HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Adjuntas |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Aguada |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Aguadilla |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Aguas Buenas |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Aibonito |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Anasco |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Arecibo |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Arroyo |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Barceloneta |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Barranquitas |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Bayamon |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Cabo Rojo |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Caguas |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Camuy |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Canovanas |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Carolina |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Catano |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Cayey |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Ceiba |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Ciales |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Cidra |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Coamo |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Comerio |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Corozal |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Culebra |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Dorado |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Fajardo |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Florida |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Guanica |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Guayama |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Guayanilla |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Guaynabo |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Gurabo |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Hatillo |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Hormigueros |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Humacao |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Isabela |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Jayuya |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Juana Diaz |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Juncos |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Lajas |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Lares |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Las Marias |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Las Piedras |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Loiza |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Luquillo |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Manati |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Maricao |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Maunabo |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Mayaguez |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Moca |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Morovis |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Naguabo |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
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HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Naranjito |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Orocovis |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Patillas |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Penuelas |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Ponce |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Quebradillas |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Rincon |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Rio Grande |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Sabana Grande |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Salinas |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
San German |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
San Juan |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
San Lorenzo |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
San Sebastian |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Santa Isabel |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Toa Alta |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Toa Baja |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Trujillo Alto |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Utuado |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Vega Alta |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Vega Baja |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Vieques |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 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 Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Villalba |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Yabucoa |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
-- |
|
|
HumanaChoice Value H2029-001 (PPO) in PR - H2029-001-0
Benefit Details
|
Yauco |
$43.00 |
$360 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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|
|