northern california highlights: king and...

Northern California Highlights: King And Tulare

• MOOP $5900 • PCP $5 / SPEC $30 • Plans includes Hearing benefits • 4 star plans • Over the Counter (OTC) Benefits on our HMO products • Transportation benefits • SilverSneakers – free fitness and gym membership • $0 Tier 1 & 2 Rx Benefits if member uses Humana Mail order for 90 day supply

Benefit Highlights

• Key Medical Group • Strong Relationships with Providers

Network Highlights

• Strong Brand Recognition In Market • Local Market office and Support Team

Competitive Advantages

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This material is confidential and for contracted, licensed, and appointed agent use only. This material, including any subpart(s), is not to be used as marketing and is not to be provided to a prospect, an applicant, member, group, or the general public. Benefits are subject to CMS approval and may change. For proposed benchmark and ensured accuracy of plan benefit data please refer to the 2018 Summary of Benefits.

California Highlights: Northern California

Humana Gold Plus

$47 Premium MOOP: $3,400 PCP $0 / SPEC $20 Inpatient: $250/day (Days 1-6) Rx Included Contract/PBP: H5619-026 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: San Joaquin

Humana Gold Plus

$29 Premium MOOP: $3,400 PCP $0 / SPEC $20 Inpatient: $300/day (Days 1-5) RX Included Contract/PBP: H5619-032 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Stanislaus

Humana Gold Plus

$47 Premium MOOP: $3,200 PCP $0 / SPEC $12 Inpatient: $290/Day (Days 1-5) Rx Included Contract/PBP: H5619-029 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Contra Costa

Humana Gold Plus

$11.40 Premium MOOP: $6,700 PCP 20% /SPEC 20% Inpatient: $480/Day (Days 1-3) Rx Included Contract/PBP: H5619-038 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: San Joaquin, Stanislaus, Fresno, Kings, Madera, Tulare

HMO HMO DSNP HMO

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California Highlights: Northern California

Humana Gold Plus

$0 Premium MOOP: $6,700 PCP $0 / SPEC: $10 Inpatient: $350/Day (Days 1-6) Rx Included Contract/PBP: H5619-012 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Fresno

Humana Gold Plus

$0 Premium MOOP: $5,900 PCP $0 / SPC $10 Inpatient: $295/Day (Days 1-5) RX Included Contract/PBP: H5619-013 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Madera

Humana Gold Plus

$0 Premium MOOP: $5,900 PCP $5 / SPEC $30 Inpatient: $250/Day (Days 1-5) Rx Included Contract/PBP: H5619-015 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Kings and Tulare

HMO HMO HMO

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California Highlights: Los Angeles County

• $0 Premium • $0 copay for PCP, Specialist and Hospital • Very Competitive Drug Formulary • Plans includes Dental, Hearing, & Vision benefits • 4 star plan • Over the Counter (OTC) $75 a quarter • Transportation benefits 24 one way trips • SilverSneakers – free fitness and gym membership • $0 Tier 1 & 2 Rx Benefits if member uses Humana Mail order for 90 day supply • Tier 1 & 2 Rx coverage through the gap • $10 copay for Acupuncture unlimited visits

Benefit Highlights

• Extensive contractual relationships with major provider groups and hospitals in Los Angeles county • Most Hospitals participate in our HMO Plans • Strong Relationships with Providers

Network Highlights

• Extensive contractual relationships with major provider groups and hospitals. • Strong and Growing membership • Local Market office and Support Team • Year Round Selling opportunities: Medi -Medi look alike plan


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California Highlights: Los Angeles County

Humana Gold Plus 021

Premium: $0 MOOP: $2,200 Specialist: $0 Inpatient: $0 Unlimited Rx Included or No Rx: Included Contract/PBP: H5619-021 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Los Angeles County, Orange County


Premium: $0 MOOP: $6,700 PCP Pref/ Non Pref/SPEC: $0 Inpatient: $0 Rx Included or No Rx: LIS Contract/PBP: H5619-037 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Los Angeles County, Orange County, San Bernardino County, Riverside County and San Diego County

HMO Local PPO

PDP

HMO

SNP

Regional PPO

PFFS

Medicare Supplement

Medi Medi Look-a-Like

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California Highlights: Santa Barbara/Ventura Counties


