W hat you need to know About Humana Headquartered in Louisville KY Over 50 years experience in the health industry Diverse portfolio of products Over 121 million medical members nationwide ID: 597398
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Slide1
Humana, Healthcare Reform and YouWhat you need to knowSlide2
About HumanaHeadquartered in Louisville, KYOver 50 years experience in the health industryDiverse portfolio of products
Over 12.1 million medical members nationwideOver 4 million Medicare members nationwideOver 11 million members in specialty productsCorporate Social Responsibility
Humana FoundationKaBOOMWalkit ChallengeArbor Day FoundationHabitat for Humanity
2Slide3
Plan Designs DescriptionsSlide4
4Essential Health Benefits
Plans must cover 10 categories of mandated essential health benefits:
Essential Health Benefit Categories
Ambulatory patient services
Emergency Services
Maternity and newborn care
Pediatric services including dental and vision care
Rehabilitative/
habilitative
services and devices
Mental health and substance use disorder services, including behavioral health treatment
Preventive and wellness services and chronic disease management
Hospitalization
Prescription Drugs
Laboratory servicesSlide5
Plans on the Exchange
How are the plans categorized?Plan tiers are categorized by “actuarial value”
5Catastrophic plans are lower cost with limited benefits for people under 30 or people with financial hardship*.
*Financial hardship: above 400% FPL, but would pay premium exceeding 8% of income
for
lowest-priced Bronze Plan.
What is “actuarial value”?
As an example, a Gold Plan has an actuarial value of 80%. That means, for a standard population:
The plan will pay 80% of their health care expenses
The enrollees themselves will pay 20% through a combination of deductibles, copays, and coinsuranceSlide6
Product DescriptionsHumana Preferred (PPOs)LOCAL
-Humana’s PPO gives members the choice to go to their preferred healthcare provider within a local geographic areaNATIONAL-Humana’s PPO gives members the choice to go to their preferred healthcare provider within a
national frameworkSlide7
Humana Local Preferred (PPOx)
Humana Local Preferred: Memphis, Nashville, Knoxville (30 counties total)Referral not required
Out-of-network coverageLocal Medical Network (PPOx)Rx network (Walmart, Sam’s Club, CVS, Rightsource)
Closed RX5 formulary
Allows for OON coverage and does not require a referral
Offered in markets
where we are competitively pricedOffered
in all metallic tiers + catastrophicSlide8
Humana Local Preferred (PPO)Slide9
Humana Local Preferred (PPO)Benefits of Humana Preferred productsGood for consumers using doctors and hospitals in our PPOx
networkAccess to out-of-network doctors, specialists and hospitals
Freedom of choiceFor a family, there is only a Family deductible and Family OOP, which is twice the single deductible / OOP
Humana Preferred Plans
give consumers the
freedom to
choose any doctor, hospital or specialist so that they can receive care
from any
healthcare provider
(But consumers receive the
most
benefit when they utilize an in-network provider)Slide10
TN-Humana Local Preferred(On and Off Marketplace )
BenefitBasic 6350/6350Bronze 6300/6300 HSAQ
Silver 4600/6300Gold 2500/3500Platinum 1000/1500Med. Deductible (IN)$6350
single
2x family
$6300 single2x family$4600 single
2x family$2500 single2x family$1000 single2x
family
Coinsurance (IN/OON)
100%/75%
100%/75%
80%/60%
80%/60%
80%/60%
Max OOP (IN)
$6350
single
2x family
$6300 single
2x family
$6300 single
2x family$3500 single2x family$1500 single
2x familyPreventive Services100%100%
100%100%100%PCP/Specialists/Urgent
Care$35 PCP copay (3); all else Ded.Deductible/ Coinsurance$25 /$35/$50
$25 /$35/$50
$25 /$35/$50RX
Deductible/ Coinsurance
Deductible/ Coinsurance$10/20/50/ 50%/50%$1500 Rx ded Tiers 3-5
$5/10/20/
35%/35%
$500 Rx
ded
Tiers 3-5
$5/10/20/
35%/35%
$500 Rx
ded
Tiers 3-5
The above represents only a summary; please consult benefit summary for full details.
