March 19, 2010

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Humana – Portrait Share 80 Plus Rx Unlimited and Dental – TENNESSEE

A comparison of the Portrait Share 80 Plus Rx Unlimited 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 Portrait Share 80 Plus Rx Unlimited and Dental Application Portrait Share 80 Plus Rx Unlimited and Dental Application
Brochure Portrait Share 80 Plus Rx Unlimited and Dental Brochure Portrait Share 80 Plus Rx Unlimited and Dental Brochure
Copay Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment. N/A
Office Visit
  • Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.
    		•  60% after deductible
    Deductible $1,000 (Two members must meet their deductible). $2,000 (Two members must meet their deductible).
    Coinsurance 80% 60%
    Coinsurance Limit Maximum Out-of-Pocket Expense Limit: $2,000 Individual and $4,000 Family. Maximum Out-of-Pocket Expense Limit: $8,000 Individual and $16,000 Family.
    Out-of-Pocket Maximum Maximum Out-of-Pocket Expense Limit: $2,000 Individual and $4,000 Family. Maximum Out-of-Pocket Expense Limit: $8,000 Individual and $16,000 Family.
    Lifetime Maximum $5,000,000 per covered person $5,000,000 per covered person
    Prescription Drugs
  • $500 prescription drug deductible per individual.
  • 100% after Copayments (up to 30-day supply):
    • Level One (lowest copayment for lowest cost generic and brand-name drugs)- $15 copayment is not subject to prescription drug deductible.
    • Level Two (higher copayment for higher cost generic and brand-name drugs)- $35 copayment after prescription drug deductible.
    • Level Three (higher copayment than Level Two for higher cost, mostly brand-name drugs that may have generic or therapeutic equivalents in Levels One or Two)- $55 copayment after prescription drug deductible.
    • Level Four (highest copayment for high-technology drugs)- 25% copayment after prescription deductible up to $2,500 maximum out-of-pocket per calendar year.
  • Mail Order (90-day supply)- 100% after three times the retail copayment.
    		•
  • $500 prescription drug deductible per individual.
  • 70% after Copayments (up to 30-day supply):
    • Level One (lowest copayment for lowest cost generic and brand-name drugs)- $15 copayment is not subject to prescription drug deductible.
    • Level Two (higher copayment for higher cost generic and brand-name drugs)- $35 copayment after prescription drug deductible.
    • Level Three (higher copayment than Level Two for higher cost, mostly brand-name drugs that may have generic or therapeutic equivalents in Levels One or Two)- $55 copayment after prescription drug deductible.
    • Level Four (highest copayment for high-technology drugs)- 25% copayment after prescription deductible up to $2,500 maximum out-of-pocket per calendar year.
  • Mail Order (90-day supply)- 70% after three times the retail copayment.
    		•
    Emergency Room 80% after $75 copayment per visit and deductible (copayment waived if admitted). 60% after $75 copayment per visit and deductible (copayment waived if admitted).
    Adult Preventative Care
  • Routine annual physical exam- 80%
  • Routine immunizations (to age 18)- 80%
  • Routine Pap smears and PSA and Routine mammograms- 80% (Age and/or frequency limits apply)
  • Routine lab, pathology and X-ray- 80% after deductible
    		•  Not covered
    Child Preventative Care
  • Routine immunizations (to age 18)- 80%
    		•  Not covered
    Lab / X-Ray Portrait Share 80 Plus Rx Unlimited and Dental Portrait Share 80 Plus Rx Unlimited and Dental
    Maternity Complications of pregnancy and sick baby services- 80% after deductible. Complications of pregnancy and sick baby services- 60% after deductible.
    Physical Therapy Portrait Share 80 Plus Rx Unlimited and Dental Portrait Share 80 Plus Rx Unlimited and Dental
    Skilled Nursing 80% after deductible (up to 30 days per calendar year). 60% after deductible (up to 30 days per calendar year).
    Home Health Care 80% after deductible (up to 60 days per calendar year). 60% 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 80% after deductible 60% after deductible
    Optional Benefits Prescription drug, no deductible
  • Lifetime maximum benefit
  • $500 Supplemental Accident Benefit
  • $1,000 Supplemental Accident Benefit
    		•  Prescription drug, no deductible
  • Lifetime maximum benefit
  • $500 Supplemental Accident Benefit
  • $1,000 Supplemental Accident Benefit
    		•