Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in KY - H6622-017-0
Benefits & Contact Info
|
Boone |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in KY - H6622-017-0
Benefits & Contact Info
|
Campbell |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in KY - H6622-017-0
Benefits & Contact Info
|
Grant |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a 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 - Diabetes and Heart (HMO C-SNP) in KY - H6622-017-0
Benefits & Contact Info
|
Kenton |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in KY - H6622-017-0
Benefits & Contact Info
|
Pendleton |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Allen |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a 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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Ashland |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Auglaize |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Brown |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a 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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Butler |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Carroll |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Champaign |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a 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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Clark |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Clermont |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Clinton |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a 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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Columbiana |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Cuyahoga |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Darke |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a 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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Defiance |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Delaware |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Erie |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Fairfield |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Franklin |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Fulton |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Geauga |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Greene |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Hamilton |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Hancock |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Hardin |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Henry |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Holmes |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Knox |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Lake |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Licking |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Logan |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Lorain |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Lucas |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Madison |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
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|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Mahoning |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Marion |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
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|
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Medina |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
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|
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Miami |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
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|
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Morrow |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
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|
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Ottawa |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
|
|
|
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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Paulding |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
|
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|
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Pickaway |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Portage |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a 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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Preble |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Sandusky |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a 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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Seneca |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Shelby |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Stark |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a 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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Summit |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Trumbull |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Tuscarawas |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a 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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Union |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Van Wert |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Warren |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a 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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Wayne |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Williams |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Wood |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a 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 - Diabetes and Heart (HMO C-SNP) in OH - H6622-017-0
Benefits & Contact Info
|
Wyandot |
$0.00 |
$200 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 30% Select Care Drugs: $7.00
all covered insulin pay $35 or less | n/a Browse Formulary |
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