Sales Manager206-612-6441sgeorge1@humana.comMarket Manager North Puget Sound/Eastern WA

Washington Island

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyED Drugs are available on a tier 1 copay for a retailsupply, and $0 copay for tier 1 90 day supply when usingmail order through Humana Pharmacy on HMO plansFull PPO and HMO suite of products designed to meet avariety of consumer needsGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.HMO DE-SNP plan includes new $50 food card monthlyallowance, $300 quarterly OTC allowance, unlimitedtransportation and dental coverage with $3000 annualmaximumMany Plans include Naturopath, Acupuncture, Vision,Hearing, OTC and SilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans. Some Humana Plans include Routine non-emergentmedical transportation at no additional cost

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network servicesMost major hospital facilities within the market are in-network

Market Service AreaKing

Washington King County - Seattle Market

FOR AGENT USE ONLY

MA / MAPDPlan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) HumanaChoice (PPO)

Plan Number H5619-057-000 H5619-097-000 H5216-047-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withlow cost shares and additional ancillaries

Moderate Plan Premium HMO MAPD Planwith low cost shares and additionalancillaries

High Plan Premium LPPO MAPD Plan withmoderate cost shares and additionalancillaries

Premium $0 $33 $102

PCP $0 $0 $10

Specialist $50 $40 $45

Referrals Required Yes Yes No

Inpatient Hospital $450 per day Days 1-4 $360 per day Days 1-5 $300 per day Days 1-5

Max Out-of-Pocket $6500 In-Network $5000 In-Network $6700 In-Network

Rx Deductible $100 tiers 3-5 $50 tiers 3-5 $320 tiers 3-5

Rx Preferred $2/$8/$47/$100/31% $2/$8/$47/$100/32% $4/$15/$47/$100/27%

Key Extra Benefits Vision, Hearing, Fitness, OTC $50/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Vision, Hearing, Fitness, OTC $30/Quarterfor select health and wellness products

Market Service Area King County - Seattle Market Market-wide King County - Seattle Market Market-wide King County - Seattle Market Market-wide

Washington King County - Seattle Market

FOR AGENT USE ONLY

Plan Name HumanaChoice (PPO)

Plan Number H5216-046-000

Plan Highlights MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $0

PCP $0

Specialist $35

Referrals Required No

Inpatient Hospital $360 per day Days 1-5

Max Out-of-Pocket $3600 In-Network

Rx Deductible No Coverage

Rx Preferred No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area King County - Seattle Market Market-wide

Washington King County - Seattle Market

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-067-000

Plan Highlights Dual Eligible Special Needs plan forQMB,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $3000 annually; $0 copayments cover: exams,x-rays, cleanings, fluoridetreatment,extractions, fillings, crowns,dentures, denture adjustments, denturereline, deep cleaning, recementation,emergency treatment for pain, oral surgery,periodontal maintenance, and root canals

Healthy Foods Card $50 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing $0 annual exams, fittings and TruHearingadvanced level hearing aids, plus 48batteries.

OTC Allowance $300 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto unlimited one-way trip(s) per year by car,van, wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area King County - Seattle Market Market-wide

Washington King County - Seattle Market

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area King County - Seattle Market Market-wide King County - Seattle Market Market-wide King County - Seattle Market Market-wide

Washington King County - Seattle Market

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan G Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Washington King County - Seattle Market

FOR AGENT USE ONLY

Local Support

Local Support - WashingtonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerLuan Quach Local Sales Manager206-696-6194lquach@humana.comDE-SNP Manager WA

Mike Seat Local Sales Manager206-465-4681mseat@humana.comMarket Manager Puget Sound South

Samantha George Local Sales Manager206-612-6441sgeorge1@humana.comMarket Manager North Puget Sound/Eastern WA

Washington King County - Seattle Market

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.HMO DE-SNP plan includes new $50 food card monthlyallowance, $300 quarterly OTC allowance, unlimitedtransportation and dental coverage with $3000 annualmaximumMany Plans include Acupuncture, Vision, Hearing, OTCand SilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans. Some Humana Plans include Routine non-emergentmedical transportation at no additional cost

Network Highlights

All major hospital facilities within the market are in-networkFor a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network services

