Humana Autograph Plans
Colorado Health Insurance
 

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Humana HSA
Humana Autograph Plans
(Click here to view all Humana Plans available in Colorado)

The HumanaOne Autograph health plans offer a selection of cost sharing features, plan deductibles, and optional benefits, so it can be customized to your needs, allowing you to choose the level of protection you want at a cost that fits your budget.

Please view the Autograph Plan Brochures to see detailed information including Plan Provisions, Limits & Exclusions, and State Variations:

Share 80 Plus Rx/Copay Humana Autograph Adobe Acrobat Information  -  Share 70 Plus Rx Humana Autograph Adobe Acrobat Information

 

Humana Autograph Plans Apply Online

Plans at a Glance:

There are two HumanaOne Autograph non-HSA plans: the Autograph Share 80 Plus Rx/Copay and the Autograph Share 70 Plus Rx.  The main distinctions between the two plans are the lifetime maximum ($5 mil/$2 mil), the coinsurance (80%/70%), and the office visit copay ($35/none).
Share 80 Plus Rx/Copay
Plan pays for services at
PARTICIPATING providers
Plan pays for services at
NON-PARTICIPATING providers
Annual Deductible
· Annual amount (does not apply to maximum out-of-pocket expense)
Please run an Instant Quote to find deductibles in your area
Please run an Instant Quote to find deductibles in your area
Maximum Out-of-Pocket Expense
(after deductible)
· Individual (must be satisfied by each covered person)
Individual
$2,000
Family
 $4,000
Individual
$8,000
Family
$16,000

Preventive Care
· Well-child care (including immunizations) (birth to age 13)
· Routine annual PSA and digital rectal exam
· Routine annual Mammograms

· Routine Annual physical exam (age 13 and older)
· Routine immunizations
(age 13 to 18)
· Routine pap smear

· Routine lab, pathology and X-ray
You pay 20% coinsurance





You pay 20% coinsurance




You pay 20% coinsurance
You pay 40% coinsurance

 

 

Not Covered




Not Covered

Physician Services
· Office visits: Primary care

 

· Office Visits: Specialty care
(limited to 6 combined Primary and Specialty care visits/calendar year)
(includes allergy injections)

 

· Diagnostic lab, X-ray and allergy testing

 

· Allergy serum
· Inpatient services
· Outpatient services (includes surgery)
$35 copayment for 6 visits, then you pay 20% coinsurance after deductible


$50 copayment for 6 visits, then you pay 20% coinsurance after deductible

 

First $200/yr covered 100%, then you pay 20% coinsurance after deductible



You pay 20% coinsurance after deductible
You pay 40% coinsurance after deductible

 

You pay 40% coinsurance after deductible



You pay 40% coinsurance after deductible




You pay 40% coinsurance after deductible

Hospital
Services
· Inpatient care
· Outpatient surgery - facility
· Outpatient nonsurgical
· Newborn hospital stay


· Emergency room (includes physician visits)

You pay 20% coinsurance after deductible

 

You pay 20% coinsurance after $75 copayment per visit and deductible (copayment waived if admitted)

You pay 40% coinsurance after deductible

 

You pay 40% coinsurance after $75 copayment per visit and deductible (copayment waived if admitted)

Prescription Drugs
· Prescription drug deductible (Covered prescription drugs are assigned to one of four different levels with corresponding copayment amounts.)

· Benefit for each prescription or refill (up to 30-day supply)
- Level One - lowest copayment for lowest cost generic and brand-name drugs
- Level Two - higher copayment for higher cost generic and brand-name drugs
- Level Three - higher copayment than Level Two for higher cost, mostly brand-name drugs that may have generic or therapeutic equivalents in Levels One or Two
- Level Four - highest copayment for high-technology drugs (certain brand-name drugs, biotechnology drugs and self-administered injectable medications

· Mail Order (90 day supply)
$1,000 prescription drug deductible per individual

 

100% after:

$15 co-pay, not subject to prescription deductible

$35 co-pay after prescription drug deductible

$55 co-pay after prescription drug deductible



25% co-pay up to $2,500 out of pocket maximum per year



100% covered after three times the retail copayment
$1,000 prescription drug deductible per individual

 

70% after:

$15 co-pay, not subject to prescription deductible

$35 co-pay after prescription drug deductible

$55 co-pay after prescription drug deductible



25% co-pay up to $2,500 out of pocket maximum per year



70% covered after three times the retail copayment

Other Medical Services
· Skilled nursing facility (up to 30 days per calendar year)
· Home health care (up to 60 days per calendar year)
· Durable medical equipment
· Hospice
· Complications of pregnancy and sick baby services
· Transplant services (organ) **
You pay 20% coinsurance after deductible

 

** when services are performed at a National Transplant Network provider
You pay 40% coinsurance after deductible

 

** subject to out of pocket maximum of $35,000 per covered transplant per year
Mental Health (mental disorders, alcohol and chemical dependence)
Inpatient and Outpatient care (Combined $2,500 per calendar year maximum.  Outpatient care not to exceed $500 of the $2,500 calendar year maximum.)
You pay 50% coinsurance
after deductible
You pay 50% coinsurance
after deductible

