Group Forms Humana

APPLICATIONS

Back to Group Health Insurance Forms.

 
Humana Plans 2014 Network Office Visit Copays Prescriptions Deductible & Coinsurance Out-of-Pocket Limits
Gold 100/70 NPOS #1 (H-1) NPOS $25/$40 $10/$30/$50/25%/35% $500 + 0% $4000 Ind/$8000 Family
Gold 100/70 NPOS #2 (H-2) NPOS $25/$40 $10/$30/$50/25%/35% $1000 + 0% $4000 Ind/$8000 Family
Gold Simplicity #1 (H-3) NPOS $30/$55 $10/$30/$55/25%/35% $0 + 0% ($350/day hospital) $6350 Ind/$12,700 Family
Gold 80/50 NPOS #8 (H-4) NPOS $25/$40 $10/$30/$50/25%/35% $500 + 20% $4000 Ind/$8000 Family
Gold 80/50 NPOS #9 (H-5) NPOS $25/$40 $10/$30/$50/25%/35% $1000 + 20% $4000 Ind/$8000 Family
Gold 70/50 NPOS #14 (H-6) NPOS $20/$45 $10/$30/$50/25%/35% $1000 + 30% $4000 Ind/$8000 Family
Silver 100/70 NPOS #3 (H-7) NPOS $30/$65 $10/$45/$70/25%/35% $1500 + 0% $6350 Ind/$12.700 Family
Silver 100/70 NPOS #4 (H-8) NPOS $30/$60 $10/$35/$55/25%/35% $2000 + 0% $6350 Ind/$12,700 Family
Silver 100/70 NPOS #5 (H-9) NPOS $35/$55 $10, $100 deductible, $45/$90/25%/35% $2000 + 0% $5000 Ind/$10,000 Family
Silver 90/60 NPOS #6 (H-10) NPOS $30/$80 $10, $100 deductible, $45/$90/25%/35% $1500 + 10% $6350 Ind/$12,700 Family
Silver 90/60 NPOS #7 (H-11) NPOS $30/$75 $10/$45/$90/25%/35% $2000 + 10% $6350 Ind/$12,700 Family
Silver 80/50 NPOS $10 (H-12) NPOS $40/$65 $10, $100 deductible, $45/$75/25%/35% $1500 + 20% $5000 Ind/$10,000 Family
Silver 80/50 NPOS #13 (H-13) NPOS $45/$70 $10, $100 deductible, $35/$55/25%/35% $2000 + 20% $5000 Ind/$10,000 Family
Silver 80/50 NPOS #1 (H-14) NPOS Deductible & Coinsurance $10/$45/$90/25%/35% $2000 + 20% $5000 Ind/$10,000 Family
Silver 80/50 NPOS #1 (H-15) NPOS $30/$75 $10/$45/$70/25%/35% $2000 + 20% $6350 Ind/$12,700 Family
Silver 70/50 NPOS #2 (H-16) NPOS Deductible & Coinsurance $10/$45/$90/25%/35% $1500 + 30% $5000 Ind/$10,000 Family
Silver 80/50 NPOS #12 (H-17) NPOS $30/$75 $10, $250 Deductible, $35/$70/25%/35% $2000 + 20% $6350 Ind/$12,700 Family
Silver 70/30 NPOS #15 (H-18) NPOS $35/$60 $10, $100 deductible, $45/$75/25%/35% $2000 + 30% $6350 Ind/$12,700 Family
Silver 60/50 NPOS #18 (H-19) NPOS $35/$55 $10/$35/$75/25%/35% $2000 + 40% $6350 Ind/$12,700 Family
Silver 70/50 NPOS #16 (H-20) NPOS $40/$70 $10, $250 deductible, $35/$55/25%/35% $2000 + 30% $6350 Ind/$12,700 Family
Silver 60/50 NPOS #17 (H-21) NPOS $30/$60 $10, $100 deductible, $45/$75/25%/35% $2000 + 40% $6350 Ind/$12,700 Family
Silver 50/50 NPOS #20 (H-22) NPOS $25/$40 $10/$35/$75/25%/35% $2000 + 50% $6350 Ind/$12,700 Family
Silver 60/50 NPOS #19 (H-23) NPOS $40/$70 $10, $250 deductible, $40/$70/25%/35% $2000 + 40% $6350 Ind/$12,700 Family
Silver Simplicity NPOS #3 (H-24) NPOS $50/$100 $10/$40/$70/25%/35% $0 + 0% ($1500/day for hospital) $6350 Ind/$12,700 Family
Silver 50/50 NPOS #21 (H-25) NPOS $30/$75 $10, $100 deductible, $30/$50/25%/35% $2000 + 50% $6350 Ind/$12,700 Family
Silver 50/50 NPOS #22 (H-26) NPOS $35/$60 $10, $100 deductible, $45/$75/25%/35% $2000 + 50% $6350 Ind/$12,700 Family
Silver 50/50 NPOS #23 (H-27) NPOS $45/$70 $10, $250 deductible, $40/$70/25%/35% $2000 + 50% $6350 Ind/$12,700 Family
Bronze 70/50 NPOS #3 (H-28) NPOS Deductible & Coinsurance $10, $100 deductible, $45/$60/25%/35% $5000 + 30% $6350 Ind/$12,700 Family
Gold 100/70 HSA #1 (H-29) NPOS HSA Deductible Deductible $1750 (Aggregate) + 0% $1750 Ind/$3500 Family
Silver 80/50 HSA #3 (H-30) NPOS HSA Deductible & Coinsurance Deductible & Coinsurance $1500 (Aggregate) + 20% $6350 Ind/$12,700 Family
Bronze 90/60 HSA #2 (H-31) NPOS HSA Deductible & Coinsurance Deductible & Coinsurance $5000 (Embedded) + 10% $6350 Ind/$12,700 Family
Bronze 100/70 HSA #2 (H-32) NPOS HSA Deductible Deductible $5500 (Aggregate) + 0% $5500 Ind/$11,000 Family
Bronze 80/50 HSA #4 (H-33) NPOS HSA Deductible & Coinsurance Deductible & Coinsurance $4000 (Embedded) + 20% $6350 Ind/$12,700 Family
Bronze 70/50 HSA #7 (H-34) NPOS HSA Deductible & Coinsurance Deductible & Coinsurance $3500 (Embedded) + 30% $6350 Ind/$12,700 Family
Bronze 80/50 HSA #4 (H-35) NPOS HSA Deductible & Coinsurance Deductible & Coinsurance $4000 (Aggregate) + 20% $6350 Ind/$12,700 Family
Bronze 80/50 HSA #5 (H-36) NPOS HSA Deductible & Coinsurance Deductible & Coinsurance $5000 (Embedded) + 20% $6350 Ind/$12,700 Family
 
