HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Autauga |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Baldwin |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Barbour |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Bibb |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Blount |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Bullock |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Butler |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Calhoun |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Chambers |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Cherokee |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Chilton |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Choctaw |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Clarke |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Clay |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Cleburne |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Coffee |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Colbert |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Conecuh |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Coosa |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Covington |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Crenshaw |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Cullman |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Dale |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Dallas |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
DeKalb |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Elmore |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Escambia |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Etowah |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Fayette |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Franklin |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Geneva |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Greene |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Hale |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Henry |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Houston |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Jackson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Jefferson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Lamar |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Lauderdale |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Lawrence |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Lee |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Limestone |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Lowndes |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Macon |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Madison |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Marengo |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Marion |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Marshall |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Mobile |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Monroe |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Montgomery |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Morgan |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Perry |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Pickens |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Pike |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Randolph |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Russell |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Shelby |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
St. Clair |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Sumter |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Talladega |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Tallapoosa |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Tuscaloosa |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Walker |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Washington |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Wilcox |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in AL - R5826-001-0
Benefit Details
|
Winston |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Anderson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Bedford |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Benton |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Bledsoe |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Blount |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Bradley |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Campbell |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Cannon |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Carroll |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Carter |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Cheatham |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Chester |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Claiborne |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Clay |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Cocke |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Coffee |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Crockett |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Cumberland |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Davidson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Decatur |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
DeKalb |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Dickson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Dyer |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Fayette |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Fentress |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Franklin |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Gibson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Giles |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Grainger |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Greene |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Grundy |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Hamblen |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Hamilton |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Hancock |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Hardeman |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Hardin |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Hawkins |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Haywood |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Henderson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Henry |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Hickman |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Houston |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Humphreys |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Jackson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Jefferson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Johnson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Knox |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Lake |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Lauderdale |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Lawrence |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Lewis |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Lincoln |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Loudon |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Macon |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Madison |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Marion |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Marshall |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Maury |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
McMinn |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
McNairy |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Meigs |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Monroe |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Montgomery |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Moore |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Morgan |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Obion |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Overton |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Perry |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Pickett |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Polk |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Putnam |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Rhea |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Roane |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Robertson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Rutherford |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Scott |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Sequatchie |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Sevier |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Shelby |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Smith |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Stewart |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Sullivan |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Sumner |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Tipton |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Trousdale |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Unicoi |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Union |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Van Buren |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Warren |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Washington |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Wayne |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Weakley |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 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 R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
White |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Williamson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
|
HumanaChoice R5826-001 (Regional PPO) in TN - R5826-001-0
Benefit Details
|
Wilson |
$75.00 |
$360 |
Yes, some additional gap coverage. | Preferred Generic: $4.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
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