HumanaChoice H5216-188 (PPO) in IN - H5216-188-0
Benefit Details
|
Clark |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in IN - H5216-188-0
Benefit Details
|
Floyd |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in IN - H5216-188-0
Benefit Details
|
Harrison |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Adair |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Allen |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Barren |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Bath |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Bourbon |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Boyd |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Boyle |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Bullitt |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Butler |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Carroll |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Carter |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Casey |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Clark |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Clay |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Clinton |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Crittenden |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Cumberland |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Edmonson |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Fayette |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Floyd |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Franklin |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Fulton |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Gallatin |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Green |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Greenup |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Hardin |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Harlan |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Henry |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Hickman |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Jackson |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Jefferson |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Jessamine |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Johnson |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Knott |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Leslie |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Letcher |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Lincoln |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Livingston |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Logan |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Madison |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Magoffin |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Marion |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Martin |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Meade |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Menifee |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Metcalfe |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Monroe |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Montgomery |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Morgan |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Nelson |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Oldham |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Owen |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Owsley |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Perry |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Pike |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Powell |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Scott |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Shelby |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Simpson |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Spencer |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Trimble |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Union |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Warren |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $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 H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Whitley |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-188 (PPO) in KY - H5216-188-0
Benefit Details
|
Woodford |
$15.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|