Premium: $18 MOOP: $5,900 PCP Pref/SPEC: $5/$10 Inpatient: $350 days 1-5, $0 days 6-90 Rx Included or No Rx: Included Contract/PBP: H5619-023 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Santa Barbara County and Ventura County


Premium: $0 MOOP: $6,700 PCP Pref/ Non Pref/SPEC: $0 Inpatient: $0 Rx Included or No Rx: LIS Contract/PBP: H5619-038 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving County: Only Ventura County

HMO Local PPO

PDP

HMO

SNP

Regional PPO

PFFS

Medicare Supplement

D-SNP

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California Highlights: Southern California

• $0 Premium in all three counties • Plans includes Dental, Hearing, & Vision benefits • 4 star plans • Over the Counter (OTC) Benefits on our HMO products • Transportation benefits • SilverSneakers – free fitness and gym membership • $0 Tier 1 & 2 Rx Benefits if member uses Humana Mail order for 90 day supply

Benefit Highlights

• Orange County: HealthCare Partners, Prospect Medical Group, Monarch HealthCare, Memorial Care Medical Group • Riverside: PrimeCare, Riverside Medical Clinic, Empire Medical Group & Hemet Community Medical Group • San Diego: UCSD, Greater Tri-Cities Medical Group, Mercy Physicians Medical Group & Scripps Physicians Medical Group • Strong Relationships with Providers

Network Highlights

• 19,239 Members Strong and Growing • Over 54,000 PDP members • 4 Local Market offices and Support Team for Broker assistance • Year Round Selling opportunities: Dual Eligible Look-Alike Plan available with great ancillary benefits


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Arizona Highlights: Maricopa (partial Pinal for HMO)

• 2, $0 HMO Premium plans and 1 HMO plan with a premium • LPPO plan available to give Beneficiaries more choice for Out of Network opportunities • Plans includes Dental, Hearing & Vision benefits • HMO’s are 4 STAR plans • Over the Counter (OTC) Benefits on our HMO products • SilverSneakers – free fitness/gym membership • Well Dine – meals delivered after a hospital stay • Telemedicine • $0 Tier 1 & 2 Rx Benefits if member uses Humana Pharmacy Mail order for 90 day supply • Fixed copays on HMO and LPPO plan for Hearing Aids (starting at $399 for the new Maricopa HMO, H2649-063)

Benefit Highlights

• Hospitals: Banner, Tenet, Honor (Scottsdale – Lincoln), Iasis • All hospitals participate in our HMO, LPPO, PFFS and RPPO plans • Key provider is IORA and overall we have an excellent PCP and Specialist network • NO “silos” in our networks – members can go anywhere in network

Network Highlights

• Strong membership statewide with expected increases for 2018 • Strong brand recognition in Market • Local Market office and Support Team – “Red Carpet Concierge Service”


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Arizona Highlights: Maricopa (partial Pinal for HMO)

Gold Plus HMO

$0 Premium MOOP: $3,200 PCP: Pref/$0* Non Pref/$20 SPEC: $25 Inpatient: $175 day/1-5 Rx Included Contract/PBP: H2649-063 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Maricopa and partial Pinal *IORA and Banner Providers

Gold Plus HMO

$0 Premium MOOP: $5,500 PCP: $0 SPEC: $35 Inpatient: $225 day/1-7 Rx Included Contract/PBP: H2649-032 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Maricopa and partial Pinal

Gold Plus HMO

$85.00 Premium MOOP: $4,900 PCP: $5 SPEC: $45 Inpatient: $289 day/1-6 Rx Included Contract/PBP: H2649-030 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Maricopa and partial Pinal

Choice

$125.00 Premium MOOP: $6,700 (in network) PCP: $5 SPEC: $45 Inpatient: $289 day/1-6 Rx Included Contract/PBP: H5216-034 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Maricopa, Pinal, Pima and Santa Cruz

HMO HMO HMO Local PPO

New Plan for 2018

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Texas Highlights: West Texas Abilene, Amarillo, Austin, Corpus Christi, Laredo, Lubbock, Midland-Odessa,

Rio Grande Valley, San Antonio, Waco

Humana Gold Plus- San

Antonio $0 Premium MOOP: $3,400 PCP $0/SPEC $25 Inpatient: $100 days 1-7 Rx Included Embedded Dental, Vision and Hearing Contract/PBP: H2649-046 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson

