HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Adams |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Alexander |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Bond |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Boone |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Brown |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Bureau |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Calhoun |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Carroll |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Cass |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Champaign |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Christian |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Clark |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Clay |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Clinton |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Coles |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Cook |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Crawford |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Cumberland |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
DeKalb |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
De Witt |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Douglas |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
DuPage |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Edgar |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Edwards |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Effingham |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Fayette |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Ford |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Franklin |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Fulton |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Gallatin |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Greene |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Grundy |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Hamilton |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Hancock |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Hardin |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Henderson |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Henry |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Iroquois |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Jackson |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Jasper |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Jefferson |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Jersey |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Jo Daviess |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Johnson |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Kane |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Kankakee |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Kendall |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Knox |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Lake |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
La Salle |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Lawrence |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Lee |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Livingston |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Logan |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
McDonough |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
McHenry |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
McLean |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Macon |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Macoupin |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Madison |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Marion |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Marshall |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Mason |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Massac |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Menard |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Mercer |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Monroe |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Montgomery |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Morgan |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Moultrie |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Ogle |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Peoria |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Perry |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Piatt |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Pike |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Pope |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Pulaski |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Putnam |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Randolph |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Richland |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Rock Island |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
St. Clair |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Saline |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Sangamon |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Schuyler |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Scott |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Shelby |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Stark |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Stephenson |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Tazewell |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Union |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Vermilion |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Wabash |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Warren |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Washington |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Wayne |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
White |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Whiteside |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Will |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Williamson |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Winnebago |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0
Benefit Details
|
Woodford |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Adams |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Ashland |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Barron |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Bayfield |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Brown |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Buffalo |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Burnett |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Calumet |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Chippewa |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Clark |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Columbia |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Crawford |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Dane |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Dodge |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Door |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Douglas |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Dunn |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Eau Claire |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Florence |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Fond du Lac |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Forest |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Grant |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Green |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Green Lake |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Iowa |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Iron |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Jackson |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Jefferson |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Juneau |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Kenosha |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Kewaunee |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
La Crosse |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Lafayette |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Langlade |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Lincoln |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Manitowoc |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Marathon |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Marinette |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Marquette |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Menominee |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Milwaukee |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Monroe |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Oconto |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Oneida |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Outagamie |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Ozaukee |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Pepin |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Pierce |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Polk |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Portage |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Price |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Racine |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Richland |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Rock |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Rusk |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
St. Croix |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Sauk |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Sawyer |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Shawano |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Sheboygan |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Taylor |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Trempealeau |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Vernon |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Vilas |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Walworth |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Washburn |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Washington |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Waukesha |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Waupaca |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% 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 R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Waushara |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Winnebago |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0
Benefit Details
|
Wood |
$135.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 20% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|