HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Allen |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Anderson |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Atchison |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Barber |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Barton |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Bourbon |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Brown |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Butler |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Chase |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Chautauqua |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Cherokee |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Cheyenne |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Clark |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Clay |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Cloud |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Coffey |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Comanche |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Cowley |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Crawford |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Decatur |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Dickinson |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Doniphan |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Douglas |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Edwards |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Elk |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Ellis |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Ellsworth |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Finney |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Ford |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Franklin |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Geary |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Gove |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Graham |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Grant |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Gray |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Greeley |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Greenwood |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Hamilton |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Harper |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Harvey |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Haskell |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Hodgeman |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Jackson |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Jefferson |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Jewell |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Johnson |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Kearny |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Kingman |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Kiowa |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Labette |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Lane |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Leavenworth |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Lincoln |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Linn |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Logan |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Lyon |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
McPherson |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Marion |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Marshall |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Meade |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Miami |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Mitchell |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Montgomery |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Morris |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Morton |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Nemaha |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Neosho |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Ness |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Norton |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Osage |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Osborne |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Ottawa |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Pawnee |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Phillips |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Pottawatomie |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Pratt |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Rawlins |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Reno |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Republic |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Rice |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Riley |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Rooks |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Rush |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Russell |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Saline |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Scott |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Sedgwick |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Seward |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Shawnee |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Sheridan |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Sherman |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Smith |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Stafford |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Stanton |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Stevens |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Sumner |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Thomas |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Trego |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Wabaunsee |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Wallace |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Washington |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Wichita |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Wilson |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Woodson |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in KS - R4845-002-0
Benefit Details
|
Wyandotte |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Adair |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Alfalfa |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Atoka |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Beaver |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Beckham |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Blaine |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Bryan |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Caddo |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Canadian |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Carter |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Cherokee |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Choctaw |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Cimarron |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Cleveland |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Coal |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Comanche |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Cotton |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Craig |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Creek |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Custer |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Delaware |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Dewey |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Ellis |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Garfield |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Garvin |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Grady |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Grant |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Greer |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Harmon |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Harper |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Haskell |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Hughes |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Jackson |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Jefferson |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Johnston |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Kay |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Kingfisher |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Kiowa |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Latimer |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Le Flore |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Lincoln |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Logan |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Love |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
McClain |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
McCurtain |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
McIntosh |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Major |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Marshall |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Mayes |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Murray |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Muskogee |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Noble |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Nowata |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Okfuskee |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Oklahoma |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Okmulgee |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Osage |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Ottawa |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Pawnee |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Payne |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Pittsburg |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Pontotoc |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Pottawatomie |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Pushmataha |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Roger Mills |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Rogers |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Seminole |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Sequoyah |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Stephens |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Texas |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Tillman |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Tulsa |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Wagoner |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Washington |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Washita |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
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 R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Woods |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice R4845-002 (Regional PPO) in OK - R4845-002-0
Benefit Details
|
Woodward |
$41.00 |
$395 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|