Humana Gold Plus –

Corpus Christi $0 Premium MOOP: $3,400 PCP $0/SPEC $25 Inpatient: $50 days 1-5 Rx Included Embedded Dental, Vision and Hearing Contract/PBP: H2649-045 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Aransas, Bee, Jim Wells, Kleberg, Nueces, San Patricio

HMO - Austin

$0 Premium MOOP: $6,700 PCP $0/SPEC $45 Inpatient:$260 days 1-5 Rx Included Embedded Dental, Vision and Hearing Contract/PBP: H2649-051 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Hays, Travis, Williamson

Dual Eligible SNP

$0 Premium MOOP: $0 PCP $0/SPEC $0 Inpatient: $0 Rx Included Embedded Dental, Vision and Hearing Contract/PBP: H2649-050 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson, Aransas, Bee, Jim Wells, Kleberg, Nueces, San Patricio

HMO HMO HMO Local PPO

PDP

HMO

SNP

Regional PPO

PFFS

DSNP HMO

Medicare Supplement

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Texas Highlights: West Texas Abilene, Amarillo, Austin, Corpus Christi, Laredo, Lubbock, Midland-Odessa,

Rio Grande Valley, San Antonio, Waco

Humana Gold Plus- San

Antonio CSNP $0 Premium MOOP: $5,900 PCP $0/SPEC $40 Inpatient: $100 days 1-7 Rx Included Embedded Dental, Vision and Hearing Contract/PBP: H2649-054 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties : Atascosa, Bandera, Bexar, Comal, Kendall, Wilson

Humana Gold Plus- Corpus

Christi $0 Premium MOOP: $4,400 PCP $0/SPEC $25 Inpatient: $50 days 1-5 Rx Included Embedded Dental, Vision and Hearing Contract/PBP: H2649-053 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Kleberg, Nueces, San Patricio

Humana Choice PPO

$0 Premium MOOP: $5,400 PCP $10/SPEC $35 Inpatient: $295 days 1-5 Rx Not Included $40 Part B Giveback Embedded Vision Contract/PBP: H5216-128 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Available in 102 select counties throughout Texas

Humana Choice PPO

$17 Premium MOOP: $6,700 PCP $5/SPEC $35 Inpatient: $325 days 1-5 Rx Included Embedded Dental and Vision Contract/PBP: H5216-043-001 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Available in 76 select counties throughout Texas

CSNP HMO CSNP HMO LPPO LPPO

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Northeast Texas Highlights: Dallas Fort Worth

Gold Choice HMO

$0 Premium MOOP: $4,900 PCP/SPEC: $0/$25 Inpatient: $200 days 1-7 Rx Included Contract/PBP: H2649-065-001 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Dallas, Collin, Denton, Tarrant, Wise, Ellis, Johnson

HumanaChoice

LPPO $17 Premium MOOP: 6,700 PCP/SPEC: $5/$35 Inpatient: $325 days 1-5 Rx Included Contract/PBP: H2516-043-001 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Select Counties in Texas, mostly metro areas

Humana Gold Plus

SNP-DE $$27.50 Premium waived by Dual Eligibility MOOP: $6,700 PCP/SPEC: $0/$0 Inpatient: $0 Rx Included Contract/PBP: H2649-048 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Bowie, Cass, Collin, Dallas, Delta, El Paso, Ellis, Fannin, Fort Bend, Gregg, Harris, Harrison, Johnson, Montgomery, Red River, Rockwall, Tarrant, Titus, Wise

HumanaChoice

RPPO $48 Premium MOOP: $6,700/$10,000 PCP/SPEC: $25/$45 Inpatient: $360 Days 1-4 Rx Included Contract/PBP: R5826-091 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: State of Texas

HMO Local PPO

PDP

HMO

SNP

Regional PPO

PFFS

Regional PPO

Medicare Supplement

Local PPO

HumanaChoice LPPO MA-Only

$0 Premium MOOP: $5,400/$6,700 PCP/SPEC: $10/$35 Inpatient: $295 days 1-5 Contract/PBP: H5216-128 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: 110 select counties throughout the State of TX

Local PPO HMO

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Northeast Texas Highlights: Houston

Gold Choice HMO

$0 Premium MOOP: $3,400 PCP/SPEC: $0/$35 Inpatient: $350 per admit Rx Included Contract/PBP: H2649-064 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Fort Bend, Harris, Jefferson, Montgomery

