HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Adair |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Allen |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Anderson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Ballard |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Barren |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Bath |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Bell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Boone |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Bourbon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Boyd |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Boyle |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Bracken |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Breathitt |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Breckinridge |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Bullitt |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Butler |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Caldwell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Calloway |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Campbell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Carlisle |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Carroll |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Carter |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Casey |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Christian |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Clark |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Clay |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Clinton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Crittenden |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Cumberland |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Daviess |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Edmonson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Elliott |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Estill |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Fayette |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Fleming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Floyd |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Franklin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Fulton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Gallatin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Garrard |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Grant |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Graves |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Grayson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Green |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Greenup |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Hancock |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Hardin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Harlan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Harrison |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Hart |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Henderson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Henry |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Hickman |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Hopkins |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Jackson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Jefferson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Jessamine |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Johnson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Kenton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Knott |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Knox |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Larue |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Laurel |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Lawrence |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Lee |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Leslie |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Letcher |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Lewis |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Lincoln |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Livingston |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Logan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Lyon |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
McCracken |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
McCreary |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
McLean |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Madison |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Magoffin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Marion |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Marshall |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Martin |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Mason |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Meade |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Menifee |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Mercer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Metcalfe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Monroe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Montgomery |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Morgan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Muhlenberg |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Nelson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Nicholas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Ohio |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Oldham |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Owen |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Owsley |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Pendleton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Perry |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Pike |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Powell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Pulaski |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Robertson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Rockcastle |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Rowan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Russell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Scott |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Shelby |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Simpson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Spencer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Taylor |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Todd |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Trigg |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Trimble |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Union |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Warren |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Washington |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Wayne |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Webster |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Whitley |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Wolfe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in KY - H5216-105-0
Benefit Details
|
Woodford |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Barbour |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Berkeley |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Boone |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Braxton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Brooke |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Cabell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Calhoun |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Clay |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Doddridge |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Fayette |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Gilmer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Grant |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Greenbrier |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Hampshire |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Hancock |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Hardy |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Harrison |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Jackson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Jefferson |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Kanawha |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Lewis |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Lincoln |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Logan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
McDowell |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Marion |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Marshall |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Mason |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Mercer |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Mineral |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Mingo |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Monongalia |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Monroe |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Morgan |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Nicholas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Ohio |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Pendleton |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Pleasants |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Pocahontas |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Preston |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Putnam |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Raleigh |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Randolph |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Ritchie |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Roane |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Summers |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Taylor |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Tucker |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Tyler |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Upshur |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Wayne |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Webster |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Wetzel |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Wirt |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Wood |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice H5216-105 (PPO) in WV - H5216-105-0
Benefit Details
|
Wyoming |
$0.00 |
No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,200 |
|
|
|
|