Humana Health Insurance in Colorado

Company:  Plans:  HumanaOne Plans

Humana offers both traditional and Health Savings Account (HSA) plans. It has revamped its HSA plan coverage and rates, so it now offers some of the most popular and competitive plans in many areas.

Humana HSA Plans at a Glance Humana Co-pay Plans at a Glance Co-pay Plan Prescription Coverage Value 100% Plan Effective Dates Additional Coverages

All of these plans help with prescriptions. Two dental plans may also be combined with any of these plans at additional cost.

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

Take a look at Health Savings Account plans first because they keep premiums low and let you deduct what you spend on health care to lower your taxes. If your daughter’s braces are coming out of your pocket, you should get a tax break for that. If acupuncture is working great for you, you can not only get a tax break, but also get tax-free interest to pay for it. Because HSA plans offer the big three (low premiums, tax deductions and tax-free earnings), you owe it to yourself to find out more about these plans.

Humana HSA Plans at a Glance:

Humana offers two HSA plans allowing you to pick a plan that suits your needs, the HumanaOne HSA and the HumanaOne Enhanced HSA. The main difference is that the Enhanced HSA plan includes 100% in-network and 70% out-of-network coverage for prescriptions after the deductible has been met. The standard HumanaOne HSA plan does not cover outpatient prescription drugs.

Plans are available with 100-percent coverage for in-network providers after you have met the deductible, and preventive care is covered before the deductible has been met.

These HSA plans also offer a choice of deductibles. Many of our clients like to move to a plan with a larger deductible after they build up their HSA balance to cover more out-of-pocket costs if necessary. Generally speaking, plans with higher deductibles cost less in monthly premiums.

Humana transplant network providers are covered at the 100-percent rate and other transplant providers are covered at 70 percent up to $35,000 per transplant under both plans.

Overall, PPO networks are very popular because they negotiate discounted rates with their network of providers, and they still offer some coverage for out-of-network providers. That reduced rate is very helpful when you’re paying for health care before meeting the plan’s deductible.

Please note that Humana’s PPO network does have an inadequate number of providers in Dolores, Gunnison, Hinsdale, Mineral, Ouray, Saguache, San Juan and San Miguel counties. Out-of-network providers may bill you for the excess if they charge more than the plan pays when: 1) You are required to travel a “reasonable distance” beyond the plan’s service area in order to see a network provider; 2) You knowingly seek non-network services; or 3) An out-of-network provider is reimbursed less than the billed charge.

Below is a quick comparison of plans. This is a general overview of plan features. The policy contains the actual terms and conditions. Waiting periods, limitations and exclusions apply.

	HumanaOne Enhanced HSA 100% In-network 70% Out-of-network	HumanaOne HSA 100% In-network 70% Out-of-network
Annual Individual Deductibles 1 (Family Deductibles 2 Are Double Individual Deductibles; Out-of-network Deductibles Are Double In-network Deductibles)	For individuals: $1,500, $2,500, $3,500, $5,000, or $5,950.	For individuals: $1,500, $2,500, $3,500, $5,000, or $5,950.
Annual Out-of-pocket Maximum	Same as the deductible for in-network care. $7,500 for individual out-of-network. $15,000 for family out-of-network.	Same as the deductible for in-network care. $7,500 for individual out-of-network. $15,000 for family out-of-network.
Preventive Care (Does Not Include Diagnostic Procedures)	100% with in-network providers. 70% or 100% with out-of-network providers. 3	100% with in-network providers. 70% to 100% with out-of-network providers. 3
Diagnostic Doctor Care (after Deductible)	100% with in-network providers and 70% with out-of-network providers.	100% with in-network providers and 70% with out-of-network providers.
Diagnostic Lab / X-rays (after Deductible)	100% with in-network providers and 70% with out-of-network providers.	100% with in-network providers and 70% with out-of-network providers.
Inpatient Hospital and Outpatient Services (after Deductible)	100% with in-network providers and 70% with out-of-network providers.	100% with in-network providers and 70% with out-of-network providers.
Ambulance and Emergency Room Services	100% after deductible.	100% after deductible.
Transplants (after Deductible)	100% with Humana transplant network providers and 70% with other providers up to $35,000 per transplant.	100% with Humana transplant network providers and 70% with other providers up to $35,000 per transplant.
Mental Health (includes Mental Illness and Chemical Dependency Inpatient and Outpatient Services with Some Exclusions) 4	After separate mental health deductible (which is the same as the in-network or the out-of-network medical deductible), 100% coverage for in-network or 70% coverage for out-of-network services.	Not covered.
Inpatient / Outpatient Alcohol Misuse Behavioral Counseling for Age 18 or Older)		After separate mental health deductible (which is the same as the in-network or the out-of-network medical deductible), 100% coverage for in-network or 70% coverage for out-of-network services.
Other Medical Services (after Deductible)	100% with in-network providers and 70% with out-of-network providers. Limits do apply.5	100% with in-network providers and 70% with out-of-network providers. Limits do apply.5
Prescription Drugs 6 (after Deductible)	100% in-network or 70% out-of-network.	Not covered: member has access to discount card.
Optional Dental Benefits (at Additional Cost)	Traditional Plus includes basic, major and preventive services for any dentist, but you have more coverage for in-network providers. Preventive Plus includes basic and preventive services and has discounts for other services. Click Dental Coverage to see plans.	Traditional Plus includes basic, major and preventive services for any dentist, but you have more coverage for in-network providers. Preventive Plus includes basic and preventive services and has discounts for other services. Click Dental Coverage to see plans.