HumanaChoice

LPPO $17 Premium MOOP: 6,700 PCP/SPEC: $5/$35 Inpatient: $325 days 1-5 Rx Included Contract/PBP: H2516-043-001 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties :Select Counties in Texas, mostly metro areas

Humana Gold Plus

SNP-DE $$27.50 Premium waived by Dual Eligibility MOOP: $6,700 PCP/SPEC: $0/$0 Inpatient: $0 Rx Included Contract/PBP: H2649-048 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Bowie, Cass, Collin, Dallas, Delta, El Paso, Ellis, Fannin, Fort Bend, Gregg, Harris, Harrison, Johnson, Montgomery, Red River, Rockwall, Tarrant, Titus, Wise

HumanaChoice

RPPO $48 Premium MOOP: $6,700/$10,000 PCP/SPEC: $25/$45 Inpatient: $360 Days 1-4 Rx Included Contract/PBP: R5826-091 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: State of Texas

HMO Local PPO

PDP

HMO

SNP

Regional PPO

PFFS

Regional PPO

Medicare Supplement

HumanaChoice LPPO MA-Only

$0 Premium MOOP: $5,400/$6,700 PCP/SPEC: $10/$35 Inpatient: $295 days 1-5 Contract/PBP: H5216-128 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: 110 select counties throughout the State of TX

Local PPO HMO

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Texas Highlights: El Paso

El Paso HMO

$0 Premium MOOP: $3,400 PCP/SPEC: $0/$30 Inpatient: $125 days 1-5 Rx Included or No Rx: Included Contract/PBP: H2649-049 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: El Paso

Dual SNP

$0 Premium MOOP: $6,700 PCP/SPEC: $0/$0 Inpatient: $0 Rx Included or No Rx: Included Contract/PBP: H2649-048 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: El Paso

Plan Name

$17 Premium MOOP: $6,700 PCP/SPEC: $5/$35 Inpatient: $325 per day, Days 1-5 Rx Included or No Rx: Included Contract/PBP: H5216-043-001 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: El Paso

Plan Name

$48 Premium MOOP: $6,700 PCP/SPEC: $25/$45 Inpatient: $360/5 Rx Included or No Rx: Included Contract/PBP: H5826-091 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: El Paso

HMO SNP Local PPO Local PPO

PDP

HMO

SNP

Regional PPO

PFFS

Regional PPO

Medicare Supplement

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New Mexico Highlights

Albuquerque HMO

$0 Premium MOOP: $4,500 PCP/SPEC: $0/$40 Inpatient: $295 per day, days 1-5 Rx Included or No Rx: Included Contract/PBP: H2649-029 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Bernalillo, Sandoval, Santa Fe, Torrance, Valencia

NM LPPO

$27 Premium MOOP: $6,700 PCP/SPEC: $0/$50 Inpatient: $345 per day, days 1-5 Rx Included or No Rx: Included Contract/PBP: H5216-079 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Bernalillo, Catron, Cibola, Colfax, Curry, Grant, Lincoln, Los Alamos, McKinley, Rio Arriba, Sandoval, San Miguel, Santa Fe, Sierra, Taos, Torrance, Valencia, Chavez (Expansion))

Southern NM LPPO (New)

$0 Premium w $40 part B giveback MOOP: $6,700 PCP/SPEC: $20/$50 Inpatient: $600 per day, days 1-3 Rx Included or No Rx: Included Contract/PBP: H5216- Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Dona Ana, Luna, Otero, Chaves (Expansion)

HMO Local PPO Local PPO Local PPO

PDP

HMO

SNP

Regional PPO

PFFS

Medicare Supplement

NM MA-Only LPPO

$0 Premium MOOP: $4,900 PCP/SPEC: $0/$30 Inpatient: $300 per day, days 1-5 Rx Included or No Rx: No RX Contract/PBP: H5216-077 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Doña Ana, Luna, Otero, Bernalillo, Catron, Cibola, Colfax, Curry, Grant, Lincoln, Los Alamos, McKinley, Rio Arriba, Sandoval, San Miguel, Santa Fe, Sierra, Taos, Torrance, Valencia

Local PPO

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Colorado Highlights

Colorado $0 HMO

$0 Premium MOOP: $6,200 PCP/SPEC: $0/$50 Inpatient: $325 per day, days 1-5 Rx Included or No Rx: Included Contract/PBP: H2649-043 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Adams, Arapahoe, Boulder, Broomfield, Clear Creek, Denver, Douglas, El Paso, Elbert, Fremont, Jefferson, Larimer, Pueblo, Teller, Weld,

