Title of presentation can be either two or three

Welcome Gwinnett County Board of
Commissioners Retirees
The Humana Medicare Employer PPO Plan
Let’s talk about
 Medicare Advantage
 Humana Medicare
employer plans
 Your employer-sponsored
 The plan’s extra benefits
 How to enroll
About Humana: Experience behind the coverage
Humana offers a wide range of products and services that use a holistic
approach to lifelong well-being
Dedication to the community
 More than 50 years of helping people of all ages
Financial stability
 Fortune 100 company
National coverage
 We offer Medicare plans in 50 states, including
Puerto Rico and the District of Columbia
Overview of Humana’s Medicare Advantage Plan
Medicare Advantage health plans are private insurance companies’ health plans
approved by Medicare. Medicare Advantage plans include:
All the benefits of Original Medicare plus extra coverage
Maximum out-of-pocket protections
Worldwide emergency coverage
Original Medicare
Secondary/ Supplement
Medicare Advantage plan Part C
and Prescription Drug (Part D) Plan
Medicare Part D
Medicare Part C is available only to those enrolled in Parts A and B of Medicare through age or disability.
Your Humana member identification ID card
When you go to the doctor or hospital
 Show your Humana member ID card and tell the provider that Humana
Medicare Employer PPO is your Medicare health plan
 Do not show your red, white, and blue Medicare card
 You will pay plan deductibles or copayments at your appointment or the
provider may bill you later
 The doctor or hospital will bill Humana for the rest
Your Humana Medicare Employer PPO Plan
The Humana Medicare Employer
Preferred Provider Organization (PPO) plan
Gwinnett County Board of Commissioners and Humana
teamed up to design a Medicare health plan just for you
In this plan, you must have both Medicare Part A and B and
continue to pay your Medicare Part B premium
Your Humana Medicare Employer PPO plan
Plan highlights
Choose any doctor or hospital
that accepts Medicare – who
accepts Assignment and
agrees to bill Humana
In all plans, there’s a limit to how
much maximum out-of-pocket
costs you pay
One member ID card
No copayments for all
preventive services/health
Extra benefits
Affordable copayments for
doctor visits
Worldwide coverage for
No referral needed to see any
Your Humana Medicare Employer PPO Plan
In Network
Annual Deductible
Combined in and Out-of Network
Combined in and Out-of Network
Annual Maximum
Out of Pocket*
Inpatient Hospital
100% after combined annual
deductible and $500 copayment
per admission
100% after combined annual
deductible and $500 copayment
per admission
100% per visit after $50
100% per visit after $50
Ambulatory Surgical
Out of Network
*If you reach the limit on out-of-pocket costs, you keep getting covered hospital and
medical services and we will pay the full cost for the rest of the year.
Your Humana Medicare Employer PPO Plan
In Network
Out of Network
100% per visit after $0-$75
copayment or 20% of the cost
(based on services received)
100% per visit after $0-$75
copayment or 20% of the cost
(based on services received)
Emergency Room
100% per visit after $50 copayment
(waived if admitted within 72
100% per visit after $50 copayment
(waived if admitted within 72
Primary Care
100% per visit after $15 copayment
100% per visit after $15 copayment
100% per visit after $30 copayment
100% per visit after $30 copayment
Hospital Visits
Durable Medical
Your Part D Coverage
Network Retail Pharmacies
A 30-day supply (A 90-day
supply at three times your
30-day cost*)
Mail-order Benefit*
A 90-day supply
Tier 1
Generic or Preferred
$10 copayment
$15 copayment
Tier 2
Preferred Brand
$30 copayment
$75 copayment
Tier 3
Non-Preferred Brand
$60 copayment
$150 copayment
30%* coinsurance ($100
maximum per prescription)
Tier 4 Specialty
*Specialty drugs are not available in a 90-day supply. Regardless of tier placement, Specialty drugs are limited
to a 30-day supply.
Your Part D Coverage
How coverage works with Prescription Drug Schedule
Rx Rider 77
$0 - $4,700 – you pay a cost share
Once your true out-of-pocket costs reach $4,700, you pay
the greater of $2.65 for generics (including brand-name
drugs treated as generic) and $6.60 for all other drugs, or
5 percent coinsurance
Prescription drug formulary
Group Plus formulary
• Open formulary – includes all prescription drugs
approved by CMS
• Most* generics are in Tier 1
• *Certain high-cost generics can fall out of Tier 1
Four-tier design
Tier 1: Preferred generic
Tier 2: Preferred brand
Tier 3: Non-preferred brand
Tier 4: Specialty
Mail Order Pharmacy
You will have access to mail order
pharmacies, including Humana’s owned,
RightSource. With RightSource,
you will have:
Easy ordering
Refill reminders
Discounts and potential savings
Visit RightSourceRx.com/Medicare
After you become a Humana member, you can sign in with your MyHumana username and
password or register to get started. You can also sign up by calling 1-855-297-7117 (TTY: 711)
Monday – Friday, 8 a.m. – 8 p.m., and Saturday, 9 a.m. – 6 p.m., Eastern time. New prescriptions
typically take 7-10 business days to receive. Call RightSource if you have questions.
Other mail-order pharmacies are also available in our network.
