Page 59 - Cover letter and evaluation for Michele Buros

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Zip Code: 15146
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits, drug costs
and more coverage and star ratings. Drug List ID: 2133754848
Password Date: 02/21/2018
Important Coverage Information

Symbols
A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment
will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the
enrollee is not responsible for obtaining (prior) authorization.
Some Dental Coverage Some Vision Coverage
* Estimated

Humana Value Plus 500 West Main Street Overall Star Rating: [?] Enroll
H5216-117 (PPO) Louisville, KY 40202
(H5216-117-0) Members: 4 out of 5 stars
1-800-457-4708
Organization: Humana Insurance 711 (TTY/TDD)
Company
Plan Type: Local Preferred Non Members:
Provider Organization 1-800-833-2364
711 (TTY/TDD)

Benefits Highlights

Monthly health plan premium $0.00

Health plan deductible $183 annual deductible
Other health plan deductibles?
In-Network: No
Maximum out-of-pocket enrollee $10,000 In and Out-of-network
responsibility (does not include $6,700 In-network
prescription drugs)
Optional supplemental benefits [?] No

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