HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Alcona |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Alger |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Allegan |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Alpena |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Antrim |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Arenac |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Baraga |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Barry |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Bay |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Benzie |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Berrien |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Branch |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Calhoun |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Cass |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Charlevoix |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Cheboygan |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Chippewa |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Clare |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Clinton |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Crawford |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Delta |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Dickinson |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Eaton |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Emmet |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Genesee |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Gladwin |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Gogebic |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Grand Traverse |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Gratiot |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Hillsdale |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Houghton |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Huron |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Ingham |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Ionia |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Iosco |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Iron |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Isabella |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Jackson |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Kalamazoo |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Kalkaska |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Kent |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Keweenaw |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Lake |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Lapeer |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Leelanau |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Lenawee |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Livingston |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Luce |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Mackinac |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Macomb |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Manistee |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Marquette |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Mason |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Mecosta |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Menominee |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Midland |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Missaukee |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Monroe |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Montcalm |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Montmorency |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Muskegon |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Newaygo |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Oakland |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Oceana |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Ogemaw |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Ontonagon |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Osceola |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Oscoda |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Otsego |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Ottawa |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Presque Isle |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Roscommon |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Saginaw |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
St. Clair |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
St. Joseph |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Sanilac |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Schoolcraft |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Shiawassee |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Tuscola |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Van Buren |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Washtenaw |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Wayne |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|
HumanaChoice R3887-002 (Regional PPO) in MI - R3887-002-0
Benefit Details
|
Wexford |
$119.00 |
$210 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $13.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
| $5,300 Browse Formulary |
|
|
|
|