Out
of Network Deductible and Out of Network Out-of-Pocket are considerably higher than the in-network counterparts
Off Marketplace plans have embedded Pediatric Dental always included; coverage is 50% after deductible, up to the OOP LimitSlide11
Cost Sharing SubsidyFor clients who are 100% to 250% FPL
Protects your clients from high out-of-pocket costs at point of serviceConsumer will have the option to purchase this subsidized plan in addition to benefiting from the Advance Premium Tax CreditIf
a consumer does not choose to purchase the Silver cost-sharing plan, then they will not receive the cost-sharing subsidyHowever, consumer is still eligible for the Advance Premium Tax Credit for any plan she purchases on the exchange
XSlide12
Cost Sharing Impact to Plan Design
In network:Silver 4600/6300Silver
(200-250% FPL)Silver (150-200% FPL)
Silver
(
100-150% FPL)
Med. Deductible (IN)$4600 single
2x family
$3250
single
2X
Family
$900
single
2X Family
$500
single
2X Family
Coinsurance (IN/OON)
80%/60%
80%/60%
80%/60%80%/60%
Max OOP (IN)$6300 single2x family$4750 single 2X Family
$1450 single
2X Family$750 single
2X FamilyPreventive Services
100%
100%
100%
100%
PCP/Specialists/
Urgent
Care
$25
/$35/$50
$25
/$35/$50
$25
/$35/$50
$25
/$35/$50
RX
$10/20/50/50%/50%
$1500 Rx
ded
Tiers 3-5
$10/20/50/50%/50%
$1000
Rx
ded
Tiers 3-5
$10/20/50/50%/50%
$500
Rx
ded
Tiers 3-5
$10/20/50 50%/50%
$250
Rx
ded Tiers 3-5
Out of Network is considerably higher member cost-sharing and is the same as the Standard Silver plan. Slide13
Humana Smart Choice DentalHumana Smart Choice Dental
Immediate and affordable benefitsCompetitive adult/family rates
Comprehensive child coverage, additional coverage for major services Also, a limited orthodontic benefit for kids is availableNo annual max for kids! Out of pocket protection: $700 max out of pocket per child, $1400 for 2+ childrenSlide14
Humana National Preferred
Off ExchangePlans follow Metallic tiers (Same as On-Exchange)National Choice Care
PPO Network Humana National Pharmacy Network (include major retailers)Rx4 Open Formulary Offered in Bronze and Silver metallic tiers + catastrophic
Offered off of
the marketplaceSlide15
TN-Humana National Preferred (Off Marketplace)
BenefitBasic 6350/6350Bronze 6300/6300 HSAQ
Bronze 4850/6350Silver 3650/3650 HSAQSilver 4250/6250Gold 2500/33500Platinum
1000/1500
Med.
Deductible (IN)$6350 single
2x family$6300 single2x family$4850 Single2x family
$3650 single2x family
$4250 single
2x family
$2500 single
2x family
$1000
Si
ngle
2x family
Coinsurance (IN/OON)
100%/75%
100%/75%
80%/60%
100%/75%
80%/60%80%/60%80%/60%Max OOP
(IN)$6350 single2x family$6300 single2x family
$63502x family$3650 single2x family$6250
$3500$1500PreventiveServices100%100%100%
100%100%100%100%
PCP/Specialists/Urgent Care$35 PCP copay (3); all else Ded
Deductible$55/$80/$1003 visit limitthen ded
/coinsDeductible$35/$60/$100
$25/$35/$50
$35/$60/$100
RX
Deductible
Deductible
$20/75/50%/50%
$1500
Rx
ded
Tier 2-4
Deductible
$15/35/50/50%
$1500
Rx
ded
Tiers 2-4
$5/10/15/35%
$500
Rx
ded
Tiers 2-4
$5/10/15/35%
$500
Rx
ded
Tiers 2-4
The above represents only a summary; please consult benefit summary for full details.
Out
of Network Deductible and Out of Network Out-of-Pocket are considerably higher than the in-network counterparts
Off Marketplace plans have embedded Pediatric Dental always included. Coverage is 50% after deductible to OOP limit. Slide16
16Summary of Benefits & Coverage
Name of plan
Plan Benefits
About the network
Type of planSlide17
17Summary of Benefits & Coverage
Referral requirement?
Plan Benefits – Office Visits . Slide18
18Summary of Benefits & Coverage
Prescription Drug Categories and BenefitsPlan Benefits –
Urgent Care . Slide19
19Summary of Benefits & Coverage
Plan Benefits – All Other Categories .Slide20
20Payment information
6350/635
0Slide21
After EnrollmentSlide22
22Features of Humana
One of the largest health plan providers in the countryMany choices MyHumana at Humana.comMyHumana mobile app HumanaFirst Nurse Advice Line:Toll free, 24/7Talk with a registered nurseCan help you decide which level of care is right for you: Urgent care, convenient care center or the emergency room Slide23
23Tools and Resources for Navigators & Stakeholders
Humana Dedicated Support Line for certified Navigators and Certified Application Counselors - 888-891-0730Dedicated Customer Service line for pre-enrollment questions for clients - 888-747-7650Coming soon – Tip Sheets and Newsletter specific to Navigators and Certified Application Counselors