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Humana Monogram Total Plus Rx – Indiana Health Insurance Plan

A detailed comparison of the Humana Monogram Total Plus Rx health insurance plan as offered in Indiana is listed below for both Network and Non-Network coverage. This is a review of the coverage for this specific Humana plan. However, GoHealthInsurance offers a large variety of health insurance options to fit your needs. If you wish, get a new Humana health insurance quote for Indiana now or view all of our Humana health insurance quotes.

  Network Non-Network
Copay Not applicable Not applicable
OfficeVisit
  • Preventive Office Visits: 100%
  • Physician Office Visits (including allergy injections): 100% after deductible
    		•
  • Preventive Office Visits: Not covered
  • Physician Office Visits (including allergy injections): 75% after deductible
    		•
    Deductible true Individual: $7,500, Family: $15,000 (per calendar year; copayments do not apply; two family members must each meet their individual deductible) Individual: $15,000, Family: $30,000 (per calendar year; copayments do not apply; two family members must each meet their individual deductible)
    Coinsurance 100% 75%
    Coinsurance Limit Individual: $0, Family: $0 (per calendar year; deductibles and copayments do not apply) Individual: $5,000, Family: $10,000 (per calendar year; deductibles and copayments do not apply)
    Out-of-Pocket Maximum N/A N/A
    Lifetime Maximum Unlimited Unlimited
    Prescription Drugs Rx4 Prescription Drug (medical out-of-pocket maximum does not apply) -
    • Deductible per Individual: Separate $1,000 deductible (Level 1 drugs subject to copay, no deductible)
    • Copay for each Prescription or Refill (up to 90-day supply; with a
    		 Rx4 Prescription Drug (medical out-of-pocket maximum does not apply) -
    • Deductible per Individual: Separate $1,000 deductible (Level 1 drugs subject to copay, no deductible)
    • Copay for each Prescription or Refill (up to 90-day supply; with a
    Emergency Room 100% after $125 copayment per visit and deductible (copayment waived if admitted) 100% after $125 copayment per visit and deductible (copayment waived if admitted)
    Adult Preventative Care
  • Preventive Office Visits: 100%
  • Pap Smear: 100%
  • Prostate Screening: 100%
  • Preventive Lab and X-ray: 100%
  • Mammogram: 100%
    		•
  • Preventive Office Visits: Not Covered
  • Pap Smear: Not Covered
  • Prostate Screening: Not Covered
  • Preventive Lab and X-ray: Not Covered
  • Mammogram: 75% after deductible
    		•
    Child Preventative Care
  • Preventive Office Visits: 100%
  • Child Immunizations to age 18: 100%
    		•
  • Preventive Office Visits: Not Covered
  • Child Immunizations to age 18: Not Covered
    		•
    Lab / X-Ray Diagnostic Lab and X-ray: 100% after deductible Diagnostic Lab and X-ray: 75% after deductible
    Maternity Pregnancy Complications and Sick Baby Services: 100% after deductible (prior authorization required in order to be eligible for these benefits) Pregnancy Complications and Sick Baby Services: 75% after deductible (prior authorization required in order to be eligible for these benefits)
    Physical Therapy N/A N/A
    Home Health Care
  • Hospice: 100% after deductible (prior authorization required in order to be eligible for these benefits)
  • Home Health Care (up to 60 visits per calendar year): 100% after deductible (prior authorization required in order to be eligible for these
    		•
  • Hospice: 75% after deductible (prior authorization required in order to be eligible for these benefits)
  • Home Health Care (up to 60 visits per calendar year): 75% after deductible (prior authorization required in order to be eligible for these b
    		•
    Mental Health Mental Health -
    • Inpatient Services: 100% after deductible
    • Outpatient and Office Therapy Sessions: 100% after deductible
    Chemical and Alcohol Dependency (Services other than for treatment of mental illness, medical out-of-pocket maxi    		 Mental Health -
    • Inpatient Services: 75% after deductible
    • Outpatient and Office Therapy Sessions: 75% after deductible
    Chemical and Alcohol Dependency (Services other than for treatment of mental illness, medical out-of-pocket maximu
    Hospital Care Physician Services -
    • Allergy Testing: 100% after deductible
    • Allergy Serum: 100% after deductible
    • Inpatient and Outpatient Services: 100% after deductible
    • Surgery: 100% after deductible
    Facility Services -
    • Inpati
    		 Physician Services -
    • Allergy Testing: 75% after deductible
    • Allergy Serum: 75% after deductible
    • Inpatient and Outpatient Services: 75% after deductible
    • Surgery: 75% after deductible
    Facility Services -
    • Inpatient
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