2016 Humana Individual–Medical Plan Designs

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Humana Individual On-X Plans available

Network Summary:Knoxville PPOx

Knoxville: East Tennessee Children's Hospital, Fort Sanders Regional Hospital, Omni Community Health, Park West Medical Center and the University of Tennessee Medical CenterKingston: Omni Community Health at KingstonTazewell: Claiborne County HospitalOak Ridge: Methodist Medical Center of Oak RidgeOneida: Omni Community Health Oneida, Pioneer Community Hospital of ScottHarriman: Roane Medical CenterLenoir City: Fort Loudoun Medical CenterMorristown: Morristown Hamblen Healthcare CenterSevierville: LeConte Medical Center

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Humana Individual On-X Plans available

Network SummaryMemphis PPOx

Collierville: Baptist Memorial Hospital -- ColliervilleCovington: Baptist Memorial Hospital – CovingtonGermantown: Baptist Rehabilitation -- GermantownMemphis: Delta Medical Center, St. Jude’s Children’s Research Hospital, Shelby County Healthcare Corporation, Baptist Memorial Children’s Hospital, Baptist Memorial Hospital for Women, Baptist Memorial Hospital, Baptist Memorial Restorative Care Hospital, Saint Francis Hospital, Saint Francis Hospital BartlettRipley: Lauderdale Community HospitalSouthhaven, MS: Baptist Memorial Hospital – DesotoTipton: Baptist Memorial Hospital - Tipton

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Humana Individual On-X Plans available

Network SummaryNashville PPOx

Ashland City: Centennial Medical Center at AshlandClarksville: Gateway Medical Center, Clarkesville VA CBOCFranklin: Williamson Medical CenterGallatin: Sumner Regional Medical CenterHartsville: Trousdale Medical CenterHendersonville: Hendersonville Medical CenterHermitage: Summit Medical CenterMadison: Skyline Medical CampusNashville: Centennial Medical Center, Skyline Medical Center, Southern Hills Medical CenterSpringfield: Northcrest Medical CenterSmyrna: Stonecrest Medical Center

All PPOx Networks use the Select Rx network = CVS, Walmart, Sam’s Club, Humana Pharmacy, Publix

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Humana Individual On-X Plans available

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Humana Individual On-X Plans available

All of these PPOx networks offer the following plan options:

Catastrophic (called “Basic” ): For under 30 years of age or if an individual qualifies for a hardship exemption; high deductible but includes 3 Primary Care Physician (PCP) copays

Bronze: High deductible Health Plan & H.S.A. eligible. Lowest price for plans eligible for Advanced Premium Tax Credit (APTC)

Silver: Copay plan. Available in Base plan, and Cost Share Reduction Plans (CSR): 200-250% Federal Poverty Level (FPL), 150-200% FPL, 100-150% FPL)

Gold: Copay plan

Note: Humana will not offer a Platinum plan in 2016.

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Main changes to Humana PPOx plans in TNEasier access to care:

• CVS Minute Clinic (retail clinic) and Concentra Urgent care clinics available as in-network nationwide (where available)

• Lower PCP copays and Generic RX copays on our Silver Cost Share Reduction Plans (our best selling plans)

• $0 Rx deductible on Silver & Gold plans = Easier access to medication = easier medication adherence

Easier to Understand plans:

• Embedded deductibles (individual protection) on all 2016 PPOx plans in TN

Other important changes:

• New ER benefit: ER copay + Deductible + Coinsurance

• In general: “you pay a $250 copay for every emergency room visit. You also pay all emergency room charges until you reach your deductible. Once you reach your deductible, you pay 20% coinsurance until you reach your maximum out-of-pocket.”

