HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Aitkin |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Anoka |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Becker |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Beltrami |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Benton |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Big Stone |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Blue Earth |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Carlton |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Carver |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Cass |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Clay |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Clearwater |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Crow Wing |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Dakota |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Fillmore |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Hennepin |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Houston |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Hubbard |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Isanti |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Itasca |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Kanabec |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Kittson |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Koochiching |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Lac qui Parle |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Lake |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Lake of the Woods |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Le Sueur |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Lincoln |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Lyon |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
McLeod |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Mahnomen |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Marshall |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Martin |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Meeker |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Mille Lacs |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Morrison |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Murray |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Nobles |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Norman |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Otter Tail |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Pennington |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Pine |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Pipestone |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Polk |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Ramsey |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Red Lake |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Renville |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Rice |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Rock |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Roseau |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
St. Louis |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Scott |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Steele |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Todd |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Traverse |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Wadena |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Washington |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Wilkin |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Winona |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Wright |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in MN - H5216-397-0
Benefits & Contact Info
|
Yellow Medicine |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in WI - H5216-397-0
Benefits & Contact Info
|
Burnett |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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HumanaChoice H5216-397 (PPO) in WI - H5216-397-0
Benefits & Contact Info
|
Polk |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 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 H5216-397 (PPO) in WI - H5216-397-0
Benefits & Contact Info
|
St. Croix |
$69.00 |
$250 Tier 1, 2 and 3 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 29%
all covered insulin pay $35 or less | $3,500 Browse Formulary |
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