HumanaChoice R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Adams |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Alexander |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Bond |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Boone |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Brown |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Bureau |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Calhoun |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Carroll |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Cass |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Champaign |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Christian |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Clark |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Clay |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Clinton |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Coles |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Cook |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Crawford |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Cumberland |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
DeKalb |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
De Witt |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Douglas |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
DuPage |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Edgar |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Edwards |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Effingham |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Fayette |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Ford |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Franklin |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Fulton |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Gallatin |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Greene |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Grundy |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Hamilton |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Hancock |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Hardin |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Henderson |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Henry |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Iroquois |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Jackson |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Jasper |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Jefferson |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Jersey |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Jo Daviess |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Johnson |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Kane |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Kankakee |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Kendall |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Knox |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Lake |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
La Salle |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Lawrence |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Lee |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Livingston |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Logan |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
McDonough |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
McHenry |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
McLean |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Macon |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Macoupin |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Madison |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Marion |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Marshall |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Mason |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Massac |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Menard |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Mercer |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Monroe |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Montgomery |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Morgan |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Moultrie |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Ogle |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Peoria |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Perry |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Piatt |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Pike |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Pope |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Pulaski |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Putnam |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Randolph |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Richland |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Rock Island |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
St. Clair |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Saline |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Sangamon |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Schuyler |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Scott |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Shelby |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Stark |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Stephenson |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Tazewell |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Union |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Vermilion |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Wabash |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Warren |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Washington |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Wayne |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
White |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Whiteside |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Will |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Williamson |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Winnebago |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in IL - R5361-002-0
Benefit Details
|
Woodford |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Adams |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Ashland |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Barron |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Bayfield |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Brown |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Buffalo |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Burnett |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Calumet |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Chippewa |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Clark |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Columbia |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Crawford |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Dane |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Dodge |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Door |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Douglas |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Dunn |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Eau Claire |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Florence |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Fond du Lac |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Forest |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Grant |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Green |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Green Lake |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Iowa |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Iron |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Jackson |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Jefferson |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Juneau |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Kenosha |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Kewaunee |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
La Crosse |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Lafayette |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Langlade |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Lincoln |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Manitowoc |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Marathon |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Marinette |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Marquette |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Menominee |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Milwaukee |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Monroe |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Oconto |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Oneida |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Outagamie |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Ozaukee |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Pepin |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Pierce |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Polk |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Portage |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Price |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Racine |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Richland |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Rock |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Rusk |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
St. Croix |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Sauk |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Sawyer |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Shawano |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Sheboygan |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Taylor |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Trempealeau |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Vernon |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Vilas |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Walworth |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Washburn |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Washington |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Waukesha |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Waupaca |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Waushara |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Winnebago |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% 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 R5361-002 (Regional PPO) in WI - R5361-002-0
Benefit Details
|
Wood |
$137.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: 19% Generic: 25% Preferred Brand: 25% Non-Preferred Drug: 25% Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|