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The
HumanaOne Portrait health plan is a full coverage
plan with benefits that you might expect from big employers,
including copays for doctor visits and prescription drugs.
It is similar to the Anthem Blue
Preferred plan.
Please
view the Portrait Plan Brochure to see detailed information
including Plan Provisions, Limits & Exclusions, and State
Variations:
Share
80 Plus Rx/Copay 
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Plans
at a Glance:
The
Portrait plan is a Share 80 Plus Rx and Unlimited
Office Copay plan. What that means is the plan
pays 80% of costs after your deductible is met, 100% of
prescription drugs after the prescription deductible and
co-pay are met and your in network office visits for covered
illness and injury are covered 100% before your deductible
and after your co-pay.
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Share
80 Plus Rx/Copay
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Plan
pays for services at
PARTICIPATING providers
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Plan
pays for services at
NON-PARTICIPATING providers
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| Annual
Deductible |
| · |
Annual
amount (does not apply to maximum out-of-pocket
expense) |
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Maximum
Out-of-Pocket Expense
(after deductible) |
| · |
Individual
(must be satisfied by each covered person) |
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Individual
$2,000
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Family
$4,000
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Individual
$8,000
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Family
$16,000
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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
lab, pathology and X-ray |
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Physician Services |
| · |
Office
visits: Primary care (unlimited visits)
(includes allergy injections) |
| · |
Office
Visits: Specialty care (unlimited visits)
(includes allergy injections) |
| · |
Diagnostic
lab, X-ray and allergy testing |
| · |
Outpatient
services (includes surgery) |
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First
$200/yr covered 100%, then you pay 20%
coinsurance after deductible |
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You
pay 20% coinsurance after deductible |
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You
pay 40% coinsurance after deductible |
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You
pay 40% coinsurance after deductible |
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You
pay 40% coinsurance after deductible |
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You
pay 40% coinsurance after deductible |
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Hospital
Services |
| · |
Outpatient
surgery - facility |
| · |
Emergency
room (includes physician visits) |
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You
pay 20% coinsurance after deductible |
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You
pay 20% coinsurance after $75 copayment per
visit and deductible (copayment waived if admitted) |
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You
pay 40% coinsurance after deductible |
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You
pay 40% coinsurance after $75 copayment per
visit and deductible (copayment waived if admitted) |
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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) |
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$500
prescription drug deductible per individual |
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$15
co-pay, not subject to prescription deductible |
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$35
co-pay after prescription drug deductible |
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$55
co-pay after prescription drug deductible |
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25%
co-pay up to $2,500 out of pocket maximum per year |
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100%
covered after three times the retail copayment |
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$500
prescription drug deductible per individual |
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$15
co-pay, not subject to prescription deductible |
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$35
co-pay after prescription drug deductible |
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$55
co-pay after prescription drug deductible |
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25%
co-pay up to $2,500 out of pocket maximum per year |
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70%
covered after three times the retail copayment |
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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 |
| · |
Complications
of pregnancy and sick baby services |
| · |
Transplant
services (organ) ** |
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You
pay 20% coinsurance after deductible |
** when services are performed at a National Transplant
Network provider
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You
pay 40% coinsurance after deductible |
** subject to out of pocket maximum of $35,000 per covered
transplant per year
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| Mental
Health (mental disorders,
alcohol and chemical dependence) |
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Inpatient
and Outpatient care (Combined $2,500 per calendar
year maximum. Outpatient care not to exceed
$500 of the $2,500 calendar year maximum.) |
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You
pay 50% coinsurance
after
deductible
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You
pay 50% coinsurance
after
deductible
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Optional
Benefits |
| · |
Lifetime
Maximum Benefit |
| · |
$500
Supplemental Accident Benefit |
| · |
$1000
Supplemental Accident Benefit |
| · |
Prescription
Drug no Deductible |
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$8
million per covered person |
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First
$500 per accident covered at 100%, then base plan
benefits apply |
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First
$1000 per accident covered at 100%, then base plan
benefits apply |
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Under
this option, no deductible is required to be met
before plan benefits are payable |
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$8
million per covered person |
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First
$500 per accident covered at 100%, then base plan
benefits apply |
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First
$1000 per accident covered at 100%, then base plan
benefits apply |
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Under
this option, no deductible is required to be met
before plan benefits are payable |
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Lifetime
Maximum
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$5,000,000
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* Covered
expenses incurred in the last three months of the calendar year
and applied to the deductible will be credited to the next calendar
year deductible.
Note:
This chart contain a general summary of benefits, exclusions,
and limitations. Please refer to the Portrait HSA Plan brochure
for the actual terms and conditions that apply:
Share
80 Plus Rx/Copay
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Coverage
Synopsis:
Share
80 Plus Rx and unlimited Copay
The
Share 80 Plus Rx and unlimited Copay plan pays 100% of
your primary care physician office visits after a $35 co-pay,
for an unlimited amount of visits, and 80% of your preventive
care visits before your deductible is met with participating
providers. The office visit co-payment benefit does not
apply to preventive care services. For non-participating
providers, the plan pays 60% of the costs after your non-participating
provider deductible is met. Some preventive care is not
covered with Non-Participating providers (such as: Routine annual
physical exam (age 13 and older), routine immunizations (age
13 and older), routine pap smear, and routine lab, pathology
and X-ray). The plan also pays for 100% of your prescription
drugs after your $500 prescription drug deductible and corresponding
co-pay are met.
Lifetime
maximum is $5 million, and can be increased to $8 million with
the optional lifetime maximum benefit.
With
this plan you can add an option to have a $0 prescription drug
deductible. Cost for this benefit is based on your individual
characteristics, i.e. age, gender, etc.
