HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Adams |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Allen |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Bartholomew |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Benton |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Blackford |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Boone |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Brown |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Carroll |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Cass |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Clark |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Clay |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Clinton |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Crawford |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Daviess |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Dearborn |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Decatur |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
DeKalb |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Delaware |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Dubois |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Elkhart |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Fayette |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Floyd |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Fountain |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Franklin |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Fulton |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Gibson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Grant |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Greene |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Hamilton |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Hancock |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Harrison |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Hendricks |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Henry |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Howard |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Huntington |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Jackson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Jasper |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Jay |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Jefferson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Jennings |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Johnson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Knox |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Kosciusko |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Lagrange |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Lake |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
La Porte |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Lawrence |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Madison |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Marion |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Marshall |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Martin |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Miami |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Monroe |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Montgomery |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Morgan |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Newton |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Noble |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Ohio |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Orange |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Owen |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Parke |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Perry |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Pike |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Porter |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Posey |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Pulaski |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Putnam |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Randolph |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Ripley |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Rush |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
St. Joseph |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Scott |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Shelby |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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|
|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Spencer |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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|
|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Starke |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Steuben |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Sullivan |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Switzerland |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Tippecanoe |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Tipton |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Union |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Vanderburgh |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Vermillion |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Vigo |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Wabash |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Warren |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Warrick |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Washington |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Wayne |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Wells |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
White |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in IN - R0865-003-0
Benefit Details
|
Whitley |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Adair |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Allen |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Anderson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Ballard |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Barren |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Bath |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Bell |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Boone |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Bourbon |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Boyd |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Boyle |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Bracken |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Breathitt |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Breckinridge |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Bullitt |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Butler |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Caldwell |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Calloway |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Campbell |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Carlisle |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Carroll |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Carter |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Casey |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Christian |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Clark |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Clay |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Clinton |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Crittenden |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Cumberland |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Daviess |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Edmonson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Elliott |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Estill |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Fayette |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Fleming |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Floyd |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Franklin |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Fulton |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Gallatin |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Garrard |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Grant |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Graves |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Grayson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Green |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Greenup |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Hancock |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Hardin |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Harlan |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Harrison |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Hart |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Henderson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Henry |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Hickman |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Hopkins |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Jackson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Jefferson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Jessamine |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Johnson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Kenton |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Knott |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Knox |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Larue |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Laurel |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Lawrence |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Lee |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Leslie |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Letcher |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Lewis |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Lincoln |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Livingston |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Logan |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Lyon |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
McCracken |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
McCreary |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
McLean |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Madison |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Magoffin |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Marion |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Marshall |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Martin |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Mason |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Meade |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Menifee |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Mercer |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Metcalfe |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Monroe |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Montgomery |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Morgan |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Muhlenberg |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Nelson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Nicholas |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Ohio |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Oldham |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Owen |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Owsley |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Pendleton |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Perry |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Pike |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Powell |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Pulaski |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Robertson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Rockcastle |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Rowan |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Russell |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
|
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|
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Scott |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Shelby |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Simpson |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Spencer |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Taylor |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Todd |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Trigg |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Trimble |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Union |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Warren |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Washington |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Wayne |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Webster |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Whitley |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Wolfe |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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HumanaChoice R0865-003 (Regional PPO) in KY - R0865-003-0
Benefit Details
|
Woodford |
$72.00 |
$195 Tier 1, 2 and 3 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
select insulin coverage $35 or less | $7,550 Browse Formulary |
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