HUMANA MEDICARE ADVANTAGE EMPLOYER HMO

The Humana Medicare Advantage Employer HMO is a first time offering for the State of Louisiana retirees. To be eligible you must have Medicare Part A, be enrolled in Medicare Part B, and live in the service area.

About the OGB Humana Medicare Advantage Employer HMO plan:

  • Part D prescription drug benefits provided by Humana.
  • Worldwide emergency coverage for emergency Medicare-covered services.
  • Robust Provider network.

Covered Benefit

Member Share

Plan Year Deductible

$0

Out-of-Pocket-Maximum (In-Network)

$2,500

Co-pay – Primary Care/Specialist

$5/$20 per visit

Emergency Room

$50 co-pay per visit; waived if admitted within 24 hours

Inpatient Hospital

$50/day (days 1-10)

Prescription Drugs (Part D)

 
  •  Tier 1 – Preferred Generics
  •  Retail 30 day – $5 copay
  •  Retail 90 day – $15 copay
  •  Mail Order 90 day – $10
  •  Tier 2- Generics
  •  Retail 30 day – $25 copay
  •  Retail 90 day – $75 copay
  •  Mail Order 90 day – $50 copay
  •  Tier 3
  •  Retail 30 day – $50 copay
  •  Retail 90 day – $150 copay
  •  Mail Order 90 day – $50
  •  Tier 4
  •  Retail & Mail Order 30 day – 25%
You may view the formulary at www.humana.com

Additional Benefits

Preventative Dental

$0 copay for preventative visits.

Comprehensive Dental

50% coinsurance limited to $1,000 per year for basic services.

Routine Hearing Exam

One hearing exam per year; up to $500 reimbursement allowance for hearing aids per year.

Eyewear

$130 allowance for one pair of eye glasses or contact lenses per year.

 

CONTACT INFORMATION

Humana

www.Humana.com

1-877-889-9885

7:00 AM – 7:00 PM

Monday – Friday

Provider Directory

Online Directory

To request a printed directory – 1-800-457-4708

Plan Information

Guide Book

Summary of Benefits

Prescription Drug Guide

Go 365 Wellness

Benefit Comparison

Premium Rates