Market Service AreaKitsap

Washington Kitsap

FOR AGENT USE ONLY

MA / MAPDPlan Name Humana Gold Plus (HMO) HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H5619-099-000 H5216-047-000 H5216-048-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withlow cost shares and additional ancillaries

High Plan Premium LPPO MAPD Plan withmoderate cost shares and additionalancillaries

High Plan Premium LPPO MAPD Plan withlow cost shares and additional ancillaries

Premium $0 $102 $201

PCP $10 $10 $0

Specialist $50 $45 $30

Referrals Required Yes No No

Inpatient Hospital $450 per day Days 1-4 $300 per day Days 1-5 $325 per day Days 1-4

Max Out-of-Pocket $6700 In-Network $6700 In-Network $6700 In-Network

Rx Deductible $200 tiers 3-5 $320 tiers 3-5 $435 tiers 2-5

Rx Preferred $4/$15/$47/$100/29% $4/$15/$47/$100/27% $16/$18/$47/$100/25%

Key Extra Benefits Vision, Hearing, Fitness, OTC $50/Quarterfor select health and wellness products

Vision, Hearing, Fitness, OTC $30/Quarterfor select health and wellness products

Dental, Vision, Fitness, OTC $30/Quarterfor select health and wellness products

Market Service Area Kitsap Market-wide Kitsap Market-wide Kitsap Market-wide

Washington Kitsap

FOR AGENT USE ONLY

Plan Name HumanaChoice (PPO)

Plan Number H5216-046-000

Plan Highlights MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $0

PCP $0

Specialist $35

Referrals Required No

Inpatient Hospital $360 per day Days 1-5

Max Out-of-Pocket $3600 In-Network

Rx Deductible No Coverage

Rx Preferred No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Kitsap Market-wide

Washington Kitsap

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-067-000

Plan Highlights Dual Eligible Special Needs plan forQMB,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $3000 annually; $0 copayments cover: exams,x-rays, cleanings, fluoridetreatment,extractions, fillings, crowns,dentures, denture adjustments, denturereline, deep cleaning, recementation,emergency treatment for pain, oral surgery,periodontal maintenance, and root canals

Healthy Foods Card $50 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing $0 annual exams, fittings and TruHearingadvanced level hearing aids, plus 48batteries.

OTC Allowance $300 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto unlimited one-way trip(s) per year by car,van, wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Kitsap Market-wide

Washington Kitsap

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Kitsap Market-wide Kitsap Market-wide Kitsap Market-wide

Washington Kitsap

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan G Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Washington Kitsap

FOR AGENT USE ONLY

Local Support

Local Support - WashingtonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerLuan Quach Local Sales Manager206-696-6194lquach@humana.comDE-SNP Manager WA

Mike Seat Local Sales Manager206-465-4681mseat@humana.comMarket Manager Puget Sound South

Washington Kitsap

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyED Drugs are a tier 1 copay for a retail supply, and $0copay for tier 1 90 day supply when using mail orderthrough Humana Pharmacy on HMO plansFull PPO and HMO suite of products designed to meet avariety of consumer needsGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.HMO DE-SNP plan includes new $50 food card monthlyallowance, $300 quarterly OTC allowance, unlimitedtransportation and dental coverage with $3000 annualmaximumMany Plans include Naturopath, Acupuncture, Vision,Hearing, OTC and SilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans. Some Humana Plans include Routine non-emergentmedical transportation at no additional cost

Network Highlights

All major hospital facilities within the market are in-networkFor a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network services

Market Service AreaPierce

Washington Pierce

FOR AGENT USE ONLY

MA / MAPDPlan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) HumanaChoice (PPO)

Plan Number H5619-100-000 H5619-061-000 H5216-048-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withlow cost shares and additional ancillaries

Moderate Plan Premium HMO MAPD Planwith low cost shares and additionalancillaries

High Plan Premium LPPO MAPD Plan withlow cost shares and additional ancillaries

Premium $0 $49 $201

PCP $0 $0 $0

Specialist $50 $40 $30

Referrals Required Yes Yes No

Inpatient Hospital $450 per day Days 1-4 $360 per day Days 1-5 $325 per day Days 1-4