1. The medical deductible is separate from other deductibles. Expenses applied to the medical deductible do not apply to mental health, prescription or other deductibles that are specific to a health condition.
   
   
2. For family coverage with the Enhanced 100 plan, all members’ covered expenses apply to the family deductible.  For example, if one member’s covered expenses equal the family deductible, the rest of the family is covered without having to meet an individual deductible. For family coverage with the 100 plan, once three members have met the individual deductible, the family deductible has been met for all members. In a two-person family, both people must meet the individual deductible – not the family deductible.
   
   
3. In-network and out-of-network provider services are 100-percent covered for child immunizations from birth to age 18. Both in-network and out- of-network provider services are also 100-percent covered for endoscopic services, mammograms, pap smears and prostate screenings. Well-child exams and lab services from birth to age 13 are 100-percent covered from in-network providers and 70-percent covered from out-of-network providers. Doctor appointments and lab services for those 13 or older are also 100-percent covered from in-network providers. Only doctor appointments and lab services for those 13 or older from out-of-network providers are not covered until the deductible has been met. Once that has been met, these services are covered at 70 percent.
   
   
4. The mental health deductible is separate from other deductibles, so expenses applied to it do not go toward the out-of-pocket maximum or medical, prescription or condition-specific deductibles.
   
   
5. Combined in-network / out-of-network limits: 30 days of skilled nursing facility care per calendar year; 60 home health care visits per calendar year; 30 (combined) audiology, cardiac, cognitive, occupational, physical, speech, and respiratory therapy sessions per calendar year; 10 spinal adjustments per calendar year only with Enhanced 100; 15 hospice family counseling visits per lifetime; and $100 worth of hospice medical social services per family per lifetime.
   
   
6. Reimbursement only for out-of-network by submitting a claim. Humana offers preferred mail-order service at RightSourceRx.com.

   

Humana Co-pay Plans at a Glance:

Humana offers three co-pay plans, which are popular because they allow you to see a doctor with a small charge before the plan’s deductible has been met. Preventive care is 100-percent covered with in-network providers without a deductible or a co-pay. Both of the 80-percent coverage options also give you a choice of deductibles so you can select the one that best suits your situation.

Other doctor services are covered before the deductible has been met with $35 co-pays for in-network primary care doctors, and with $60 co-pays for in-network specialists and urgent care doctors. Most other services, like lab work and emergency care, are 80-percent covered with either of the 80% plans, or 70-percent covered with the 70% plan after the deductible has been met.

Humana transplant network providers are also covered at the 80- or 70-percent rate depending on the plan selected. In addition, either of two dental options may be added to these plans at an additional cost.

Below is a quick comparison of plans. This is a general overview of plan features. The policy contains the actual terms and conditions. Waiting periods, limitations and exclusions apply.