Plan Description SBC Office Visit
Copay
Prescription Deductible &
Coinsurance
Out-of-Pocket
Limit
HSA-HDHP NPOS 11
$3000 100/70
SBC Deductible,
then $30/$55
Deductible,
then $10/$40/$70/25%
$3000 + 0% $5000 incl.
Rx Copays
HSA-HDHP NPOS 11
$4000 100/70
SBC Deductible,
then $30/$55
Deductible,
then $10/$40/$70/25%
$4000 + 0% $5000 incl.
Rx Copays
HSA-HDHP NPOS 11
$3000 90/60
SBC Deductible &
Coinsurance
Deductible &
Coinsurance
$3000 + 10% $5000
HSA-HDHP NPOS 11
$2000 80/50
SBC Deductible &
Coinsurance
Deductible &
Coinsurance
$2000 + 20% $5000
HSA-HDHP NPOS 11 $3000 80/50 SBC Deductible &
Coinsurance
Deductible &
Coinsurance
$3000 + 20% $5000
NPOS 11
$3000 100/70
SBC $30/$55 $10/$40/$70/25% $3000 + 0% $3000
NPOS 11 PPO $5000 100/70 SBC $30/$55 $10/$40/$70/25% $5000 + 0% $5000
NPOS 11
$1000 80/50
SBC $30/$55 $10/$40/$70/25% $1000 + 20% $4000
NPOS 11
$1000 80/50
SBC $30/$55 $250 Ded, then
$10/$40/$70/25%
$1000 + 20% $4000
NPOS 11
$1500 80/50
SBC $30/$55 $10/$40/$70/25% $1500 + 20% $4500
NPOS 11
$1500 80/50
SBC $30/$55 $250 Ded, then
$10/$40/$70/25%
$1500 + 20% $4500
NPOS 11 $3000 80/50 SBC $30/$55 $10/$40/$70/25% $3000 + 20% $6000
NPOS 11 $3000 80/50 Ded. Rx SBC $30/$55 $250 Ded, then
$10/$40/$70/25%
$3000 + 20% $6000
NPOS 11
$1000 70/50
SBC $30/$65 $250 Ded, then
$10/$40/$70/25%
$1000 + 30% $4000
NPOS 11
$2000 70/50
SBC $30/$65 $250 Ded, then
$10/$40/$70/25%
$2000 + 30% $5000
NPOS 11
$3000 70/50
SBC $30/65 $250 Ded, then
$10/$40/$70/25%
$3000 + 30% $6000
HMO OA11
$2000 100
SBC $30/$55 $10/$40/$70/25% $2000 + 0% $2000
HMO OA11
$2000 80
SBC $30/$55 $10/$40/$70/25% $2000 + 20% $5000
HMO OA11
$3000 80
SBC $30/$55 $10/$40/$70/25% $3000 + 20% $6000
Simplicity
$40/$65
Coming Soon
SBC $40/$65 $10/$40/$70/25%
Simplicity
$50/$75
Coming Soon
SBC $50/$75 $10/$40/$70/25%
Simplicity
$50/$100
Coming Soon
SBC $50/$100 $10/$40/$70/25%