Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Adair |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Allen |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Barren |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 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 Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Bath |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Boyd |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Boyle |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Butler |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Carroll |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Carter |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 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 Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Casey |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Clay |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Clinton |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Crittenden |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Cumberland |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Edmonson |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Floyd |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Franklin |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Fulton |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Gallatin |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Grant |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Green |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Greenup |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Harlan |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Henry |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Hickman |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Jackson |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Johnson |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Knott |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Leslie |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Letcher |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Lincoln |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Livingston |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Logan |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Magoffin |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Marion |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Martin |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Meade |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Menifee |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Metcalfe |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Monroe |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Morgan |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Nelson |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Owen |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Owsley |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Pendleton |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 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 Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Perry |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Pike |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Powell |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Shelby |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Simpson |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Spencer |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Trimble |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Union |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Warren |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $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 |
Humana Value Plus H5216-115 (PPO) in KY - H5216-115-0
Benefit Details
|
Whitley |
$31.20 |
$260 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|