Max Out-of-Pocket $6500 In-Network $5000 In-Network $6700 In-Network

Rx Deductible $100 tiers 3-5 $50 tiers 3-5 $435 tiers 2-5

Rx Preferred $2/$8/$47/$100/31% $2/$8/$47/$100/32% $16/$18/$47/$100/25%

Key Extra Benefits Vision, Hearing, Fitness, OTC $50/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Dental, Vision, Fitness, OTC $30/Quarterfor select health and wellness products

Market Service Area Pierce Market-wide Pierce Market-wide Pierce Market-wide

Washington Pierce

FOR AGENT USE ONLY

Plan Name HumanaChoice (PPO)

Plan Number H5216-046-000

Plan Highlights MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $0

PCP $0

Specialist $35

Referrals Required No

Inpatient Hospital $360 per day Days 1-5

Max Out-of-Pocket $3600 In-Network

Rx Deductible No Coverage

Rx Preferred No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Pierce Market-wide

Washington Pierce

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-067-000

Plan Highlights Dual Eligible Special Needs plan forQMB,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $3000 annually; $0 copayments cover: exams,x-rays, cleanings, fluoridetreatment,extractions, fillings, crowns,dentures, denture adjustments, denturereline, deep cleaning, recementation,emergency treatment for pain, oral surgery,periodontal maintenance, and root canals

Healthy Foods Card $50 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing $0 annual exams, fittings and TruHearingadvanced level hearing aids, plus 48batteries.

OTC Allowance $300 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto unlimited one-way trip(s) per year by car,van, wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Pierce Market-wide

Washington Pierce

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Pierce Market-wide Pierce Market-wide Pierce Market-wide

Washington Pierce

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan G Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Washington Pierce

FOR AGENT USE ONLY

Local Support

Local Support - WashingtonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerLuan Quach Local Sales Manager206-696-6194lquach@humana.comDE-SNP Manager WA

Mike Seat Local Sales Manager206-465-4681mseat@humana.comMarket Manager Puget Sound South

Washington Pierce

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.HMO DE-SNP plan includes new $50 food card monthlyallowance, $300 quarterly OTC allowance, unlimitedtransportation and dental coverage with $3000 annualmaximumMany Plans include Acupuncture, Vision, Hearing, OTCand SilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans. Optional Supplemental Benefits that include Dental

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network servicesIn-network hospitals and provider systems include, butare not limited to, the following: Family Care Network,PeaceHealth, Northwest Physicians Network, and SkagitRegional

Market Service AreaSkagit, Whatcom

Washington Skagit - Whatcom

FOR AGENT USE ONLY

MA / MAPDPlan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) HumanaChoice (PPO)

Plan Number H5619-114-000 H5619-115-000 H5216-047-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withmoderate cost shares and additionalancillaries

Moderate Plan Premium HMO MAPD Planwith low cost shares and additionalancillaries

High Plan Premium LPPO MAPD Plan withmoderate cost shares and additionalancillaries

Premium $0 $39 $102

PCP $10 $0 $10

Specialist $50 $40 $45

Referrals Required Yes Yes No

Inpatient Hospital $490 per day Days 1-4 $360 per day Days 1-5 $300 per day Days 1-5

Max Out-of-Pocket $6700 In-Network $5000 In-Network $6700 In-Network

Rx Deductible $250 tiers 3-5 $200 tiers 3-5 $320 tiers 3-5

Rx Preferred $4/$12/$47/$100/28% $4/$12/$47/$100/29% $4/$15/$47/$100/27%

Key Extra Benefits Vision, Hearing, Fitness, OTC $50/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Vision, Hearing, Fitness, OTC $30/Quarterfor select health and wellness products

Market Service Area Skagit - Whatcom Market-wide Skagit - Whatcom Market-wide Skagit - Whatcom Market-wide

Washington Skagit - Whatcom

FOR AGENT USE ONLY

Plan Name HumanaChoice (PPO)

Plan Number H5216-046-000

Plan Highlights MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $0

PCP $0

Specialist $35

Referrals Required No

Inpatient Hospital $360 per day Days 1-5

Max Out-of-Pocket $3600 In-Network

Rx Deductible No Coverage

Rx Preferred No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Skagit - Whatcom Market-wide