SmartSummary® mailed to your home
Statements that explain your health, benefits, claims and health care
spending; issued each month you incur claims
Statements list your past prescription drug purchases and medical claims
and help you plan for the future
SmartSummaryRx shows how much your plan and you personally have
spent on health care, and how much is left before you reach the coverage
Get these statements by mail or on the
web at Humana.com
Extra benefits
Humana Active Outlook®
A lifestyle enrichment program for Humana Medicare Members
Humana Active Outlook helps you live a full, active, and
productive life
Enjoy health and wellness information through mailings,
online content, individual health coaching, classes, and
our member assistance program (MAP)
Humana’s award-winning* Humana Active Outlook
Magazine comes to you four times
a year
Get practical tips for living with chronic health conditions
from Humana Active Outlook Digest
*Humana Active Outlook has won more than 100 major
national publishing awards, including the APEX Awards for
Publication Excellence and the MarCom Awards. These
awards were not given by Medicare.
Get fit your way™ with SilverSneakers® Fitness
Reach you goals with access to more than
11,000 fitness locations where you can:
• Use fitness equipment, pools and saunas*
• Take SilverSneakers classes*
• Get help from a SilverSneakers Program AdvisorTM
• Enjoy fun social activities
*Classes and amenities vary by location.
SilverSneakers® Steps
 SilverSneakers Steps® is a personalized
fitness program for members who
don’t have convenient access to a
SilverSneakers location
 Sign up for SilverSneakers Steps® if you
can’t get to a fitness location. Select a
fitness kit that you can use at home or
on the go.
• General fitness
• Walking
• Strength
• Yoga
Now there’s an easy way to stay in control of your health. Introducing HumanaVitality®,
a wellness program just for Humana members. It’s included with your Humana Medicare
plan at no extra cost.
HumanaVitality was designed to help you get, and stay, on a healthier path – one small
step at a time.
HumanaVitality is a fun and engaging program that helps you find out more about your
health. This makes it easier to find healthy options that work for you!
HumanaVitality is based on a comprehensive lifestyle approach to wellness. It gives you
personalized goals and activities to help improve your health.
HumanaVitality not only rewards you with a healthier lifestyle, but also with great items
like gift cards, movie tickets, and fitness apparel when you earn Vitality Bucks® for
completing eligible activities.
Smoking cessation program
A service to help you quit smoking
Features include:
Tips and advice from our experts,
online or by phone
A plan to quit tobacco, created just for
Two treatments to replace nicotine
An online support group you can reach
24 hours a day, seven days a week
Health management programs
Humana at Home®
Humana at Home can help you manage the challenges specifically associated with
chronic conditions like:
 Diabetes
 Congestive heart failure
 Coronary artery disease
 Rheumatoid arthritis
 Multiple sclerosis
 Parkinson’s disease
Case management
Nobody wants to face a health crisis or major medical procedure. But if this happens, Humana’s
case managers are here to help. Our nurses can help you follow your treatment plan on your
return home. We also can connect you to other resources for more support.
Members may receive a call to enroll in one of these programs if eligible or may self-refer through Humana by
calling 1-800-662-9508; TTY: 711. We’re available 8 a.m. – 5:30 p.m., Eastern time.
MyHumana is your online resource for personalized health
benefits information. Review your plan benefits, use health and
pharmacy tools, or look up medical and prescription claims.
MyHumana Mobile app and website helps you access your
information while on the go, sign in to your secure, mobile
account or download our iPhone or Android app for details about
your plan benefits, find a doctor in network, find a lower-cost
drug alternative, review your claims and more.
HumanaFirst® Nurse Advice Line is a
toll-free, 24 hour-a-day health
information line. A registered nurse can
answer your general health questions
and provide guidance on your medical
Find out about a medical condition.
Discuss a sudden health concern.
Learn how Humana can help you live a
healthier life.
Next steps: enrollment
How you’ll enroll
Enroll by employer
Gwinnett County Board of
Commissioners will get your
information and enroll you in the
Humana plan. Humana may ask for
more information from you by mail
or phone.
What happens after I enroll?
Humana processes your enrollment and confirms that you
are eligible
Medicare confirms your enrollment
Your ID card arrives in your mailbox
Member Benefit Package arrives in your mailbox
Health Assessment
We’ll contact you about filling out a health questionnaire
Where to find more information
Group Medicare Customer Care
Group Medicare Customer Care
at 1-866-396-8810 (TTY: 711)
Monday – Friday from 8:00 a.m.
- 9:00 p.m., Eastern time.
Our phone system may answer
your call on Saturdays, Sundays,
and holidays. Leave a message
and we’ll call back by the end of
the next business day.
Humana Group Medicare
Humana is a Medicare Advantage organization with a Medicare contract. You must continue to pay your Medicare Part B
premium. The benefit information provided is a brief summary, not a complete description of benefits. Limitations,
copayments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/coinsurance may change from year to year. Enrollment in this Humana plan depends on contract renewal.
This information is available for free in other languages. Please call our customer care number at 1-866-396-8810 (TTY:
711). You can call Monday - Friday, from 8 a.m. - 9 p.m., Eastern time.
Esta información está disponible gratuitamente en otros lenguajes. Póngase en contacto con nuestro Departamento de
Atención al Cliente al 1-866-396-8810 (TTY: 711). Los representantes están disponibles de lunes a viernes de 8 a.m. a 9
p.m., hora del Este.

similar documents