AlaskaAlaska - Agent Boost Marketing · 2019. 7. 23. · extractions, dentures Healthy Foods Card...
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Market Service Area Aleutians East, Aleutians West, Anchorage, Bethel, Bristol Bay, Denali, Dillingham, Fairbanks North Star, Haines, Juneau, Kenai Peninsula, Ketchikan Gateway, Kodiak Island, Lake And Peninsula, Matanuska Susitna, Nome, North Slope, Northwest Arctic, Prince of Wales-Outer Ketchikan, Prince Wales Ketchikan, Sitka, Skagway Hoonah Angoon, Skagway-Hoonah- Angoon, Southeast Fairbanks, Valdez Cordova, Wade Hampton, Wrangell Petersburg, Wrangell-Petersburg, Yakutat, Yukon Koyukuk Alaska Alaska FOR AGENT USE ONLY
Transcript of AlaskaAlaska - Agent Boost Marketing · 2019. 7. 23. · extractions, dentures Healthy Foods Card...
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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
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 [email protected]
CA - Northern
Jared Larson Broker Relationship [email protected]
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 [email protected]
CA - Northern
Jared Larson Broker Relationship [email protected]
CA- Northern & Los Angeles
Local Market Office 925-255-0910
Local Sales ManagerCharlene Miskimen Local Sales [email protected] 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 [email protected]
CA - Northern
Jared Larson Broker Relationship [email protected]
CA- Northern & Los Angeles
Local Market Office 559-221-2522
Local Sales ManagerRichard Duran Local Sales [email protected], 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 [email protected]
CA - Los Angeles
Jared Larson Broker Relationship [email protected]
CA- Northern & Los Angeles
Local Market Office 424-246-4834
Local Sales ManagerDaralynn King Local Sales [email protected] 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 [email protected]
CA - Los Angeles
Jared Larson Broker Relationship [email protected]
CA- Northern & Los Angeles
Local Market Office 424-246-4834
Local Sales ManagerDaralynn King Local Sales [email protected] Fernando Valley
Keisha Smith Local Sales [email protected] Gabriel Valley
Ronald Morales Local Sales [email protected] 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 [email protected]
CA - Los Angeles
Jared Larson Broker Relationship [email protected]
CA- Northern & Los Angeles
Local Market Office 424-246-4834
Local Sales ManagerKeisha Smith Local Sales [email protected] 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 [email protected]
CA - Northern
Jared Larson Broker Relationship [email protected]
CA- Northern & Los Angeles
Local Market Office 925-255-0910
Local Sales ManagerCharlene Miskimen Local Sales [email protected] 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 [email protected]
CA - Los Angeles
Jared Larson Broker Relationship [email protected]
CA- Northern & Los Angeles
Local Market Office 424-246-4834
Local Sales ManagerDaralynn King Local Sales [email protected] 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 [email protected]
CA - Los Angeles
Jared Larson Broker Relationship [email protected]
CA- Northern & Los Angeles
Local Market Office 424-246-4834
Local Sales ManagerDaralynn King Local Sales [email protected] 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 [email protected]
CA - Southern
Nick DeMoe Broker Relationship [email protected]
NV, CA - Southern
Local Market Office 949-623-1447(Irvine); 951-780-0180(Riverside); 442-287-5150(Carlsbad)
Local Sales ManagerEmilee Contreras Local Sales [email protected] County
Jon Kaufman Local Sales [email protected] Diego County
Terri Bacot Local Sales [email protected] 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 [email protected]
CA - Northern
Jared Larson Broker Relationship [email protected]
CA- Northern & Los Angeles
Local Market Office 559-221-2522
Local Sales ManagerRichard Duran Local Sales [email protected], 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 [email protected]
AZ, HI
Brian John Broker Relationship Executive855-305 [email protected]
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 [email protected]
AZ, HI
Brian John Broker Relationship [email protected]
AZ, HI
Local Market Office 808-540-8570
Local Sales ManagerAnastassia Hale Local Sales [email protected] Hawaii (Oahu, Maui, Kauai)
Jose Cabrera, Sales Director Local Sales [email protected] (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 [email protected]
AZ, HI
Brian John Broker Relationship [email protected]
AZ, HI
Local Market Office 808-540-8570
Local Sales ManagerAnastassia Hale Local Sales [email protected] Hawaii (Oahu, Maui, Kauai)
Jose Cabrera, Sales Director Local Sales [email protected] (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 [email protected]
AZ, HI
Brian John Broker Relationship [email protected]
AZ, HI
Local Market Office 808-540-8570
Local Sales ManagerAnastassia Hale Local Sales [email protected] Hawaii (Oahu, Maui, Kauai)
Jose Cabrera, Sales Director Local Sales [email protected] (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 [email protected]
Nick DeMoe Broker Relationship [email protected]
NV, CA - Southern
Local Market Office 702-837-4401
Local Sales ManagerRachel Townsend Local Sales [email protected]
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 [email protected]
Nick DeMoe Broker Relationship [email protected]
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 [email protected]
Nick DeMoe Broker Relationship [email protected]
NV, CA - Southern
Local Market Office 702-837-4401
Local Sales ManagerRachel Townsend Local Sales [email protected]
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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerTom Thorpe Local Sales [email protected] 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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerTom Thorpe Local Sales [email protected] 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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerTom Thorpe Local Sales [email protected] 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 [email protected]
UT, ID
Lisa Brewer Broker Relationship [email protected]
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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerLuan Quach Local Sales [email protected] Manager WA
Tom Thorpe Local Sales [email protected] 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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerLuan Quach Local Sales [email protected] Manager WA
Samantha George Local Sales [email protected] 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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerLuan Quach Local Sales [email protected] Manager WA
Mike Seat Local Sales [email protected] Manager Puget Sound South
Samantha George Local Sales [email protected] 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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerLuan Quach Local Sales [email protected] Manager WA
Mike Seat Local Sales [email protected] 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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerLuan Quach Local Sales [email protected] Manager WA
Mike Seat Local Sales [email protected] 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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerLuan Quach Local Sales [email protected] Manager WA
Samantha George Local Sales [email protected] 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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerLuan Quach Local Sales [email protected] Manager WA
Samantha George Local Sales [email protected] 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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerLuan Quach Local Sales [email protected] Manager WA
Samantha George Local Sales [email protected] 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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerLuan Quach Local Sales [email protected] Manager WA
Mike Seat Local Sales [email protected] 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 [email protected]
OR, WA, AK
Monica Florenzan Broker Relationship [email protected]
OR, WA, AK
Local Market Office 1-800-781-4203
Local Sales ManagerSamantha George Local Sales [email protected] Manager North Puget Sound/Eastern WA
Washington Washington Outstate
FOR AGENT USE ONLY
