2014 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Acadia | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Allen | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Ascension | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Assumption | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Avoyelles | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Beauregard | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Bienville | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Bossier | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Caddo | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Calcasieu | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Caldwell | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Cameron | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Catahoula | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Claiborne | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Concordia | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
De Soto | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
East Baton Rouge | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
East Carroll | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
East Feliciana | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Evangeline | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Franklin | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Grant | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Iberia | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Iberville | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Jackson | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Jefferson | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Jefferson Davis | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
La Salle | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Lafayette | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Lafourche | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Lincoln | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Livingston | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Madison | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Morehouse | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Natchitoches | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Orleans | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Ouachita | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Plaquemines | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Pointe Coupee | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Rapides | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Red River | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Richland | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Sabine | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
St. Bernard | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
St. Charles | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
St. Helena | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
St. James | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
St. John the Baptist | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
St. Landry | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
St. Martin | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
St. Mary | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
St. Tammany | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Tangipahoa | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Tensas | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Terrebonne | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Union | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Vermilion | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Vernon | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Washington | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Webster | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
West Baton Rouge | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
West Carroll | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
West Feliciana | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in LA - R5826-011-0 Benefit Details |
Winn | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Adams | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Alcorn | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Amite | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Attala | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Benton | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Bolivar | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Calhoun | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Carroll | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Chickasaw | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Choctaw | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Claiborne | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Clarke | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Clay | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Coahoma | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Copiah | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Covington | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
DeSoto | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Forrest | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Franklin | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
George | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Greene | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Grenada | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Hancock | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Harrison | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Hinds | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Holmes | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Humphreys | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Issaquena | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Itawamba | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Jackson | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Jasper | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Jefferson | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Jefferson Davis | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Jones | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Kemper | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Lafayette | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Lamar | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Lauderdale | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Lawrence | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Leake | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Lee | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Leflore | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Lincoln | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Lowndes | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Madison | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Marion | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Marshall | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Monroe | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Montgomery | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Neshoba | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Newton | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Noxubee | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Oktibbeha | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Panola | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Pearl River | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Perry | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Pike | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Pontotoc | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Prentiss | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Quitman | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Rankin | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Scott | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Sharkey | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Simpson | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Smith | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Stone | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Sunflower | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Tallahatchie | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Tate | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Tippah | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Tishomingo | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Tunica | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Union | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Walthall | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Warren | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Washington | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Wayne | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Webster | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Wilkinson | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Winston | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Yalobusha | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
HumanaChoice R5826-011 (Regional PPO) in MS - R5826-011-0 Benefit Details |
Yazoo | $74.00 | $100 | Few Generics, Few Brands | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $6,700 Browse Formulary | |||||
|