Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Allegan |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Antrim |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Arenac |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Barry |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Berrien |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Calhoun |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Cass |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Chippewa |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Crawford |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Delta |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Dickinson |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Eaton |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Gogebic |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Grand Traverse |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Hillsdale |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Houghton |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Ingham |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Kalamazoo |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Kalkaska |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Kent |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Keweenaw |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Leelanau |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Lenawee |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Luce |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Mackinac |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Marquette |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Menominee |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Montcalm |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Muskegon |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Oceana |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Ontonagon |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Osceola |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Ottawa |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
St. Joseph |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Schoolcraft |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Shiawassee |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Van Buren |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in MI - H8145-006-0
Benefit Details
|
Wexford |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Adams |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Barron |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Brown |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Burnett |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Clark |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Dane |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Dodge |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Eau Claire |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Fond du Lac |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Forest |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Green Lake |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Jefferson |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Juneau |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Kenosha |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
La Crosse |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Lafayette |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Langlade |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Lincoln |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Manitowoc |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a 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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Marathon |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Marquette |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Milwaukee |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a 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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Oneida |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Outagamie |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Ozaukee |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a 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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Racine |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Richland |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Rusk |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a 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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Sauk |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Shawano |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Sheboygan |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a 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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Trempealeau |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Vilas |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Walworth |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a 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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Washington |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Waukesha |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Waupaca |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a 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 |
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Winnebago |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-006 (PFFS) in WI - H8145-006-0
Benefit Details
|
Wood |
$97.00 |
$400 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $6.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|