Humana's Retiree Medical Solution
Transcript of Humana's Retiree Medical Solution
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University of Ky Medicare
Presenter Reno Altschul
Date August 26, 2005
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Benefit Comparisons
UK Medicare Carve Out In-Network
Humana Gold Choice In-Network
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Max Out Of Pocket
$1500 individual $3000 Family Does not include
deductible No maximum lifetime
$5000 Does not include
deductible No maximum lifetime
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How Physicians Are Selected
Any provider Any Medicare Participating Provider
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Physician Visits
20% coinsurance after $500 deductible
Primary Care 100% after $10 co-payment
Specialist Care 100% after $20 co-payment
Primary Care includes diagnostic procedures, lab tests and x-rays, routine physical, medical supplies, and physical, speech, occupational therapy received during an office visit
Specialist Care includes diagnostic procedures, lab test, x-rays, medical supplies, physical, speech, occupational therapy, and Medicare covered services for chiropractic and podiatry, received during an office visit
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Preventive Care
20% coinsurance after deductible
100% with $0 co-payment (if other services are billed as routine preventive, the appropriate co-payment/coinsurance will apply based on the type of service and place of treatment)
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Preventive Services
Bone Mass Measurement(1 per year) Colorectal Screening (1 per year) Diabetes Self-Management (1 per year) Nutritional Therapy (Diabetic or ESRD Patients) Pap Smears and Pelvic Exam Screening (1 per year) Prostate Cancer Screening (I per year) Mammography Screening (1 per year) Immunization (1per year)
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Urgent Treatment Center
20% coinsurance after deductible
100% after $20 co-payment per visit
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Ambulance
20% coinsurance after deductible
100% after $50 co-payment per date of service
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Skilled Nursing Facility
20% coinsurance after deductible, 100 day limit per plan year
100% covered from days 1-100 per benefit period
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Emergency Room
20% coinsurance after deductible
100% after $50 co-payment per visit 9not waived for admission)
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Outpatient (non-surgical)
20% coinsurance after deductible
100% after $20-$50 co-payment per visit, based on where services received
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Outpatient (surgical)
20% coinsurance after deductible
100% after $25-50 co-payment per visit, based on where services received
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Hospital Services Inpatient
20% coinsurance after deductible
100% after $100 co-payment per day (days 1-5) per admission
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Outpatient Therapy
20% coinsurance after deductible, 30 visit limit per plan year on physical therapy
$20 co-payment all settings, includes cardiac, occupational, physical, and speech therapies. No visit limitations as long as medically necessary.
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Prescription Drug Coverage
$8.00 Generic $20.00 Preferred $40.00 Non-Preferred
$10.00 Level One $20 Level Two $40 Level Three 25% coinsurance Level
Four Once the member’s true
out of pocket cost for levels 1-4 reaches $3600, the member pays the greater of $2.00 for a generic or a preferred drug that is a multiple source drug, and $5.00 for all other drugs, or 5% coinsurance. Rx coverage is unlimited.
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Mental/Nervous (Outpatient)
20% coinsurance after deductible, 20 day limit per plan year (in combination with Substance Abuse)
100% after $20 co-payment per visit (not in combination with Substance Abuse, which is 100% after $10-$50 co-payment based on place of treatment)
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Mental/Nervous Inpatient
20% coinsurance after deductible, 31 day limit per plan year (in combination with Substance Abuse)
100% after $100 co-payment per admission (days 1-5) 190 day lifetime limit (not in combination with Substance Abuse)
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Durable Medical Equipment/Prosthetics
20% coinsurance after deductible, 100 day limit per plan year
20% coinsurance (Medicare fee schedule)
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Home Health Care
20% coinsurance after deductible, 100 day limit per plan year
100% covered
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