Humana Gold Plus H6622-019 (HMO) in KY - H6622-019-0
Benefit Details
|
Boone |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in KY - H6622-019-0
Benefit Details
|
Campbell |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in KY - H6622-019-0
Benefit Details
|
Grant |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in KY - H6622-019-0
Benefit Details
|
Kenton |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in KY - H6622-019-0
Benefit Details
|
Pendleton |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Allen |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Auglaize |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Brown |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Butler |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Carroll |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Champaign |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Clark |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Clermont |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Clinton |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Columbiana |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Cuyahoga |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Darke |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Delaware |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Erie |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Fairfield |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Franklin |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Fulton |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Geauga |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Greene |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Hamilton |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Hancock |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Holmes |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Lake |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Licking |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Lorain |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Lucas |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Madison |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Mahoning |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Marion |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Medina |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Miami |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Montgomery |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Ottawa |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Pickaway |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Portage |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Preble |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Sandusky |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Seneca |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Shelby |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Stark |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Summit |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Trumbull |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Union |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Van Wert |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Warren |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
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Wayne |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 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 |
Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Wood |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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Humana Gold Plus H6622-019 (HMO) in OH - H6622-019-0
Benefit Details
|
Wyandot |
$90.00 |
$125 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 31%
all covered insulin pay $35 or less | $3,900 Browse Formulary |
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