HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Aitkin |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Anoka |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Becker |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Beltrami |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Benton |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Big Stone |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Blue Earth |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Brown |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Carlton |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Carver |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Cass |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Clay |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Clearwater |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Crow Wing |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Dakota |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Dodge |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Faribault |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Fillmore |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Freeborn |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Goodhue |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Hennepin |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Houston |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Hubbard |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Isanti |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Itasca |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Kanabec |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Kittson |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Lac qui Parle |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Lake |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Lake of the Woods |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Le Sueur |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Lincoln |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Lyon |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
McLeod |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Mahnomen |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Marshall |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Martin |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Meeker |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Mille Lacs |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Morrison |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Mower |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Nicollet |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Nobles |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Norman |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Olmsted |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Otter Tail |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Pennington |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Pine |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Pipestone |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Polk |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Ramsey |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Red Lake |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Renville |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Rice |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Rock |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Roseau |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
St. Louis |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Scott |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Sibley |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Steele |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Todd |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Wabasha |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Wadena |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Waseca |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Washington |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Watonwan |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Wilkin |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Winona |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in MN - H5216-092-0
Benefits & Contact Info
|
Wright |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in ND - H5216-092-0
Benefits & Contact Info
|
Burleigh |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in ND - H5216-092-0
Benefits & Contact Info
|
Cass |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in ND - H5216-092-0
Benefits & Contact Info
|
Grand Forks |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in ND - H5216-092-0
Benefits & Contact Info
|
Morton |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in ND - H5216-092-0
Benefits & Contact Info
|
Richland |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in ND - H5216-092-0
Benefits & Contact Info
|
Stutsman |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 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 H5216-092 (PPO) in SD - H5216-092-0
Benefits & Contact Info
|
Minnehaha |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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HumanaChoice H5216-092 (PPO) in SD - H5216-092-0
Benefits & Contact Info
|
Pennington |
$79.00 |
$545 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25%
all covered insulin pay $35 or less | $6,700 Browse Formulary |
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