CO Premium HMO

Non Denver $38 Premium MOOP: $5,500 PCP/SPEC: $0/$45 Inpatient: $240 per day, days 1-5 Rx Included or No Rx: Included Contract/PBP: H2649-061-002 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Boulder, Clear Creek, El Paso, Elbert, Fremont, Larimer, Pueblo, Teller, Weld

CO Springs / Western

Slope LPPO (New) $19 Premium MOOP: $6,700 PCP/SPEC: $0/$40 Inpatient: $325 per day, days 1-5 Rx Included or No Rx: Included Contract/PBP: H5216-078-002 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: El Paso, Teller, Delta, Mesa, Montrose

Colorado LPPO

$69 Premium MOOP: $6,700 PCP/SPEC: $10/$50 Inpatient: $325 per day, days 1-5 Rx Included or No Rx: Included Contract/PBP: H5216-078-001 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Adams, Alamosa, Arapahoe, Archuleta, Boulder, Broomfield, Chaffee, Clear Creek, Conejos, Costilla, Crowley, Custer, Denver, Douglas, Elbert, Fremont, Gilpin, Grand, Huerfano, Jefferson, Larimer, Las Animas, Logan, Morgan, Otero, Park, Pueblo, Weld

HMO HMO Local PPO Local PPO

PDP

HMO

SNP

Regional PPO

PFFS

Local PPO

Medicare Supplement

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Colorado Highlights

Local PPO

PDP

HMO

SNP

Regional PPO

PFFS

Medicare Supplement

CO Medicaid Only HMO (Designed for Full Duals)

$26.20 Premium (No cost to Full Duals) MOOP: $6,700 (No cost to Full Duals) PCP/SPEC: $0/$45 (No cost to Full Duals) Inpatient: $600 per day, days 1-3 (No cost to Full Duals) Rx Included or No Rx: Included Contract/PBP: H2649-643 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Adams, Arapahoe, Denver, Douglas, Jefferson

HMO

CO MA-Only LPPO $0 Premium MOOP: $4,900 PCP/SPEC: $0/$30 Inpatient: $300 per day, days 1-5 Rx Included or No Rx: No RX Contract/PBP: H5216-077 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Adams, Alamosa, Arapahoe, Archuleta, Boulder, Broomfield, Chaffee, Clear Creek, Conejos, Costilla, Crowley, Custer, Delta, Denver, Douglas, El Paso, Elbert, Fremont, Gilpin, Grand, Huerfano, Jefferson, Larimer, Las Animas, Logan, Mesa, Montrose, Morgan, Otero, Park, Pueblo, Teller, Weld

Local PPO

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Washington Highlights: King County

Humana Gold Plus

H5619-057

$0 Premium MOOP: $6,700 PCP/SPEC: $0/$45 Inpatient: $450 days 1-4 Rx Included: $150 Ded T3,T4,T5 Only 2/8/47/100/30% Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: King

Humana Gold Plus

H5619-097

$35 Premium MOOP: $5,000 PCP/SPEC: $0/$40 Inpatient: $345 days 1-5 Rx Included: $100 Ded T3,T4,T5 Only 2/8/47/100/31% Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: King

Humana Choice

H5216-046

$0 Premium MOOP: $3,600 / $4,500 PCP/SPEC: $10/$25 Inpatient: $275 days 1-5 No Rx: MA Only Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Clark, Cowlitz, Island, King, Kitsap, Kittitas, Pierce, Snohomish, Spokane, Thurston, Walla Walla

HMO HMO Local PPO

HMO

SNP

Local PPO

Humana Gold Plus

H5619-057

$0 Premium MOOP: $6,700 PCP/SPEC: $0/$0 Inpatient: $0 Rx Included: Copays vary by level of assistance Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Pierce, King, Snohomish Cost Share Protected – SLMB +, QMB, and QMB+

HMO DE SNP

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Washington Highlights: Kitsap County

Humana Gold Plus

H5619-099

$19 Premium MOOP: $6,700 PCP/SPEC: $10/$50 Inpatient: $450 days 1-4 Rx Included: $200 Ded T3,T4,T5 Only 4/15/47/100/29% Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Kitsap

