March 20, 2010

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Humana – Autograph Total/HSA with Dental – INDIANA

A comparison of the Autograph Total/HSA with 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/HSA with Dental Application Autograph Total/HSA with Dental Application
Brochure Autograph Total/HSA with Dental Brochure Autograph Total/HSA with Dental Brochure
Copay N/A N/A
Office Visit 100% after deductible 70% after deductible
Deductible $4,000 $8,000
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 $2,000,000 per covered person $2,000,000 per covered person
Prescription Drugs
  • Discount Card included
  • There is no coverage for retail and/or mail order prescription drugs unless stated in the policy.
    		•  Not covered
    Emergency Room 100% after deductible 70% after deductible
    Adult Preventative Care
  • Routine physical exam and PSA- 100% (Benefit payable after 90-day waiting period for preventative care and 12 month waiting period for mental health)($300 of covered expenses per person per calendar year, subject to applicable)(Age and/or frequency limits apply)
  • Routine Pap smears- 100% (Age and/or frequency limits apply)
  • Mammogram (limited to 130% of medicare reimbursement rate)- 100% (Age and/or frequency limits apply)
  • Routine lab, pathology and X-ray- 100% after deductible (Benefit payable after 90-day waiting period for preventative care and 12 month waiting period for mental health)($300 of covered expenses per person per calendar year, subject to applicable)
    		•
  • Child health supervision services (birth to age one, up to $500 per calendar year; includes annual hearing screening benefit $75 maximum)- 70% after deductible
  • Child health supervision services (ages 1 to 8, up to $150 per calendar year)- 70% after deductible
    		•
    Child Preventative Care
  • Child health supervision services (birth to age one, up to $500 per calendar year; includes annual hearing screening benefit $75 maximum)- 100%
  • Child health supervision services (ages 1 to 8, up to $150 per calendar year)- 100%
    		•
  • Child health supervision services (birth to age one, up to $500 per calendar year; includes annual hearing screening benefit $75 maximum)- 70% after deductible
  • Child health supervision services (ages 1 to 8, up to $150 per calendar year)- 70% after deductible
    		•
    Lab / X-Ray Autograph Total/HSA with Dental Autograph Total/HSA with 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/HSA with Dental Autograph Total/HSA with 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 Autograph Total/HSA with Dental Autograph Total/HSA with Dental
    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
    		•