	Enhanced Copay   80% In-network 60% Out-of-network	Copay 80% 80% In-network 60% Out-of-network	Copay 70% 70% In-network 50% Out-of-network
Annual Deductible Choices Individual In-network 1 Family In-network 2 Individual Out-of-network Family Out-of-network	$1,000 / $2,500 $3,000 / $7,500 $2,000 / $5,000 $6,000 / $15,000	$3,500 / $5,000 $10,500 / $15,000 $7,000 / $10,000 $21,000 / $30,000	$5,000 $15,000 $10,000 $30,000
Annual Out-of-pocket Maximum 3 Individual In-network Family In-network  Individual Out-of-network Family Out-of-network	$2,500 $5,000 $10,000 $20,000	$3,500 $7,000 $12,000 $24,000	$5,000 $10,000 $20,000 $40,000
Preventive Care (Does Not Include Diagnostic Procedures)	100% with in-network providers. 60% or 100% with out-of-network providers. 4	100% with in-network providers. 60% or 100% with out-of-network providers. 4	100% with in-network providers. 50% or 100% with out-of-network providers. 4
Diagnostic Doctor Care  In-network Primary Care In-network Specialist or Urgent Care Doctor Out-of-network	$35 co-pay 5 / visit $60 co-pay 5 / visit After deductible, 60% coverage.	Before deductible, 6 in-network appointments with co-pays at $35 for primary care, and $60 for specialists, and urgent care.  After deductible, 80% coverage for in-network and 60% for out-of-network.	Before deductible, 3 in-network appointments with co-pays at $35 for primary care, and $60 for specialists, and urgent care.  After deductible, 70% coverage for in-network and 50% for out-of-network.
Diagnostic Lab / X-rays In-network after Deductible Out-of-network after Deductible	100% up to $500 per calendar year, followed by 80% with exceptions.6 Flat 60%.	100% up to $400 per calendar year, followed by 80% with exceptions. 6 Flat 60%.	100% up to $300 per calendar year, followed by 70% with exceptions. 6 Flat 50%.
Inpatient / Outpatient Services after Deductible	80% for in-network; 60% for out-of-network.	80% for in-network; 60% for out-of-network.	70% for in-network; 50% for out-of-network.
Emergency Room Services after Deductible (Access Fee Waived if Admitted to Hospital)	80% for in-network or out-of-network. $100 access fee.	80% for in-network or out-of-network. $100 access fee.	70% for in-network or out-of-network. $125 access fee.
Ambulance (after Deductible)	80% for in-network or out-of-network.	80% for in-network or out-of-network.	70% for in-network or out-of-network.
Transplants (after Deductible)	80% for Humana transplant network provider.	80% for Humana transplant network provider; 60% for other providers up to $35,000 per transplant.	70% for Humana transplant network provider; 50% for other providers up to $35,000 per transplant.
Mental Health (includes Mental Illness and Chemical Dependency)  Expenses Do Not Count Toward the Medical, Prescription of Certain Illness Deductibles, or Out-of-pocket Maximum.	50% after separate mental health deductible in the same amount as applicable in-network or out-of-network medical deductible.	50% after separate mental health deductible in the same amount as applicable in-network or out-of-network medical deductible.	50% after separate mental health deductible in the same amount as applicable in-network or out-of-network medical deductible.
Other Medical Services (after Deductible)	80% with in-network providers and 60% with out-of-network providers. Limits do apply. 7	80% with in-network providers and 60% with out-of-network providers. Limits do apply. 7 Medical Services	70% with in-network providers and 50% with out-of-network providers. Limits do apply. 7
Optional Dental Benefits  (at Additional Cost)	Traditional Plus includes basic, major and preventive services for any dentist, but you have more coverage for in-network. Preventive Plus includes basic and preventive services and has discounts for other services. Click Dental Coverage to see plans.	Traditional Plus includes basic, major and preventive services for any dentist, but you have more coverage for in-network. Preventive Plus includes basic and preventive services and has discounts for other services. Click Dental Coverage to see plans.	Traditional Plus includes basic, major and preventive services for any dentist, but you have more coverage for in-network. Preventive Plus includes basic and preventive services and has discounts for other services. Click Dental Coverage to see plans.
Prescription Drugs	See chart below.

1. The medical deductible is separate from other deductibles. Expenses applied to the medical deductible do not apply to mental health, prescription or other deductibles that are specific to a health condition.
   
   
2. In a two-person family, both people must meet the individual deductible – not the family deductible. For larger families, once three members have met the individual deductible, the family deductible has been met for all members.
   
   
3. Access fees, co-payments, deductibles and premiums are not included in your annual out-of-pocket maximum. Co-insurance costs are included.
   
   
4. In-network and out-of-network provider services are 100-percent covered for child immunizations from birth to age 18. Both in-network and out- of-network provider services are also 100-percent covered for endoscopic services, mammograms, pap smears and prostate screenings. Well-child exams and lab services from birth to age 13 are 100-percent covered from in-network providers and 60-percent covered from out-of-network providers. Doctor appointments and lab services for those 13 or older are also 100-percent covered from in-network providers. Only doctor appointments and lab services for those 13 or older from out-of-network providers are not covered until the deductible has been met. Once that has been met, these services are covered at 60 percent.
   
