Humana Group Medicare Advantage PPO plan

The Humana Group Medicare Advantage PPO plan demonstrates the Board of Pensions’ commitment to member health and well-being at every stage of life, including the transition from active work into and throughout retirement.

How coverage works

The Humana Group Medicare Advantage PPO plan provides all the benefits of Original Medicare (Parts A and B). The plan is a fully insured Medicare Part C (Medicare Advantage) plan that covers medically necessary items and services from a large national network of hospitals and physicians, as well as any doctor, specialist, or hospital that accepts Medicare and agrees to bill Humana.

You pay $0 for many types of healthcare services and supplies, including preventive care; in-person and virtual visits with a primary care physician; lab services, when performed in a primary care physician’s (PCP’s) office or in a free-standing laboratory; and home healthcare.

The annual deductible is $0 so you pay nothing before the plan begins to pay benefits for services.

For inpatient hospital care, the plan pays 100% after you pay a $320 copayment per admission.

For other types of services, the plan pays 96% of the cost, and you pay 4%; your share is called coinsurance. Examples of services that require you to pay coinsurance include:

• specialist care
  
• outpatient hospital services
  
• urgent care
  
• occupational, physical, and speech therapy
  
• durable medical equipment
  

Out-of-pocket costs for all medical expenses are capped at $2,590 per year; prescription drugs have a separate out-of-pocket maximum of $2,500 per year.

Prescription drug coverage

The plan also includes Medicare Part D prescription drug coverage, with no gap in prescription coverage (donut hole) commonly found in other Medicare Advantage and Medicare supplement plans, and significantly more prescription drug options than the standard individual formulary.

The plan covers medication in four tiers: Tier 1: Generic or Preferred Generic; Tier 2: Preferred Brand; Tier 3: Non-Preferred Drug; and Tier 4: Specialty tier.

You pay just a $5 copayment for Tier 1 Generic or Preferred Generic prescription drugs. Your cost for medication in each of the other tiers varies depending on the prescription and may be found in the Humana Group Medicare Advantage PPO Plan — Pharmacy Summary of Benefits.

Out-of-pocket prescription expenses are capped at $2,500 annually. After you reach this maximum each year, the plan pays 100% of your total drug costs for the remainder of the year.

Added value for retirees

In addition to Part D prescription drug coverage, the plan also provides extras like dental, vision, and hearing aid benefits and a variety of wellness, clinical, and fitness programs. Following are some of the benefits offered:

• dental coverage for exams, teeth cleanings, X-rays, fillings, anesthesia, dentures, and crowns
• annual routine eye exams, eyeglasses (lenses and frames), and contacts
• part of your cost for hearing aids prescribed by an audiologist and one routine hearing exam
• SilverSneakers health and fitness program
• Go365 wellness program by Humana
• Humana Care Management
• Humana Well Dine meal program
• smoking cessation
• advance care planning with MyDirectives
• health coaching
• Humana Neighborhood Center

For coverage details, visit the Humana Board of Pensions website or call Humana Customer Care at 855-273-0021 (TTY: 711).

“During retirement a chief concern is healthcare and insurance. ... the Humana plan includes dental, vision, and hearing benefits, and offers consultative health assessments at no charge.  The group nature of the Humana plan and the shepherding stewardship of the Board of Pensions affirm that, after all, we are one body in Christ!”

— Humana Group Medicare Advantage PPO plan participant

Member costs

You pay nothing to participate in the Humana Group Medicare Advantage PPO plan, and your out-of-pocket cost in some instances is $0 or minimal.

Premium

Retired members pay no monthly subscription rate to participate in the Humana Group Medicare Advantage PPO plan.

Because the plan is a Medicare Advantage Plan, you must continue to keep Medicare Parts A and B and pay your Medicare Part B premium.

Out-of-pocket costs

You share in the cost of certain covered services in the form of copayments and coinsurance as explained under How coverage works.

How to enroll

When you retire, you may enroll in the Humana Group Medicare Advantage PPO plan if you are enrolled in Medicare Parts A and B.

To enroll in Humana Group Medicare Advantage PPO plan coverage, you’ll need to complete the Humana Group Medicare PPO plan Enrollment form. This form is included in the personalized retirement packet you receive after you notify the Board of Pensions of your retirement date. Submit the completed, signed form at least 45 days before your retirement date, but no later than 60 days after your last day of medical coverage through the Board as an active employee.

Family members who may enroll

These family members may enroll in the Humana Group Medicare Advantage PPO plan when you retire, whether you choose to enroll at retirement or not: