HumanaChoice H5216-097 (PPO) in AR - H5216-097-0
Benefits & Contact Info
|
Crittenden |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in MS - H5216-097-0
Benefits & Contact Info
|
Benton |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in MS - H5216-097-0
Benefits & Contact Info
|
DeSoto |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in MS - H5216-097-0
Benefits & Contact Info
|
Tate |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in MS - H5216-097-0
Benefits & Contact Info
|
Tunica |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Bedford |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Benton |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Bledsoe |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Bradley |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Cannon |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Carroll |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Cheatham |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Chester |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Clay |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Coffee |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Crockett |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Davidson |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Decatur |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
DeKalb |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Dickson |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Fayette |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Franklin |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Gibson |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Giles |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Grundy |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Hamilton |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Hardeman |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Hardin |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Henry |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Hickman |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Houston |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Humphreys |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Jackson |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Lake |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Lawrence |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Lewis |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Lincoln |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
McMinn |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
McNairy |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Macon |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Madison |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Marion |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Marshall |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Maury |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Meigs |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Montgomery |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Overton |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Perry |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Polk |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Rhea |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Robertson |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Rutherford |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Sequatchie |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Shelby |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Smith |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Stewart |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Sumner |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Tipton |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Trousdale |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Van Buren |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Warren |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Wayne |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
White |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 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 H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Williamson |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|
HumanaChoice H5216-097 (PPO) in TN - H5216-097-0
Benefits & Contact Info
|
Wilson |
$53.00 |
$150 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 30%
all covered insulin pay $35 or less | $8,850 Browse Formulary |
|
|
|
|