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Portrait Share 80 Plus Rx Unlimited and Dental – Humana –

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
Copay $35 primary care/$50 specialist unlimited visits for illness or injury Not applicable
OfficeVisit
  • Preventive Office Visits: 100%
  • Physician Office Visits (including allergy injections): 100% after office visit copayment
    		•
  • Preventive Office Visits: Not Covered
  • Physician Office Visits (including allergy injections): 60% after deductible
    		•
    Deductible
    Coinsurance 80% 60%
    Coinsurance Limit Individual: $2,000, Family: $4,000 (per calendar year; deductibles and copayments do not apply)
    Out-of-Pocket Maximum N/A N/A
    Lifetime Maximum Unlimited Unlimited
    Prescription Drugs Rx4 Prescription Drug (medical out-of-pocket maximum does not apply) -
    • Deductible per Individual: Separate $500 deductible (Level 1 drugs subject to copay, no deductible)
    • Copay for each Prescription or Refill (up to a 90-day supply; with applicable copay for each 30 day supply) -
      • Level 1: $15
      • Level 2: $35
      • Level 3: $55
      • Level 4: 25%
    • Copayment Maximum (applies to Level 4 drugs only): $2,500 per individual per calendar year
    • Benefit per Prescription or Refill: 100% after prescription copayment
    • Mail Order (up to 90-day supply): 100% after three times retail copay
    		 Rx4 Prescription Drug (medical out-of-pocket maximum does not apply) -
    • Deductible per Individual: Separate $500 deductible (Level 1 drugs subject to copay, no deductible)
    • Copay for each Prescription or Refill (up to a 90-day supply; with applicable copay for each 30 day supply) -
      • Level 1: $15
      • Level 2: $35
      • Level 3: $55
      • Level 4: 25%
    • Copayment Maximum (applies to Level 4 drugs only): $2,500 per individual per calendar year
    • Benefit per Prescription or Refill: 70% after prescription copayment
    • Mail Order (up to 90-day supply): 70% after three times retail copay
    Emergency Room 80% after $75 copayment per visit and deductible (copayment waived if admitted) 80% after $75 copayment per visit and deductible (copayment waived if admitted)
    Adult Preventative Care
  • Preventive Office Visits: 100%
  • Pap Smear: 100%
  • Prostate Screening: 100%
  • Preventive Lab and X-ray: 100%
  • Mammogram: 100%
    		•
  • Preventive Office Visits: Not Covered
  • Pap Smear: Not Covered
  • Prostate Screening: Not Covered
  • Preventive Lab and X-ray: Not Covered
  • Mammogram: 60% after deductible
    		•
    Child Preventative Care
  • Preventive Office Visits: 100%
  • Child Immunizations to age 18: 100%
    		•
  • Preventive Office Visits: Not Covered
  • Child Immunizations to age 18: Not Covered
    		•
    Lab / X-Ray Diagnostic Lab and X-ray: First $200 per calendar year 100% then 80% after deductible Diagnostic Lab and X-ray: 60% after deductible
    Maternity Pregnancy Complications and Sick Baby Services: 80% after deductible (prior authorization required in order to be eligible for these benefits) Pregnancy Complications and Sick Baby Services: 60% after deductible (prior authorization required in order to be eligible for these benefits)
    Physical Therapy N/A N/A
    Home Health Care
  • Hospice: 80% after deductible (prior authorization required in order to be eligible for these benefits)
  • Home Health Care (up to 60 visits per calendar year): 80% after deductible (prior authorization required in order to be eligible for these benefits)
    		•
  • Hospice: 60% after deductible (prior authorization required in order to be eligible for these benefits)
  • Home Health Care (up to 60 visits per calendar year): 60% after deductible (prior authorization required in order to be eligible for these benefits)
    		•
    Mental Health Basic Mental Health -
    • Inpatient Services: 80% after deductible
    • Outpatient and Office Therapy Sessions: 80% after deductible
    Chemical and Alcohol Dependency (Services other than for treatment of mental illness, medical out-of-pocket maximum does not apply) -
    • Inpatient Services: 50% after deductible
    • Outpatient and Office Therapy Sessions: 50% after deductible
    		 Basic Mental Health -
    • Inpatient Services: 60% after deductible
    • Outpatient and Office Therapy Sessions: 60% after deductible
    Chemical and Alcohol Dependency (Services other than for treatment of mental illness, medical out-of-pocket maximum does not apply) -
    • Inpatient Services: 50% after deductible
    • Outpatient and Office Therapy Sessions: 50% after deductible
    Hospital Care Physician Services -
    • Allergy Testing: First $200 per calendar year 100% then 80% after deductible
    • Allergy Serum: 80% after deductible
    • Inpatient and Outpatient Services: 80% after deductible
    • Surgery: 80% after deductible
    Facility Services -
    • Inpatient Services: 80% after deductible
    • Outpatient Surgery: 80% after deductible
    		 Physician Services -
    • Allergy Testing: First 60% after deductible
    • Allergy Serum: 60% after deductible
    • Inpatient and Outpatient Services: 60% after deductible
    • Surgery: 60% after deductible
    Facility Services -
    • Inpatient Services: 60% after deductible
    • Outpatient Surgery: 60% after deductible
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