Washington Skagit - Whatcom

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-067-000

Plan Highlights Dual Eligible Special Needs plan forQMB,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $3000 annually; $0 copayments cover: exams,x-rays, cleanings, fluoridetreatment,extractions, fillings, crowns,dentures, denture adjustments, denturereline, deep cleaning, recementation,emergency treatment for pain, oral surgery,periodontal maintenance, and root canals

Healthy Foods Card $50 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing $0 annual exams, fittings and TruHearingadvanced level hearing aids, plus 48batteries.

OTC Allowance $300 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto unlimited one-way trip(s) per year by car,van, wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Skagit - Whatcom Market-wide

Washington Skagit - Whatcom

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Skagit - Whatcom Market-wide Skagit - Whatcom Market-wide Skagit - Whatcom Market-wide

Washington Skagit - Whatcom

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan G Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Washington Skagit - Whatcom

FOR AGENT USE ONLY

Local Support

Local Support - WashingtonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerLuan Quach Local Sales Manager206-696-6194lquach@humana.comDE-SNP Manager WA

Samantha George Local Sales Manager206-612-6441sgeorge1@humana.comMarket Manager North Puget Sound/Eastern WA

Washington Skagit - Whatcom

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyED Drugs are a tier 1 copay for a retail supply, and $0copay for tier 1 90 day supply when using mail orderthrough Humana Pharmacy on HMO plansFull PPO and HMO suite of products designed to meet avariety of consumer needsGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.HMO DE-SNP plan includes new $50 food card monthlyallowance, $300 quarterly OTC allowance, unlimitedtransportation and dental coverage with $3000 annualmaximumMany Plans include Naturopath, Acupuncture, Vision,Hearing, OTC and SilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans. Some Humana Plans include Routine non-emergentmedical transportation at no additional cost

Network Highlights

All major hospital facilities within the market are in-networkFor a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network services

Market Service AreaSnohomish

Washington Snohomish

FOR AGENT USE ONLY

MA / MAPDPlan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) HumanaChoice (PPO)

Plan Number H5619-063-000 H5619-059-000 H5216-047-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withlow cost shares and additional ancillaries

Moderate Plan Premium HMO MAPD Planwith low cost shares and additionalancillaries

High Plan Premium LPPO MAPD Plan withmoderate cost shares and additionalancillaries

Premium $0 $33 $102

PCP $10 $0 $10

Specialist $50 $45 $45

Referrals Required Yes Yes No

Inpatient Hospital $450 per day Days 1-4 $360 per day Days 1-5 $300 per day Days 1-5

Max Out-of-Pocket $6500 In-Network $5000 In-Network $6700 In-Network

Rx Deductible $100 tiers 3-5 $50 tiers 3-5 $320 tiers 3-5

Rx Preferred $2/$8/$47/$100/31% $2/$8/$47/$100/32% $4/$15/$47/$100/27%

Key Extra Benefits Vision, Hearing, Fitness, OTC $50/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Vision, Hearing, Fitness, OTC $30/Quarterfor select health and wellness products

Market Service Area Snohomish Market-wide Snohomish Market-wide Snohomish Market-wide

Washington Snohomish

FOR AGENT USE ONLY

Plan Name HumanaChoice (PPO)

Plan Number H5216-046-000

Plan Highlights MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $0

PCP $0

Specialist $35

Referrals Required No

Inpatient Hospital $360 per day Days 1-5

Max Out-of-Pocket $3600 In-Network

Rx Deductible No Coverage

Rx Preferred No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Snohomish Market-wide

Washington Snohomish

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-067-000

Plan Highlights Dual Eligible Special Needs plan forQMB,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $3000 annually; $0 copayments cover: exams,x-rays, cleanings, fluoridetreatment,extractions, fillings, crowns,dentures, denture adjustments, denturereline, deep cleaning, recementation,emergency treatment for pain, oral surgery,periodontal maintenance, and root canals

Healthy Foods Card $50 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing $0 annual exams, fittings and TruHearingadvanced level hearing aids, plus 48batteries.

