HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Anderson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Aransas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Armstrong |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Atascosa |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Austin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Bandera |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Bastrop |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Bee |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Bell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Bexar |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Bosque |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Brazoria |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Brazos |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Brooks |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Burleson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Burnet |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Caldwell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Calhoun |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Callahan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Cameron |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Camp |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Carson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Chambers |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Cherokee |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Coleman |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Collin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Colorado |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Comal |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Comanche |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Cooke |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Coryell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Dallas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Dawson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Deaf Smith |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Delta |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Denton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Dimmit |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Eastland |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Ector |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Edwards |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Ellis |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
El Paso |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Erath |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Falls |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Fannin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Fayette |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Fort Bend |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Franklin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Frio |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Galveston |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Gray |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Grayson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Gregg |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Grimes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Guadalupe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Hamilton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Hardin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Harris |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Harrison |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Hays |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Henderson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Hidalgo |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Hill |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Hood |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Howard |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Hudspeth |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Hunt |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Jefferson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Jim Wells |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Johnson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Jones |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Karnes |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Kaufman |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Kendall |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Kenedy |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Kerr |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Kinney |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Kleberg |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Lampasas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Lee |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Leon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Liberty |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Live Oak |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Llano |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Lubbock |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
McLennan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Marion |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Martin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Matagorda |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Maverick |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Medina |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Midland |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Milam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Montague |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Montgomery |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Morris |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Navarro |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Nueces |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Orange |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Palo Pinto |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Panola |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Parker |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Polk |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Potter |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Randall |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Real |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Refugio |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Robertson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Rockwall |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Rusk |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
San Jacinto |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
San Patricio |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Shackelford |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Shelby |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Smith |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Tarrant |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Taylor |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Tom Green |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Travis |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Trinity |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Tyler |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Upshur |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Uvalde |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Van Zandt |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Victoria |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Walker |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Waller |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Webb |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Wharton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Williamson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Wilson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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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 H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Wise |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Wood |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
|
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|
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HumanaChoice H5216-128 (PPO) in TX - H5216-128-0
Benefit Details
|
Zavala |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,400 |
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