HumanaChoice H6609-120 (PPO) in AL - H6609-120-0
Benefit Details
|
Chambers |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in AL - H6609-120-0
Benefit Details
|
Lee |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in AL - H6609-120-0
Benefit Details
|
Randolph |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in AL - H6609-120-0
Benefit Details
|
Russell |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Bryan |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Bulloch |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Burke |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Camden |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Chatham |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Chattahoochee |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Clarke |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Columbia |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Effingham |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Elbert |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Evans |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Franklin |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Glascock |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Glynn |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Greene |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Habersham |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Hancock |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Harris |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Hart |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Jackson |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Jefferson |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Lumpkin |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
McDuffie |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
McIntosh |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Madison |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Marion |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Morgan |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Muscogee |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Oconee |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Oglethorpe |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Rabun |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Randolph |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Richmond |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Screven |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Stephens |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Stewart |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Talbot |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Taliaferro |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Towns |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Union |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Warren |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Washington |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Webster |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H6609-120 (PPO) in GA - H6609-120-0
Benefit Details
|
Wilkes |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H6609-120 (PPO) in SC - H6609-120-0
Benefit Details
|
Aiken |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
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HumanaChoice H6609-120 (PPO) in SC - H6609-120-0
Benefit Details
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Barnwell |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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HumanaChoice H6609-120 (PPO) in SC - H6609-120-0
Benefit Details
|
Newberry |
$47.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $5.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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