OTC Allowance $300 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto unlimited one-way trip(s) per year by car,van, wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Snohomish Market-wide

Washington Snohomish

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Snohomish Market-wide Snohomish Market-wide Snohomish Market-wide

Washington Snohomish

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan G Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Washington Snohomish

FOR AGENT USE ONLY

Local Support

Local Support - WashingtonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerLuan Quach Local Sales Manager206-696-6194lquach@humana.comDE-SNP Manager WA

Samantha George Local Sales Manager206-612-6441sgeorge1@humana.comMarket Manager North Puget Sound/Eastern WA

Washington Snohomish

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.HMO DE-SNP plan includes new $50 food card monthlyallowance, $300 quarterly OTC allowance, unlimitedtransportation and dental coverage with $3000 annualmaximumMany Plans include Acupuncture, Vision, Hearing, OTCand SilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans. Optional Supplemental Benefits that include Dental

Network Highlights

All major hospital facilities within the market are in-networkFor a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network services

Market Service AreaSpokane

Washington Spokane

FOR AGENT USE ONLY

MA / MAPDPlan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) HumanaChoice (PPO)

Plan Number H5619-060-000 H5619-102-000 H5216-047-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withlow cost shares and additional ancillaries

Moderate Plan Premium HMO MAPD Planwith low cost shares and additionalancillaries

High Plan Premium LPPO MAPD Plan withmoderate cost shares and additionalancillaries

Premium $0 $39 $102

PCP $10 $0 $10

Specialist $50 $40 $45

Referrals Required Yes Yes No

Inpatient Hospital $450 per day Days 1-4 $345 per day Days 1-5 $300 per day Days 1-5

Max Out-of-Pocket $5900 In-Network $5000 In-Network $6700 In-Network

Rx Deductible $250 tiers 3-5 $150 tiers 3-5 $320 tiers 3-5

Rx Preferred $4/$15/$47/$100/28% $4/$15/$47/$100/30% $4/$15/$47/$100/27%

Key Extra Benefits Hearing, Fitness Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Vision, Hearing, Fitness, OTC $30/Quarterfor select health and wellness products

Market Service Area Spokane Market-wide Spokane Market-wide Spokane Market-wide

Washington Spokane

FOR AGENT USE ONLY

Plan Name HumanaChoice (PPO)

Plan Number H5216-046-000

Plan Highlights MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $0

PCP $0

Specialist $35

Referrals Required No

Inpatient Hospital $360 per day Days 1-5

Max Out-of-Pocket $3600 In-Network

Rx Deductible No Coverage

Rx Preferred No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Spokane Market-wide

Washington Spokane

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-067-000

Plan Highlights Dual Eligible Special Needs plan forQMB,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $3000 annually; $0 copayments cover: exams,x-rays, cleanings, fluoridetreatment,extractions, fillings, crowns,dentures, denture adjustments, denturereline, deep cleaning, recementation,emergency treatment for pain, oral surgery,periodontal maintenance, and root canals

Healthy Foods Card $50 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing $0 annual exams, fittings and TruHearingadvanced level hearing aids, plus 48batteries.

OTC Allowance $300 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto unlimited one-way trip(s) per year by car,van, wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Spokane Market-wide

Washington Spokane

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Spokane Market-wide Spokane Market-wide Spokane Market-wide

Washington Spokane

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan G Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Washington Spokane

FOR AGENT USE ONLY

Local Support

Local Support - WashingtonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerLuan Quach Local Sales Manager206-696-6194lquach@humana.comDE-SNP Manager WA

Samantha George Local Sales Manager206-612-6441sgeorge1@humana.comMarket Manager North Puget Sound/Eastern WA

Washington Spokane

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyGood hearing is important to your health. That’s whysome Humana Medicare Advantage plans include ahearing aid benefit through TruHearing®.HMO DE-SNP plan includes new $50 food card monthlyallowance, $300 quarterly OTC allowance, unlimitedtransportation and dental coverage with $3000 annualmaximumMany Plans include Acupuncture, Vision, Hearing, OTCand SilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans.

