March 19, 2010

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Humana – Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) – WISCONSIN

A comparison of the Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) offered by Humana is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Application Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) Application Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) Application
Brochure Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) Brochure Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) 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
  • 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.
    		•
  • 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
  • Gynecological Exam (age 13 & up)- 80%
  • Routine PSA (Age and/or frequency limits apply)- 80%
  • Routine Mammograms (limited to $50 per screening, Age and/or frequency limits apply)- 80%
  • Routine annual physical exam ($300 of covered expenses per person per calendar year, subject to applicable coinsurance)- 80%
  • Routine lab, pathology and X-ray (Age and/or frequency limits apply)- 80% after deductible
    		•
  • Child Health Supervision Services (birth to age 6)- 100% (Services include Exam, Immunizations when included with exam, and Lab when included with exam)
  • Immunizations (birth to age 3, not included with exam)- 60% after deductible
  • Immunizations (age 3-18, not included with exam)($300 of covered expenses per person per calendar year, subject to applicable coinsurance)- Not covered
    		•
    Child Preventative Care
  • Child Health Supervision Services (birth to age 6)- 100% (Services include Exam, Immunizations when included with exam, and Lab when included with exam)
  • Immunizations (birth to age 3, not included with exam)- 80%
  • Immunizations (age 3-18, not included with exam)($300 of covered expenses per person per calendar year, subject to applicable coinsurance)- 80%
    		•
  • Child Health Supervision Services (birth to age 6)- 100% (Services include Exam, Immunizations when included with exam, and Lab when included with exam)
  • Immunizations (birth to age 3, not included with exam)- 60% after deductible
  • Immunizations (age 3-18, not included with exam)($300 of covered expenses per person per calendar year, subject to applicable coinsurance)- Not covered
    		•
    Lab / X-Ray Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible)
    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 (with $0 Rx Deductible) Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible)
    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 Dental
  • Lifetime maximum benefit
  • $500 Supplemental Accident Benefit
  • $1,000 Supplemental Accident Benefit
    		•  Dental
  • Lifetime maximum benefit
  • $500 Supplemental Accident Benefit
  • $1,000 Supplemental Accident Benefit
    		•