March 12, 2010

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Humana – Autograph Total Plus Rx/HSA and Dental – ARKANSAS

A comparison of the Autograph Total Plus Rx/HSA and Dental offered by Humana is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application Autograph Total Plus Rx/HSA and Dental Application Autograph Total Plus Rx/HSA and Dental Application
Brochure Autograph Total Plus Rx/HSA and Dental Brochure Autograph Total Plus Rx/HSA and Dental Brochure
Copay N/A N/A
Office Visit 100% after deductible 70% after deductible
Deductible $2,500 $5,000
Coinsurance 100% 70%
Coinsurance Limit Maximum Out-of-Pocket Expense Limit: $0 Individual and $0 Family. Maximum Out-of-Pocket Expense Limit: $6,000 Individual and $12,000 Family.
Out-of-Pocket Maximum Maximum Out-of-Pocket Expense Limit: $0 Individual and $0 Family. Maximum Out-of-Pocket Expense Limit: $6,000 Individual and $12,000 Family.
Lifetime Maximum $5,000,000 per covered person $5,000,000 per covered person
Prescription Drugs 100% after deductible 70% after deductible
Emergency Room 100% after deductible 70% after deductible
Adult Preventative Care
  • Routine physical exam and Routine immunizations (72 months to age 18)- 100% ($300 of covered expenses per person per calendar year, subject to applicable coinsurance).
  • Routine Pap smears and PSA and Routine mammograms- 100% (Age and/or frequency limits apply).
  • Routine lab, pathology and X-ray- 100% after deductible ($300 of covered expenses per person per calendar year, subject to applicable coinsurance).
    		•
  • Routine immunizations (Birth to age 72 months)- 100%.
    		•
    Child Preventative Care
  • Routine immunizations (Birth to age 72 months)- 100%.
    		•
  • Routine immunizations (Birth to age 72 months)- 100%.
    		•
    Lab / X-Ray Autograph Total Plus Rx/HSA and Dental Autograph Total Plus Rx/HSA and Dental
    Maternity Complications of pregnancy and sick baby services- 100% after deductible. Complications of pregnancy and sick baby services- 70% after deductible.
    Physical Therapy Autograph Total Plus Rx/HSA and Dental Autograph Total Plus Rx/HSA and Dental
    Skilled Nursing 100% after deductible (up to 30 days per calendar year). 70% after deductible (up to 30 days per calendar year).
    Home Health Care 100% after deductible (up to 60 days per calendar year). 70% after deductible (up to 60 days per calendar year).
    Mental Health
  • Inpatient and Outpatient care (Combined $2,500 per calendar year maximum.
  • Outpatient care not to exceed $500 of the $2,500 calendar year maximum.)- 50% after deductible.
    		•
  • Inpatient and Outpatient care (Combined $2,500 per calendar year maximum.
  • Outpatient care not to exceed $500 of the $2,500 calendar year maximum.)- 50% after deductible.
    		•
    Hospital Care 100% after deductible 70% after deductible
    Optional Benefits Lifetime maximum benefit
  • $500 Supplemental Accident Benefit
  • $1,000 Supplemental Accident Benefit
    		•  Lifetime maximum benefit
  • $500 Supplemental Accident Benefit
  • $1,000 Supplemental Accident Benefit
    		•