– CSR plans have lower copay portion

– ER copay not waived if patient admitted to hospital

2016 H1 Medical Products – Enhancements

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2016 Medical Products – Enhancements

NEW in 2016 Silver Base (Silver 1)

CSR 200-250% FPL (Silver 1-02)

CSR 150-200% FPL (Silver 1-03)

CSR 100-150% FPL (Silver 1-04)

PCP copay $20 $15 $10 $5

Retail Clinic copay $30 $25 $20 $10

Urgent Care Copay $40 $30 $25 $15

ER (copay + ded + coins)

$250 copay + ded + coins

$200 copay + ded + coins

$200 copay + ded + coins

$150 copay + ded + coins

Tier 1 & 2 Rx $10/$20 $5/$15 $5/$10 $4/$8

Tier 3, 4, 5 Rx $50/50%/50% $45/50%/50% $35/50%/50% $25/50%/50%

Example:

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2016 Medical Products – Changes

Example of 2016 ID Card Design:

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2016 Medical Products – Changes

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2015-2016 Side by Side Plan Comparison

Metal Tier (Plan) Catastrophic Bronze HDHP Silver Copay

Silver 1

Silver Copay CSV 73%

Silver 1-02

Silver Copay CSV 87%

Silver 1-03

Silver Copay CSV 94%

Silver 1-04

Version 2015 2016 2015 2016 2015 2016 2015 2016 2015 2016 2015 2016

Plan Details

Formulary Rx5 Rx5 Rx5 Rx5 Rx5 Rx5 Rx5 Rx5 Rx5 Rx5 Rx5 Rx5

MOOP $6,600 $6,850 $6,300 $6,450 $6,300 $6,300 $4,750 $4,750 $1,450 $1,500 $750 $750

Medical

Deductible $6,600 $6,850 $6,300 $6,450 $4,600 $3,800 $3,250 $3,250 $900 $900 $500 $500

Coinsurance 100% 100% 100% 100% 80% 80% 80% 80% 80% 80% 80% 80%

PCP Copay $35 $25 Ded Ded $25 $20 $25 $15 $25 $10 $25 $5

Retail Clinic $35 Ded Ded Ded $25 $30 $25 $25 $25 $20 $25 $10

Specialist Copay Ded Ded Ded Ded $35 $40 $35 $30 $35 $25 $35 $15

Urgent Care Copay Ded Ded Ded Ded $50 $40 $50 $30 $50 $25 $50 $15

ER Copay*** Ded Ded Ded Ded Ded/Coins **$250+

Ded/Coins **$200+

Ded/Coins **$200+

Ded/Coins **$150+

OV Limit 3 3 - - Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited

Pharmacy

Deductible

Integrated with

Medical Ded.

Integrated with

Medical Ded.

Integrated with

Medical Ded.

Integrated with

Medical Ded.

$1,500 $0 $1,000 $0 $500 $0 $250 $0

Tier 1 $10 $10 $10 $5 $10 $5 $10 $4

Tier 2 $20 $20 $20 $15 $20 $10 $20 $8

Tier 3 $50 $50 $50 $45 $50 $35 $50 $25

Tier 4 50% 50% 50% 50% 50% 50% 50% 50%

Tier 5 50% 50% 50% 50% 50% 50% 50% 50%

Represents Individual, In-Network cost sharing. Family Deductible & MOOP are 2x Individual value.CSV = Cost Share Variation.

*** ER Benefit = ER copay + ded + coins

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2015-2016 Side by Side Plan Comparison Continued

Metal Tier (Plan) Gold Copay

Version 2015 2016

Plan Details Formulary Rx5 Rx5

MOOP $3,500 $3,500

Medical

Deductible $2,500 $2,250

Coinsurance 20% 20%

PCP Copay $25 $20

Retail Clinic $25 $30

Specialist Copay $35 $40

Urgent Care Copay $50 $40

ER Copay**** Ded/Coins **$250 +

OV Limit Unlimited Unlimited

Pharmacy

Deductible $500 $0

Tier 1 $5 $5

Tier 2 $10 $10

Tier 3 $20 $20

Tier 4 35% 35%

Tier 5 35% 35%

Represents Individual, In-Network cost sharing.Family Deductible & MOOP are 2x Individual value.

*** ER Benefit = ER copay + ded + coins