   
5. Before the deductible has been met, you can see a doctor for a co-pay charge and the plan covers the rest of the doctor’s fee. Co-pays do not count toward the annual out-of-network maximum.
   
   
6. Diagnostic lab includes allergy testing. Services not included in the initial amount of coverage are: CAT, ECG, EEG, EKG, MRA, MRI, PET, SPECT, cardiac catheterization, endoscopic services, and pulmonary function studies.  After the deductible has been met, these are covered at 60 percent with  both of the 80% plans, and at 50 percent with the 70% plan.
   
   
7. Limits: 30 audiology, cardiac, cognitive, occupational, physical, respiratory, and speech therapy sessions combined per calendar year. 30 days skilled nursing facility care per calendar year. 60 home health visits per calendar year. 15 hospice family counseling sessions per family per lifetime. $100 worth of hospice medical social services per family per lifetime. 10 adjustments, modalities and spinal manipulations per calendar year.

   

Co-pay Plan Prescription Coverage:

The prescription deductible is separate, so prescription expenses will not count toward medical, mental health or certain illness deductibles, or the out-of-pocket maximum.

Copay Plan  Prescription Coverage	In-network	Out-of-network
Level 1 Low-cost Generic and Brand-name Drugs for All 3 Plans	No deductible; $15 co-pay for 30-day supply.	Same if you submit claim for reimbursement.
Level 2 Higher-cost Generic and Brand-name Enhanced 80% Plan 80% Plan  70% Plan	Separate $500 deductible unless you switch to $150 deductible at extra cost; $35 co-pay for 30-day supply after meeting deductible. Same except the deductibles are $700 and $300. Same except the deductibles are $1,000 and $500 and the co-pay is $40.	Separate $500deductible unless you switch to $150 deductible at extra cost; $35 co-pay for 30-day supply and 30% co-insurance cost after meeting deductible. Same except the deductibles are $700 and $300 and there is no co-insurance cost. Same except the deductibles are $1,000 and $500.
Level 3 High-cost Mostly Brand-name Drugs Enhanced 80% Plan   80% Plan   70% Plan	Separate $500 deductible unless you switch to $150 deductible at extra cost; $60 co-pay for 30-day supply.   Same except the deductibles are $700 and $300. Same except the deductibles are $1,000 and $500 and the co-pay is $65.	Separate $500 deductible unless you switch to $150 deductible at extra cost; $60 co-pay for 30-day supply and 30% co-insurance cost after meeting deductible. Same except the deductibles are $700 and $300 and there is no co-insurance cost. Same except the deductibles are $1,000 and $500.
Level 4 High-cost and Certain Injectable Drugs Enhanced 80% Plan   80% Plan   70% Plan	Separate $500 deductible  unless you switch to $150 deductible at extra cost; 35% co-insurance cost for 30-day supply per person per calendar year up to $5,000 out-of-pocket maximum. Same except the deductibles are $700 and $300. Same except the deductibles are $1,000 and $500.	Separate $500 deductible unless you switch to $150 deductible at extra cost; 65% co-insurance cost per person per calendar year up to $5,000 out-of-pocket maximum. Same except the deductibles are $700 and $300. Same except the deductibles are $1,000 and $500.

Value 100% Plan

We always recommend our clients take advantage of the tax deductions and tax-free earnings available with Health Savings Account plans, but we are more than happy to assist you with a non-HSA plan, like the Value 100% plan, if you prefer that type of coverage.

Like all Colorado plans, the Value plan pays for preventive care from in-network providers with no co-pays before the plan’s deductible has been met. You also have a choice of annual medical deductibles. Diagnostic doctor appointments are covered at the 100-percent rate with in-network providers after the deductible has been met. That’s also true for in-network inpatient and outpatient hospital services.

Like Humana’s other plans, the Value plan includes prescription coverage and you have a choice of two dental plans that may be added at extra cost.

