2013 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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HumanaChoice H6609-004 (PPO) in IA - H6609-004-0 Benefit Details |
Pottawattamie | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Burt | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Butler | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Cass | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Colfax | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Cuming | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Dodge | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Lancaster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Otoe | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Sarpy | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Saunders | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Seward | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in NE - H6609-004-0 Benefit Details |
Washington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Adams | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Barnes | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Benson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Billings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Burleigh | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Cass | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Cavalier | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Dickey | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Dunn | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Eddy | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Emmons | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Foster | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Golden Valley | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Grand Forks | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Grant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Griggs | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Hettinger | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Kidder | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
LaMoure | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Logan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
McIntosh | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
McLean | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Mercer | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Morton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Nelson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Oliver | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Pembina | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Ramsey | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Ransom | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Richland | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Sargent | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Sheridan | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Sioux | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Steele | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Stutsman | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Towner | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Traill | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Walsh | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in ND - H6609-004-0 Benefit Details |
Wells | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Aurora | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Beadle | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Bennett | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Bon Homme | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Brookings | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Brown | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Brule | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Buffalo | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Butte | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Campbell | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Charles Mix | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Clark | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Clay | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Codington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Corson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Custer | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Davison | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Day | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Deuel | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Dewey | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Douglas | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Edmunds | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Fall River | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Faulk | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Grant | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Gregory | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Haakon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Hamlin | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Hand | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Hanson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Hughes | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Hutchinson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Hyde | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Jackson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Jerauld | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Jones | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Kingsbury | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Lake | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Lawrence | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Lincoln | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Lyman | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Marshall | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
McCook | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
McPherson | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Meade | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Mellette | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Miner | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Minnehaha | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Moody | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Pennington | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Perkins | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Potter | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Roberts | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Sanborn | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Shannon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Spink | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Stanley | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Sully | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Tripp | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Turner | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Union | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Walworth | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
HumanaChoice H6609-004 (PPO) in SD - H6609-004-0 Benefit Details |
Yankton | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,000 | ||||||
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