HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Adair |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Allamakee |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Audubon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Benton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Black Hawk |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Boone |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Buchanan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Buena Vista |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Butler |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Calhoun |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Carroll |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Cass |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Cedar |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Cerro Gordo |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Cherokee |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Clayton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Clinton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Crawford |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Dallas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Davis |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Decatur |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Delaware |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Dickinson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Emmet |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Floyd |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Franklin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Fremont |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Grundy |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Hamilton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Hancock |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Hardin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Harrison |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Henry |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Humboldt |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Ida |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Iowa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Jackson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Jasper |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Jefferson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Johnson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Jones |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
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HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Keokuk |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Kossuth |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Lee |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Linn |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Lucas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Lyon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Madison |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Mahaska |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Marion |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Marshall |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Mills |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Monona |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Monroe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Muscatine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
O'Brien |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Osceola |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Page |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Palo Alto |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Plymouth |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Pocahontas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Polk |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Pottawattamie |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Poweshiek |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Ringgold |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Sac |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Sioux |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Story |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Tama |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Union |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Van Buren |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Wapello |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Warren |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Wayne |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Webster |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Winnebago |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Winneshiek |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Woodbury |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Worth |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in IA - H5216-086-0
Benefit Details
|
Wright |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Aitkin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Anoka |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Becker |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Beltrami |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Benton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Big Stone |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Blue Earth |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Brown |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Carlton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Carver |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Cass |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Chippewa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Chisago |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Clay |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Clearwater |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Cottonwood |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Crow Wing |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Dakota |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Dodge |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Douglas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Faribault |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Fillmore |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Freeborn |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Goodhue |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Grant |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Hennepin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Houston |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Hubbard |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Isanti |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Itasca |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Jackson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Kanabec |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Kandiyohi |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Kittson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Lac qui Parle |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Lake of the Woods |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Le Sueur |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Lincoln |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Lyon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
McLeod |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Mahnomen |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Marshall |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Martin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Meeker |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Mille Lacs |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Morrison |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Mower |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Murray |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Nicollet |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Nobles |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Norman |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Olmsted |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Otter Tail |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Pennington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Pine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Pipestone |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Polk |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Pope |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Ramsey |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Red Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Redwood |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Renville |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Rice |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Rock |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Roseau |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
St. Louis |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Scott |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Sherburne |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Sibley |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Stearns |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Steele |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Swift |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Todd |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Wabasha |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Wadena |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Waseca |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Watonwan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Wilkin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Winona |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MN - H5216-086-0
Benefit Details
|
Wright |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MT - H5216-086-0
Benefit Details
|
Carbon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MT - H5216-086-0
Benefit Details
|
Cascade |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MT - H5216-086-0
Benefit Details
|
Flathead |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MT - H5216-086-0
Benefit Details
|
Ravalli |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in MT - H5216-086-0
Benefit Details
|
Stillwater |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in MT - H5216-086-0
Benefit Details
|
Yellowstone |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in ND - H5216-086-0
Benefit Details
|
Burleigh |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in ND - H5216-086-0
Benefit Details
|
Cass |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in ND - H5216-086-0
Benefit Details
|
Grand Forks |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in ND - H5216-086-0
Benefit Details
|
Morton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in ND - H5216-086-0
Benefit Details
|
Richland |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in ND - H5216-086-0
Benefit Details
|
Stutsman |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in NE - H5216-086-0
Benefit Details
|
Cass |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in NE - H5216-086-0
Benefit Details
|
Dodge |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in NE - H5216-086-0
Benefit Details
|
Douglas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in NE - H5216-086-0
Benefit Details
|
Lancaster |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in NE - H5216-086-0
Benefit Details
|
Sarpy |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in NE - H5216-086-0
Benefit Details
|
Saunders |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in NE - H5216-086-0
Benefit Details
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Bon Homme |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Brookings |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Butte |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Clark |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Clay |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Codington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Custer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Davison |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Day |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Deuel |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Fall River |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Grant |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Hamlin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Hanson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Hutchinson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Kingsbury |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Lake |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Lawrence |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Lincoln |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
McCook |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Marshall |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Meade |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Miner |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Minnehaha |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Moody |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Pennington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Roberts |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Sanborn |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Spink |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Turner |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Union |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-086 (PPO) in SD - H5216-086-0
Benefit Details
|
Yankton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 |
|
|
|
|