March 10, 2010

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Humana – Autograph Total Plus Rx/HSA – COLORADO

A comparison of the Autograph Total Plus Rx/HSA 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 Application Autograph Total Plus Rx/HSA Application
Brochure Autograph Total Plus Rx/HSA Brochure Autograph Total Plus Rx/HSA Brochure
Copay N/A N/A
Office Visit 100% after deductible 70% after deductible
Deductible $1,500 $3,000
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 annual physical exam and Routine immunizations (age 6 to 18)- 100% (Benefits payable after 90-day waiting period for preventive care and 12 month waiting period for mental health. $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 (Benefits payable after 90-day waiting period for preventive care and 12 month waiting period for mental health. $300 of covered expenses per person per calendar year, subject to applicable coinsurance).
    		•
  • Child wellness services (birth through age 5)- 70% (Age and/or frequency limits apply).
    		•
    Child Preventative Care
  • Child wellness services (birth through age 5)- 100% (Age and/or frequency limits apply).
    		•
  • Child wellness services (birth through age 5)- 70% (Age and/or frequency limits apply).
    		•
    Lab / X-Ray Autograph Total Plus Rx/HSA Autograph Total Plus Rx/HSA
    Maternity Pregnancy Complications and Sick Baby Services (No prior authorization required): 100% after deductible Pregnancy Complications and Sick Baby Services (No prior authorization required): 70% after deductible
    Physical Therapy N/A N/A
    Skilled Nursing 100% after deductible (Up to 30 days admission, prior authorization required in order to be eligible for these benefits) 70% after deductible (Up to 30 days admission, prior authorization required in order to be eligible for these benefits)
    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 Optional Benefits-
    • Lifetime Maximum Benefit
    • Supplemental Accident Benefit
    		 Optional Benefits-
    • Lifetime Maximum Benefit
    • Supplemental Accident Benefit