Humana Monogram Total Plus Rx with Dental – Virginia Health Insurance Plan

A detailed comparison of the Humana Monogram Total Plus Rx with Dental health insurance plan as offered in Virginia 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 Virginia now or view all of our Humana health insurance quotes.

  Network Non-Network
Copay N/A N/A
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
  • Gynecological Exam, Including Pap Smear, Medically Necessary Screenings, and Non-routine Immunizations (age 13 and older): 100%
  • Prostate Screening: 100%
  • Mammograms: 100%
  • Preventive Office Visits (age 6 to adult): 100%
  • Preventi
  • Gynecological Exam, Including Pap Smear, Medically Necessary Screenings, and Non-routine Immunizations (age 13 and older): 75% after deductible
  • Prostate Screening: 75% after deductible
  • Mammograms: 75% after deductible
  • Preventive Off
  • Child Preventative Care
  • Child Office Visits (birth to age 6): 100%
  • Immunizations and Lab (when included with exam)(birth to age 6): 100%
  • Gynecological Exam, Including Pap Smear, Medically Necessary Screenings, and Non-routine Immunizations (age 13 and older): 10
  • Child Office Visits (birth to age 6): 100%
  • Immunizations and Lab (when included with exam)(birth to age 6): 100%
  • Gynecological Exam, Including Pap Smear, Medically Necessary Screenings, and Non-routine Immunizations (age 13 and older): 75
  • 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, Chemical and Alcohol Dependency -
  • Inpatient Services (25 days per calendar year to age 19; 20 days per calendar year; age 19 and older): 100% after deductible
  • Outpatient Services (20 visits per calendar year)
    • visits on
  • Mental Health, Chemical and Alcohol Dependency -
  • Inpatient Services (25 days per calendar year to age 19; 20 days per calendar year; age 19 and older): 75% after deductible
  • Outpatient Services (20 visits per calendar year)
    • visits one
  • 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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