Humana Gold Plus

H5619-104

$49 Premium MOOP: $5,000 PCP/SPEC: $0/$40 Inpatient: $345 days 1-5 Rx Included: $160 Ded T3,T4,T5 Only 4/15/47/100/30% Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Kitsap

Humana Choice

H5216-046


Humana Choice

H5216-047

$102 Premium MOOP: $6,700 / $10,000 PCP/SPEC: $10/$45 Inpatient: $300 days 1-5 Rx Included: $320 Ded T3,T4,T5 Only 4/15/47/100/26% Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Clark, Cowlitz, Island, King, Kitsap, Kittitas, Snohomish, Spokane, Walla Walla

HMO HMO

Local PPO

HMO

Local PPO Local PPO

19


Washington Highlights: Pierce County

Humana Gold Plus

H5619-100

$19 Premium MOOP: $6,700 PCP/SPEC: $10/$50 Inpatient: $450 days 1-4 Rx Included: $125 Ded T3,T4,T5 Only 2/8/47/100/30% Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Pierce

Humana Gold Plus

H5619-061

$49 Premium MOOP: $5,000 PCP/SPEC: $0/$40 Inpatient: $345 days 1-5 Rx Included: $100 Ded T3,T4,T5 Only 2/8/47/100/31% Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Pierce

Humana Choice

H5216-046


HMO HMO Local PPO

HMO

SNP

Local PPO

Humana Gold Plus

H5619-057


HMO DE SNP

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Washington Highlights: Snohomish County

Humana Gold Plus

H5619-063

$0 Premium MOOP: $6,700 PCP/SPEC: $10/$50 Inpatient: $450 days 1-4 Rx Included: $200 Ded T3,T4,T5 Only 2/8/47/100/30% Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Snohomish

Humana Gold Plus

H5619-059

$35 Premium MOOP: $5,000 PCP/SPEC: $0/$40 Inpatient: $345 days 1-5 Rx Included: $160 Ded T3,T4,T5 Only 2/8/47/100/31% Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Snohomish

Humana Choice

H5216-046


HMO HMO Local PPO

HMO

SNP

Local PPO

Humana Gold Plus

H5619-057


HMO DE SNP

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Oregon Highlights: Central OR

Humana Gold Plus

H1036-219

$71 Premium MOOP: $5,700 PCP/SPEC: $10/$40 Inpatient: $395 days 1-4 Rx Included $200 Ded T3,T4,T5 Only 4/15/47/100/29% Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Deschutes, Jefferson

Humana Choice

H5216-046

$0 Premium MOOP: $3,600 / $4,500 PCP/SPEC: $10/$25 Inpatient: $275 days 1-5 No Rx: MA Only Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Benton, Clackamas, Columbia, Crook, Deschutes, Hood River, Jefferson, Lincoln, Linn, Multnomah, Washington

Humana Choice

H5216-047

$102 Premium MOOP: $6,700 / $10,000 PCP/SPEC: $10/$45 Inpatient: $300 days 1-5 Rx Included $320 Ded T3,T4,T5 Only 4/15/47/100/26% Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Crook, Deschutes, Jefferson

HMO Local PPO

Local PPO

HMO

Local PPO

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Oregon Highlights: Portland Area

Humana Gold Plus

H1036-153

$0 Premium MOOP: $5,700 PCP/SPEC: $0/$40 Inpatient: $430 days 1-4 Rx Included $200 Ded T3,T4,T5 Only 4/15/47/100/29% Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Multnomah, Clackamas, Washington

Humana Choice

H5216-046 $0 Premium MOOP: $3,600 / $4,500 PCP/SPEC: $10/$25 Inpatient: $275 days 1-5 No Rx: MA Only Contract/PBP: H0000-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Benton, Clackamas, Columbia, Crook, Deschutes, Hood River, Jefferson, Lincoln, Linn, Multnomah, Washington

HMO Local PPO

Local PPO

HMO

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Nevada Highlights: Clark & Nye County

Humana Gold Plus

Premium: $0 MOOP: $1,900 PCP: $0 SPEC: $10 Inpatient: $0 DAYS 1-3 Rx: $2/$8/$47/$100– improved formulary Transportation: 12 one-way trips Vision, dental, fitness, OTC, hearing & Go365 wellness incentives included Contract/PBP: H6622-028-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Clark, Nye (4 zips in Nye )

