Humana-Honor-PPO H5216:225-0 is a preferred provider organization (PPO) health plan administered by Humana. It provides individuals and families with extensive coverage options and flexibility in choosing healthcare providers.
This in-depth guide will cover:
- Plan Type and Network
- Costs: Premiums, Deductibles, Co-insurance
- Coverage for Services: Inpatient, Outpatient, Preventive
- Prescription Drug Benefits
- Key Perks and Limitations
- Enrollment Requirements and Options
Plan Type: PPO with the Honor Network
Humana-Honor-PPO H5216:225-0 is a PPO plan, meaning members get lower costs when using the in-network Honor PPO healthcare providers including:
- Over 1.5 million physicians and specialists across all 50 states
- 5,600+ hospitals and urgent care centers
- Over 66,000 pharmacies nationwide
Members can still see out-of-network providers, albeit at higher personal costs. No referrals are needed to see specialists.
Costs: Premiums, Deductibles, Out-of-Pocket Maximums
- $450 monthly premium for individual coverage based on location and age. Can be paid annually or monthly.
- 100% coverage of preventive services like annual checkups when using in-network providers.
- $5,000 individual deductible must be paid before coverage kicks in, except for preventive services.
- 30% co-insurance applies after deductible is met, until the out-of-pocket maximum is reached. This is the percentage of costs members pay.
- Individual out-of-pocket max of $8,550 limits total annual costs for covered in-network care.
Health Services Covered
Inpatient Coverage: After deductible, $500 copay and 30% co-insurance covers hospital stays.
Outpatient Coverage: $50 copay for office visits. 30% co-insurance for medical services at facilities.
Preventive Services: Annual physical and wellness exams, cancer screenings, routine vaccines covered at no charge when in-network.
Prescriptions: $15/$50/$100/25% costs for generic, preferred, non-preferred, specialty drugs. Covers up to 30-day supply from in-network pharmacy.
Additional Perks
- Option for cash payments to providers instead of claim submissions.
- Vast Honor PPO network available in all 50 states.
- No paperwork or referrals required for OB/GYN visits.
- 24/7 telehealth access to doctors through Teladoc service.
Enrollment Requirements and Options
- Available to individuals and families. Small business coverage also offered.
- No minimum participation required.
- Enroll during open enrollment or within 60 days of a qualifying life event.
- Must be a U.S. citizen or legal resident in plan’s coverage area.
The Humana-Honor-PPO H5216:225-0 plan provides extensive medical protection. This detailed guide summarizes the key costs, coverage, and features to help you make an informed decision.