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Humana Portrait Plan


Humana Portrait Plan

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

 

Coverage Sypnosis Optional Benefits Rate Information PPO Network Underwriting Effective Dates About Humana

 

 

 

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/CopayHumana Portrait Adobe help

 

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.

 

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 (unlimited visits) (includes allergy injections)
* Office visits: Specialty care (unlimited visits) (includes allergy injections)
* Diagnostic lab, X-ray and allergy testing.



* Allergy serum
* Inpatient services
* Outpatient services (includes surgery).
$35 copay



$50 copay



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)
$500 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
$500 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


* Prescription Drug no Deductible

$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, no 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, no deductible is required to be met before plan benefits are payable
Lifetime Maximum $5,000,000

* 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/CopayHumana Portrait Adobe help

Humana Portrait Plan

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:

1. 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 

2. Access to MyHumana for helpful health plan information, medical information, cost savings tips, and tools

3. 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 Network:

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 800-913-6381 and see if Carol can put you through to one of our Personal Benefits Managers. 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!”

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Computer Analyst

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