Network Highlights

All major hospital facilities within the market are in-networkFor a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network services

Market Service AreaThurston

Washington Thurston

FOR AGENT USE ONLY

MA / MAPDPlan Name Humana Gold Plus (HMO) Humana Gold Plus (HMO) HumanaChoice (PPO)

Plan Number H5619-064-000 H5619-062-000 H5216-048-000

Plan Highlights $0 Plan Premium HMO MAPD Plan withmoderate cost shares and additionalancillaries

Moderate Plan Premium HMO MAPD Planwith low cost shares and additionalancillaries

High Plan Premium LPPO MAPD Plan withlow cost shares and additional ancillaries

Premium $0 $44 $201

PCP $10 $5 $0

Specialist $50 $40 $30

Referrals Required Yes Yes No

Inpatient Hospital $490 per day Days 1-4 $390 per day Days 1-5 $325 per day Days 1-4

Max Out-of-Pocket $6500 In-Network $5000 In-Network $6700 In-Network

Rx Deductible $200 tiers 3-5 $160 tiers 3-5 $435 tiers 2-5

Rx Preferred $4/$15/$47/$100/29% $4/$15/$47/$100/30% $16/$18/$47/$100/25%

Key Extra Benefits Vision, Hearing, Fitness, OTC $50/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness, OTC$50/Quarter for select health andwellness products

Dental, Vision, Fitness, OTC $30/Quarterfor select health and wellness products

Market Service Area Thurston Market-wide Thurston Market-wide Thurston Market-wide

Washington Thurston

FOR AGENT USE ONLY

Plan Name HumanaChoice (PPO)

Plan Number H5216-046-000

Plan Highlights MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $0

PCP $0

Specialist $35

Referrals Required No

Inpatient Hospital $360 per day Days 1-5

Max Out-of-Pocket $3600 In-Network

Rx Deductible No Coverage

Rx Preferred No Coverage

Key Extra Benefits Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Thurston Market-wide

Washington Thurston

FOR AGENT USE ONLY

DSNPPlan Name Humana Gold Plus SNP-DE (HMO D-SNP)

Plan Number H5619-067-000

Plan Highlights Dual Eligible Special Needs plan forQMB,QMB+,SLMB+. Includes suite of richsupplemental benefits designed for dualmember needs.

Dental $3000 annually; $0 copayments cover: exams,x-rays, cleanings, fluoridetreatment,extractions, fillings, crowns,dentures, denture adjustments, denturereline, deep cleaning, recementation,emergency treatment for pain, oral surgery,periodontal maintenance, and root canals

Healthy Foods Card $50 maximum monthly allowance on aHealthy Foods Card for a member to spendtowards the purchase of approved food andbeverage items at participating retailers

Vision Annual exam and $300 credit every year foreyeglasses or contact lenses.

Hearing $0 annual exams, fittings and TruHearingadvanced level hearing aids, plus 48batteries.

OTC Allowance $300 maximum benefit coverage amount perquarter (3 months) for select over-the-counterhealth and wellness products.

Transportation $0 copayment for plan approved location upto unlimited one-way trip(s) per year by car,van, wheelchair access vehicle.

This benefit is not to exceed 50 miles per trip.

Current Service Area Thurston Market-wide

Washington Thurston

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Thurston Market-wide Thurston Market-wide Thurston Market-wide

Washington Thurston

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan G Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Washington Thurston

FOR AGENT USE ONLY

Local Support

Local Support - WashingtonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerLuan Quach Local Sales Manager206-696-6194lquach@humana.comDE-SNP Manager WA

Mike Seat Local Sales Manager206-465-4681mseat@humana.comMarket Manager Puget Sound South

Washington Thurston

FOR AGENT USE ONLY

MARKET HIGHLIGHTS

$0 copay for 90 day supply of tier 1 and 2 drugs whenusing mail order through Humana PharmacyMany Plans include Vision, Hearing, OTC andSilverSneakers® Fitness BenefitsMA-Only plan available for customers that get their drugcoverage elsewhere, such as Veterans. PPO plans within the market do not require referrals

Network Highlights

For a complete list of in-network providers, visitwww.Humana.com/PhysicianFinderHumana PPO Plans have National Network Reciprocity,allowing members to travel with the comfort of knowingthey can use any HumanaChoice Care PPO NetworkProvider across the country for in-network services