Optional
Benefits
· Lifetime Maximum Benefit


· $500 Supplemental Accident Benefit


· $1000 Supplemental Accident Benefit



· $500 Prescription Drug Benefit
$8 million per covered person


First $500 per accident covered at 100%, then base plan benefits apply

First $1000 per accident covered at 100%, then base plan benefits apply

Under this option, $500 deductible is required to be met before plan benefits are payable
$8 million per covered person


First $500 per accident covered at 100%, then base plan benefits apply

First $1000 per accident covered at 100%, then base plan benefits apply

Under this option, $500 deductible is required to be met before plan benefits are payable
Lifetime Maximum
$5,000,000

Humana autograph plans

Share 70 Plus Rx
Plan pays for services at
PARTICIPATING providers
Plan pays for services at
NON-PARTICIPATING providers
Annual Deductible
· Annual amount (does not apply to maximum out-of-pocket expense)
Please run an Instant Quote to find deductibles in your area
Please run an Instant Quote to find deductibles in your area
Maximum Out-of-Pocket Expense
(after deductible)
· Individual (must be satisfied by each covered person)
Individual
$3,000
Family
 $10,000
Individual
$6,000
Family
$20,000

Preventive Care
· Well-child care (including immunizations) (birth to age 13)
· Routine annual PSA and digital rectal exam
· Routine annual Mammograms

· Routine Annual physical exam (age 13 and older)
· Routine immunizations
(age 13 to 18)
· Routine pap smear

· Routine lab, pathology and X-ray
You pay 30% coinsurance





You pay 30% coinsurance




You pay 30% coinsurance
You pay 50% coinsurance

 

 

Not Covered




Not Covered

Physician Services
· Office visits: Primary care

 

· Office Visits: Specialty care
(limited to 6 combined Primary and Specialty care visits/calendar year)
(includes allergy injections)

 

· Diagnostic lab, X-ray and allergy testing

 

· Allergy serum
· Inpatient services
· Outpatient services (includes surgery)
$35 copayment for 6 visits, then you pay 30% coinsurance after deductible


$50 copayment for 6 visits, then you pay 30% coinsurance after deductible

 

First $200/yr covered 100%, then you pay 30% coinsurance after deductible



You pay 30% coinsurance after deductible
You pay 50% coinsurance after deductible

 

You pay 50% coinsurance after deductible



You pay 50% coinsurance after deductible




You pay 50% coinsurance after deductible

Hospital
Services
· Inpatient care
· Outpatient surgery - facility
· Outpatient nonsurgical
· Newborn hospital stay


· Emergency room (includes physician visits)

You pay 30% coinsurance after deductible

 

You pay 30% coinsurance after $125 copayment per visit and deductible (copayment waived if admitted)

You pay 50% coinsurance after deductible

 

You pay 50% coinsurance after $125 copayment per visit and deductible (copayment waived if admitted)

Prescription Drugs
· Prescription drug deductible (Covered prescription drugs are assigned to one of four different levels with corresponding copayment amounts.)

· Benefit for each prescription or refill (up to 30-day supply)
- Level One - lowest copayment for lowest cost generic and brand-name drugs
- Level Two - higher copayment for higher cost generic and brand-name drugs
- Level Three - higher copayment than Level Two for higher cost, mostly brand-name drugs that may have generic or therapeutic equivalents in Levels One or Two
- Level Four - highest copayment for high-technology drugs (certain brand-name drugs, biotechnology drugs and self-administered injectable medications

· Mail Order (90 day supply)
$1,000 prescription drug deductible per individual

 

100% after:

$15 co-pay, not subject to prescription deductible

$35 co-pay after prescription drug deductible

$55 co-pay after prescription drug deductible



25% co-pay up to $2,500 out of pocket maximum per year



100% covered after three times the retail copayment
$1,000 prescription drug deductible per individual

 

70% after:

$15 co-pay, not subject to prescription deductible

$35 co-pay after prescription drug deductible

$55 co-pay after prescription drug deductible



25% co-pay up to $2,500 out of pocket maximum per year



70% covered after three times the retail copayment

Other Medical Services
· Skilled nursing facility (up to 30 days per calendar year)
· Home health care (up to 60 days per calendar year)
· Durable medical equipment
· Hospice
· Complications of pregnancy and sick baby services
· Transplant services (organ) **
You pay 30% coinsurance after deductible

 

** when services are performed at a National Transplant Network provider
You pay 50% coinsurance after deductible

 

** subject to out of pocket maximum of $35,000 per covered transplant per year
Mental Health (mental disorders, alcohol and chemical dependence)
Inpatient and Outpatient care (Combined $2,500 per calendar year maximum.  Outpatient care not to exceed $500 of the $2,500 calendar year maximum.)
You pay 50% coinsurance
after deductible
You pay 50% coinsurance
after deductible

Optional
Benefits
· Lifetime Maximum Benefit


· $500 Supplemental Accident Benefit


· $1000 Supplemental Accident Benefit



· $500 Prescription Drug Benefit
$8 million per covered person


First $500 per accident covered at 100%, then base plan benefits apply

First $1000 per accident covered at 100%, then base plan benefits apply


Not Available