Cardiovascular Disease, Chronic Heart

Failure or Diabetes Premium: $0 MOOP: $1,900 PCP $0 SPEC: $0 Inpatient: $0 days 1-3 Rx: $5/$6/$40/$80 Transportation: 50 one-way trips Vision, dental, fitness, OTC, hearing & Go365 wellness incentives included Contract/PBP: H6622-029-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Clark & Nye (4 zips in Nye)

HMO HMO Special Needs Plan (SNP) Local PPO

PDP

HMO

SNP

Medicare Supplement

Chronic Lung Diseases

Premium: $0 MOOP: $1,900 PCP $0 SPEC: $0 Inpatient: $0 days 1-3 Rx: $1/$2/$40/$80 Transportation: 50 one-way trips Vision, dental, fitness, OTC, hearing & Go365 wellness incentives included Contract/PBP: H6622-030-000 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Clark & Nye (4 zips in Nye)

HMO Special Needs Plan (SNP)

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Nevada Highlights: Clark & Nye County

HumanaChoice PPO

Part B Premium Give Back Plan $0 Premium $50 Member Part B monthly premium reduction MOOP: $6,700 PCP: $5 SPEC: $45 Inpatient: $450 Days 1-4 Rx: $5/$13/$47/$100; $385 deductible, Tiers 3-5 only Routine vision, hearing, fitness, and Go365 wellness incentives included. Buy-up dental plan available Contract/PBP: H5216-141 Group ID: To be provided between late Sept. & 10/1 BSN: To be provided between late Sept. & 10/1 Serving Counties: Clark & Nye (4 zips in Nye )

New PPO Part B Give Back

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Idaho Highlights: Northern Idaho - Coeur d'Alene

Humana Gold Plus

Premium: $59 MOOP: $6,000 PCP / SPEC: $10 / $50 Inpatient: $450 / 1-4 Days Outpatient: $200 / 20% Rx: $320 Ded. Excludes T1 & T2 $4/$15/$47/$100/26% Contract/PBP: H5619-078 Group ID: To be provided BSN: To be provided Serving Counties: Bonner, Kootenai

Humana Choice

Premium: $56 MOOP: $6,000 / $9,000 PCP / SPEC: $10 / $40 Inpatient: $ 360/ 1-5 Days Outpatient: $200 / 20% Rx: $250 Ded. Excludes T1 & T2 $4/$15/$47/$100/28% Contract/PBP: H5216-044 Group ID: To be provided BSN: To be provided Serving Counties: Ada, Boise, Bonner, Canyon, Gem, Kootenai, Payette, ID. Malheur, OR

Humana Choice

Premium: $ 0 MOOP: $3,600 / $4,500 PCP / SPEC: $10 / $25 Inpatient: $275 / 1-5 Days Outpatient: 20% No Rx Contract/PBP: H5216-046 Group ID: To be provided BSN: To be provided Serving Counties: Ada, Boise, Bonner, Canyon, Gem, Kootenai, Payette, ID. Malheur, OR

HMO

Local PPO

HMO

Regional PPO Local PPO (MA Only) Local PPO

****All plans include MSB’s: SilverSneakers, 24 Hour Nurse Hotline, Go365, and Well Dine

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Idaho Highlights: Treasure Valley

Humana Gold Plus Premium: $0 MOOP: $6,700 PCP / SPEC: $5 / $50 Inpatient: $450 / 1-4 Days Outpatient: $200 / 20% Rx: $150 Ded. Excludes T1 & T2 $2/$8/$47/$100/30% Contract/PBP: H5619-079 Group ID: To be provided BSN: To be provided Serving Counties: Ada, Canyon, Payette

Humana Choice Premium: $33 MOOP: $5,000 PCP / SPEC: $0 / $40 Inpatient: $350/ 1-5 Days Outpatient: $200 / 20% Rx: $100 Ded. Excludes T1 & T2 $2/$8/$47/$100/31% Contract/PBP: H5619-077 Group ID: To be provided BSN: To be provided Serving Counties: Ada, Canyon, Payette

HMO HMO

HMO


27


Idaho Highlights: Treasure Valley

Humana Choice Premium: $56 MOOP: $6,000 / $9,000 PCP / SPEC: $10 / $40 Inpatient: $360/ 1-5 Days Outpatient: $200 / 20% Rx: $ 250 Ded. Excludes T1 & T2 $ 4/$15/$47/$100/28% Contract/PBP: H216-044 Group ID: To be provided BSN: To be provided Serving Counties: Ada, Boise, Bonner, Canyon, Gem, Kootenai, Payette, ID. Malheur, OR