Market Service AreaAdams, Asotin, Benton, Chelan, Clallam, Columbia, Cowlitz,Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor,Jefferson, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan,Pacific, Pend Oreille, San Juan, Skamania, Stevens, Wahkiakum,Walla Walla, Whitman, Yakima

Washington Washington Outstate

FOR AGENT USE ONLY

MA / MAPDPlan Name HumanaChoice (PPO) HumanaChoice (PPO) HumanaChoice (PPO)

Plan Number H5216-047-000 H5216-048-000 H5216-046-000

Plan Highlights High Plan Premium LPPO MAPD Plan withmoderate cost shares and additionalancillaries

High Plan Premium LPPO MAPD Plan withlow cost shares and additional ancillaries

MA Only plan, designed for individualsthat do not need additional drugcoverage. Great fit for Veterans using theVA for drug coverage.

Premium $102 $201 $0

PCP $10 $0 $0

Specialist $45 $30 $35

Referrals Required No No No

Inpatient Hospital $300 per day Days 1-5 $325 per day Days 1-4 $360 per day Days 1-5

Max Out-of-Pocket $6700 In-Network $6700 In-Network $3600 In-Network

Rx Deductible $320 tiers 3-5 $435 tiers 2-5 No Coverage

Rx Preferred $4/$15/$47/$100/27% $16/$18/$47/$100/25% No Coverage

Key Extra Benefits Vision, Hearing, Fitness, OTC $30/Quarterfor select health and wellness products

Dental, Vision, Fitness, OTC $30/Quarterfor select health and wellness products

Dental, Vision, Hearing, Fitness, OTC$75/Quarter for select health andwellness products

Market Service Area Cowlitz, Kittitas, Walla Walla Cowlitz, Kittitas, Walla Walla Cowlitz, Kittitas, Walla Walla

Washington Washington Outstate

FOR AGENT USE ONLY

Prescription Drug PlansPlan Name Humana Walmart Value Rx Plan (PDP) Humana Premier Rx Plan (PDP) Humana Basic Rx Plan (PDP)

Plan Number

Plan Highlights Lowest premium and access to preferredbenefits at Walmart and Humana Pharmacy.

Richest formulary and benefits. Preferredbenefits at Walmart and Humana Pharmacy.

Primarily provides coverage for members withExtra Help (LIS). Tier 1 & Tier 2 mail-ordercopays are $0 at Humana Pharmacy for 90-day supply.

Pairs Well With Humana Med Supp Plan Humana Med Supp Plan Humana Med Supp Plan

Premium Coming Soon Coming Soon Coming Soon

Rx Deductible $435 tiers 3-5 $435 tiers 3-5 $435 all tiers

Preferred Retail 30-day Supply $1/$4/$47/35%/25% $1/$4/$42/44%/25% No Coverage

Standard Retail 30-day Supply $10/$20/$47/50%/25% $5/$10/$47/50%/25% $0/$1/25%/41%/25%

Preferred Mail 90-day Supply $3 copay for tier 1, $12 copayment for tier 2 $0 copay for tiers 1 & 2 $0 copay for tiers 1 & 2

Market Service Area Washington Outstate Market-wide Washington Outstate Market-wide Washington Outstate Market-wide

Washington Washington Outstate

FOR AGENT USE ONLY

Other Plans

Humana Med Supp Plan A Med Supp

Humana Med Supp Plan F Med Supp

Humana Med Supp Plan F(HD) Med Supp

Humana Med Supp Plan G Med Supp

Humana Med Supp Plan N Med Supp

Plan Name Plan Number Plan Category

Washington Washington Outstate

FOR AGENT USE ONLY

Local Support

Local Support - WashingtonLon Girard Broker Relationship Manager360-852-1831lgirard@humana.com

OR, WA, AK

Monica Florenzan Broker Relationship Executive855-216-7109mflorenzan@humana.com

OR, WA, AK

Local Market Office 1-800-781-4203

Local Sales ManagerSamantha George Local Sales Manager206-612-6441sgeorge1@humana.comMarket Manager North Puget Sound/Eastern WA

Washington Washington Outstate

FOR AGENT USE ONLY