With this
Portrait Plan you can enjoy these extra benefits:
- Special
Discounts
- Eye
care and vision services - Save up to 45 percent
- Over-the
counter and prescription medication - Save up to 25 percent
- Chiropractic,
acupuncture, and massage therapy - Save up to 30 percent
- Health-related
products and services, including skin care, nutrition supplements,
and vitamins - Save up to 20 percent
- Access
to MyHumana for helpful health plan
information, medical information, cost savings tips, and
tools
- The convenience
of a one-stop destination for life, dental, and individual health
insurance
Optional
Benefits:
Dental
Coverage
You
can choose any dentist, but you can save up to 30 percent on
out-of-pocket costs when you visit one of the more than 75,000
dentist locations in the PPO network. The annual deductible
is $50 for an individual and $150 for a family.
The
plan pays 100% of all preventative services, then 50% after
the deductible for basic, major and teeth whitening services,
up to an annual maximum of $1,000. You can also receive
up to a 20% discount on orthodontia if you visit an orthodontist
from the HumanaDental PPO network and ask for the discount.
Cost
for this benefit is based on your individual characteristics,
i.e. age, gender, etc and rates start around $30 per month in
addition to the base premium. When you run a quote with
us you will see options with and without this optional benefit.
Lifetime
maximum
For
$3 more per month you can extend your coverage and get the added
protection you need with the $8 million lifetime maximum.
Zero
Deductible Prescription Benefit
You
won't have to wait until a deductible is met for your pharmacy
benefits to begin when you choose the zero dollar deductible
pharmacy benefit.
Supplemental
accident benefits
If
you have a minor accident that doesn't cost a lot, this benefit
will cover you right away--up to $500 or $1000 per incident,
before your deductible is required. Anything over the
initial benefit will go towards your deductible and base plan
benefits apply. The cost for an individual for this benefit
is an additional $8.12 per month. Family rates vary by
number of members and ages.
Rate
Information:
Rates for
all three Humana HSA plans
are available on our instant quote
page.
Rates
vary based on age, zip code of residence, and other factors.
Humana are very competitive,
particularly for their higher deductible plans. When running
your quote, please note that rates are often lower when placing
the younger spouse as primary insured.
The
premium can be paid via monthly, quarterly, semi-annual, or annual
billing, or a monthly bank draft. There is a $10 fee for
quarterly and monthly billing. The bank draft will occur
on the premium due date each month. The initial premium
can be paid with a check or credit card.
PPO
Networks:
Humana
utilizes the ChoiceCare network.
Insureds can use Humana
doctors throughout the United States. Having access to the
PPO network can mean substantial discounts in what you pay for
your health care, even before you meet your deductible.
View the complete ChoiceCare
PPO Network (check the HumanaOne and Member
radio buttons, enter your zip code and click Go. Then select
the Humana/ChoiceCare PPO Network and click Go).
Please
note that the Humana PPO network has an inadequate number of providers
in the following counties in Colorado: Dolores, Hinsdale, Mineral,
Ouray, Saguache, San Juan, San Miguel.
The
Humana plans are portable,
so you can move throughout the country without having to change
insurance companies, and still have access to their large network.
Underwriting:
The
Humana Health Insurance underwriting process is extremely fast.
Someone from their underwriting department will call you to do
a telephone interview. Often times you can be given a conditional
approval during the telephone interview, if no medical records
are needed. If medical records are needed, Humana issues
a decision within 48 hours after receipt of records.
One
important aspect of Humana's underwriting process is that it is
done up-front only, when the application is submitted. Many
insurance companies will underwrite again when a claim is submitted,
and may retroactively place a waiver on a plan if a claim occurs
in the first 12 months and they determine that it was a pre-existing
condition. With Humana, if you do not receive a rate up
or rider when you receive the policy, they cover the condition
based on the plans benefits, and do not re-underwrite.
By the way,
Humana has a history of paying claims quickly and currently pays
92% of all claims in 8 days or less.
Effective
dates:
If
you currently have or have recently had coverage, you can request
an effective date any time between the day you apply and 45 days
later. If an underwriter gives you conditional approval,
your health insurance coverage can go into effect immediately.
If you have not had major medical health insurance within the
past two months, you will have the choice of an effective date
of 30 to 45 days after the application submission date.
If
you are ready to apply and have urgent question, please use our
contact form, or call our office
at 866-749-2045 and see if Carol can put you through to one of
our advisors. For more information on how to choose a plan
and apply for coverage, see our Consumer's
Guide page.
About
Humana:
Humana
Inc., headquartered in Louisville, Kentucky, is one of the nation's
largest publicly traded health benefits companies, with approximately
6.6 million medical members located primarily in 18 states and
Puerto Rico. Humana offers coordinated health insurance
coverage and related services - through traditional and Internet-based
plans - to employer groups, government-sponsored plans, and individuals.
Humana
Insurance Company has been assigned a rating of "A-"
(Excellent) from the A.M.
Best Company, an independent insurance rating organization.
ColoHealth
is an independent authorized Humana agent in Colorado.
"You
were the most helpful in guiding me through the
process of selecting what was right for me."
You
were very responsive when I first called, followed up
well, and were patient and helpful despite me taking so
long to make my decision. You were the most helpful
in guiding me through the process of selecting what was
right for me. In today's world of web-based and
long-distance business, your personal touch was and continues
to be important for me.
I
appreciate your willingness to work with the customers,
providing information online for the customers to peruse
before they buy, providing choices to the customers, and
assisting the customers in selecting from them.
Thanks
for continuing to follow up, you have been very helpful.
I would most definitely recommend you to others!
| |
Murali
Gopalakrishnan
Computer Analyst
Superior, CO |
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