Humana Choice

Premium: $46 MOOP: $4,000 / $9,000 PCP / SPEC: $5 / $35 Inpatient: $225/ 1-6 Days Outpatient: $200 / 20% Rx: $ 160 Ded. Excludes T1 & T2 $ 4/$15/$47/$100/30% Contract/PBP: H5216-132 Group ID: To be provided BSN: To be provided Serving Counties: Ada, Boise, Canyon, Gem, Payette, ID. Malheur, OR

Humana Choice

Premium: $0 MOOP: $3,600 / $4,500 PCP / SPEC: $10 / $25 Inpatient: $275 / 1-5 Days Outpatient: 20% No Rx Contract/PBP: H5216-046 Group ID: To be provided BSN: To be provided Serving Counties: Ada, Boise, Bonner, Canyon, Gem, Kootenai, Payette, ID. Malheur, OR

Local PPO

Regional PPO Local PPO (MA Only) Local PPO


Local PPO

28

Utah Highlights: Wasatch Front

• NEW $0 PPO with Rx, a $0 PCP copay, Dental, Vision and Hearing • MD Live Telemedicine- Gives your member access to a virtual doctor visit anywhere, anytime • SilverSneakers – No cost gym membership nationwide • Acupuncture – Great benefit for those seeking alternative care • Humana Mail order Pharmacy - $0 copay on T1 and T2 with a 90 day supply • All plans included a over the counter wellness Benefit • 3 Strong $0 premium plans- HMO, PPO and MA only PPO

Benefit Highlights

Hospital • Mountain Star- Ogden Regional, Lakeview, St. Marks, Lone Peak, Timpanogos, Mountain View • IASIS- Davis, Salt lake Regional, Jordan Valley, Jordan Valley West, Mountain Point Larger Providers • Ogden Clinic, Tanner Clinic, Exodus, Grainger, Revere and much more

Network Highlights

** Market expansion into Utah county • Only $0 Premium PPO in the market • All plans rich in additional benefits • Local Market office and Support Team • Strongest Wellness benefits including the GO365 rewards program


29


Utah Highlights: Wasatch Front

Humana Gold Plus

Premium: $0 MOOP: $6,700 PCP / SPEC: $0 / $45 Inpatient: $450 / 1-4 Days Outpatient: $200 / 20% Rx: $400 Ded. Excludes T1 & T2 $4/$15/$47/$100/25% Contract/PBP: H2486-003 Group ID: To be provided BSN: To be provided Serving Counties: Davis, Salt Lake, Utah, Weber

Humana Choice

Premium: $0 MOOP: $5,000 / $10,000 PCP / SPEC: $0 / $45 Inpatient: $300 / 1-6 Days Outpatient: $200 / 20% Rx: $ 200 Ded. Excludes T1 & T2 $4/$15/$47/$100/29% Contract/PBP: H5216-131 Group ID: To be provided BSN: To be provided Serving Counties: Davis, Salt Lake, Utah, Weber

Humana Choice Premium: $0 MOOP: $3,600 / $4,500 PCP / SPEC: $10 / $25 Inpatient: $275 / 1-5 Days Outpatient: 20% No Rx Contract/PBP: H5216-046 Group ID: To be provided BSN: To be provided Serving Counties: Davis, Salt Lake, Utah, Weber

HMO

Local PPO

HMO

Regional PPO Local PPO MA only Local PPO


30

Hawaii Highlights: Hawaii

• $0 Premium • Plans includes Hearing, & Vision benefits • Acupuncture benefit • Over the Counter (OTC) Benefits • SilverSneakers – free fitness and gym membership • 24-hour nurse advice line • $0 Tier 1 & 2 Rx Benefits if member uses Humana Mail order for 90 day supply

Benefit Highlights

• MDX Hawaii Network • All Hospitals participate in our HMO Plan • Strong Relationships with Providers

Network Highlights

• 16,000 Members Strong & Growing • Member Stability with Minor Plan Changes • Enhanced Brand Recognition In Market • Exceptional Member Experience • Effective Grassroots Efforts in the Community


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northern california highlights: king and...

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