	HumanaOne Value 100% In-network 75% Out-of-network
Annual Deductible Choices Individual In-network 1 Family In-network 2 Individual Out-of-network Family Out-of-network	$5,000 / $7,500 $15,000 / $22,500 $10,000 / $15,000 $30,000 / $45,000
Annual Out-of-pocket Maximum Individual In-network Family In-network  Individual Out-of-network Family Out-of-network	Same as the deductible for in-network care. $5,000 for individual out-of-network. $10,000 for family out-of-network.
Preventive Care (Does Not Include Diagnostic Procedures)	100% with in-network providers. 75% or 100% with out-of-network providers. 3
Diagnostic Doctor Care (after Deductible)	100% with in-network providers. 75% with out-of-network providers.
Inpatient Hospital and Outpatient Services (after Deductible)	100% with in-network providers. 75% with out-of-network providers.
Ambulance and Emergency Room Services (Access Fee Waived if Admitted to Hospital)	$125 access fee, then 100% after deductible
Transplants (after Deductible)	100% for Humana transplant network provider and 75% for other providers up to $35,000 per transplant
Mental Health (includes Mental Illness and Chemical Dependency Inpatient and Outpatient Services with Some Exclusions)	50% after separate mental health deductible in the same amount as applicable in-network or out-of-network medical deductible 4
Other Medical Services (after Deductible)	100% with in-network providers and 75% with out-of-network providers. Limits do apply. 5
Optional Dental Benefits  (at Additional Cost)	Traditional Plus includes basic, major and preventive services for any dentist, but you have more coverage for in-network. Preventive Plus includes basic and preventive services and has discounts for other services. Click Dental Coverage to see plans.
Prescription Drugs (30-day Supply) Level 1 Low-cost Generic & Brand-name Level 2 Higher-cost Generic & Brand-name   Level 3 High-cost Mostly Brand-name Level 4 High-cost & Certain Injectables	No deductible; $15 co-pay. Separate $1,000 deductible; $40 co-pay after meeting deductible. Separate $1,000 deductible; $65 co-pay after meeting deductible. Separate $1,000 deductible. For in-network, 35% co-insurance cost per person per calendar year after meeting deductible up to $5,000 out-of-pocket maximum.  Additional 30% co-insurance cost for out-of-network.

1. The medical deductible is separate from other deductibles. Expenses applied to the medical deductible do not apply to mental health, prescription or other deductibles that are specific to a health condition.
   
   
2. In a two-person family, both people must meet the individual deductible – not the family deductible. For larger families, once three members have met the individual deductible, the family deductible has been met for all members.
   
   
3.  In-network and out-of-network provider services are 100-percent covered for child immunizations from birth to age 18. Both in-network and out- of-network provider services are also 100-percent covered for endoscopic services, mammograms, pap smears and prostate screenings. Well-child exams and lab services from birth to age 13 are 100-percent covered from in-network providers and 70-percent covered from out-of-network providers. Doctor appointments and lab services for those 13 or older are also 100-percent covered from in-network providers. Only doctor appointments and lab services for those 13 or older from out-of-network providers are not covered until the deductible has been met. Once that has been met, these services are covered at 70 percent.
   
   
4. The mental health deductible is separate from other deductibles, so expenses applied to it do not count toward the out-of-pocket maximum or medical, prescription or condition-specific deductibles.
   
   
5. Combined in-network / out-of-network limits: 30 days of skilled nursing facility care per calendar year; 60 home health care visits per calendar year; 30 (combined) audiology, cardiac, cognitive, occupational, physical, speech, and respiratory therapy sessions per calendar year; 10 spinal adjustments per calendar year only with Enhanced 100; 15 hospice family counseling visits per lifetime; and $100 worth of hospice medical social services per family per lifetime.

   

Effective Dates

If you've had major medical coverage in the last 90 days, your start date can be as early as the day you apply. If you haven't had coverage in the last 90 days, you'll have one of two start dates:

1. Subject to approval, your plan starts on the day you request with coverage for preventive care and accidental injuries.
   
   
2. Unless Humana agrees to an earlier date, your start date for sickness begins on the 15th day after the approved effective date of your plan.

Please contact ColoHealth at 1-866-749-2039 or use our contact form for more information on getting this coverage in place right away if necessary.

Additional Coverages

HumanaOnealso offers several additional forms of insurance coverage. These include things such as:

• Critical Illness: Pays a set amount of money for a cancer diagnosis or heart attack. Visit our Humana Critical Illness page for more information.
  
  
• Hospital Cash Value: Pays a set amount of money in the event of hospitalization or emergency room treatment. Visit our Humana Cash Value page for more information.
  
  
• Memorial Fund: Whole Life Insurance designed to pay your final expenses and more. Visit our Humana Memorial Fund page for more information.

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.

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