HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Adair |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Allamakee |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Appanoose |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Audubon |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Buena Vista |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Butler |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Calhoun |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Carroll |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Cass |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Cerro Gordo |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Cherokee |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Clayton |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Clinton |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Crawford |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Davis |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Decatur |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Dickinson |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Emmet |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Floyd |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Franklin |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Fremont |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Grundy |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Hamilton |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Hancock |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Hardin |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Harrison |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Henry |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Humboldt |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Ida |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Jackson |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Jefferson |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Keokuk |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Kossuth |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Lee |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Lucas |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Lyon |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Mahaska |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Mills |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Monona |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Monroe |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
O'Brien |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Osceola |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Page |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Palo Alto |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Plymouth |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Pocahontas |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Poweshiek |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Ringgold |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Sac |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Sioux |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Tama |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Union |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Van Buren |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Wapello |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Wayne |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Webster |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Winnebago |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $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 H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Winneshiek |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Woodbury |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Worth |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $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 H6609-140 (PPO) in IA - H6609-140-0
Benefit Details
|
Wright |
$55.00 |
$320 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|