HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Aitkin |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Anoka |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Becker |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Beltrami |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Benton |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Carlton |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Carver |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Cass |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Chisago |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Clay |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Clearwater |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Crow Wing |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Dakota |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Douglas |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Hennepin |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Hubbard |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Isanti |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Itasca |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Kanabec |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Lake |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Lake of the Woods |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Mahnomen |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Marshall |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
McLeod |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Meeker |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Mille Lacs |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Morrison |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Norman |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Otter Tail |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Pennington |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Pine |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Polk |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Ramsey |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Red Lake |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Redwood |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Roseau |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Scott |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Sherburne |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
St. Louis |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Stearns |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Todd |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Wadena |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Washington |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Wilkin |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-1
Benefit Details
|
Wright |
$69.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Blue Earth |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Brown |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Cottonwood |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Dodge |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
|
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Faribault |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
|
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Fillmore |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Freeborn |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
|
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Goodhue |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
|
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Houston |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Jackson |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
|
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Le Sueur |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
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HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Martin |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Mower |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
|
|
|
|
HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Nicollet |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
|
|
|
|
HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Olmsted |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Rice |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
|
|
|
|
HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Sibley |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
|
|
|
|
HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Steele |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Wabasha |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
|
|
|
|
HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Waseca |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
|
|
|
|
HumanaChoice H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Watonwan |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 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 H6609-142 (PPO) in MN - H6609-142-2
Benefit Details
|
Winona |
$71.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
| $5,900 Browse Formulary |
|
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