Jaime  Pericás  Prac,ce  Leader    October  6,  2016  

Humana    Commercial  Products  

2017      

Current  Products  for  Sale  

Humana  Max  

Humana  Maximum  

Humana  Complete  

Small  Groups  

Large  Groups  

48  plan  combina:ons  

Pla:num  (36)  Gold  (11)  Bronze  (1)  

 

Rx-­‐3  MAC  B    Rx-­‐4  MAC  C  Rx-­‐5  MAC  B  

 

Humana  Complete  …  

Dental  (DP)  Benefits  

Small  Groups  Oral  examina,ons   Prophylaxis  

Radiographies   Sealant  applica:ons  up  to  14  years  of  age  

Applica,on  of  fluoride  up  to  19  years  of  age  

Space  retainer  

Re-­‐cementa:on  of  space  retainer  Pulp  vitality  test  

Highlighted  benefits  are  addi,ons  to  benchmark  requirements      

Services   DP   DP0   DP1   DP2   DP3   DP4  

Preven,ve   0%   0%   0%   0%   0%   0%  

Restora,ve   X   25%   25%   25%   25%   25%  

Prosthesis   X   X   50%  $800  limit  

50%  $800  limit  

50%  $1,000  limit  

50%  $1,000  limit  

Periodon,cs   X   X   X   50%  $800  limit  

25%    $800  limit  

25%  $800  limit  

Orthodon,cs   X   X   X   50%  $1,000  limit  

50%    $1,000  limit   X  

Op,onal  benefits:  Dental  

Vision  Benefits    For  Small  group  products     Frame  

&  Lenses  

Contact  lenses  

Low  Vision  

Vision  

Ø Vision  exam  -­‐  $5  discount  Ø Contact  lenses  exam  -­‐  $10  discount  Ø Plas,c  lenses  cost  

Ø   Single  Vision  $50    Ø   Bifocal      $70    Ø   Trifocal      $105  

Ø  Frames  Ø  35%    discount  on  frames    

Ø Addi,onal  services  Ø  20%  discount  

Ø Contact  lenses  Ø  15%  discount  on  conven,onal  lenses  

EyeMed  vision  care  discount  program  Vision  Care:  Discount  Program  

Advantages  Hospital    copays   Dental  benefits    for  child  &  adult  $0.00  

copay  

Emergency/Urgent  copay  Trauma  $0.00  copay  

Organ  transplant  coverage  

USA  ER  with  PR  copay   Coverage  in  USA  for  elec:ve  services  not  available  in  PR  with  same  PR  copayment/coinsurance    

Comprehensive  Major  Medical  design  

Humana  Complete  does  not  require  Step  Therapy  in  any  Rx  plan.  

MOOP  accumula:on  not  limited  to  EHB  

Coverage  in  USA  for  eligible  dependent  students  residing  in  PR  with  same  PR  copayment/coinsurance    

Humana  Complete                                                              

Law  177  (August  13,  2016)  

 Diabetes  Mellitus    Type  I  

under  21  years    

Strips  

Lancets  

Insuline  Pump  

Glucometer  

The  law  prohibits  discrimina:on  on  the  basis  of  race,  color,  na:onal  origin,  sex,  age,  or  disability  in  health  programs  or  ac:vi:es  that  receive  Federal  financial  assistance  or  are  administered  by  an  Execu:ve  agency  or  any  en:ty  established  under  Title  I  of  the  ACA.  Sec:on  1557  has  been  in  effect  since  enactment  of  the  ACA.    

   

Breast  cancer  mammography   Pap  Smear   Prosta:c  Specific  

An:gent  test  (PSA)  

                             2016  Preven:ve  Services  (Changes  for  both  sex)    

 ACA  Sec:on  1557  (May  13,  2016)    

 Access  your  health  informa:on  any:me,  anywhere  Whether  you  prefer  downloading  a  mobile  applica,on,  using  your  mobile  device  or  receiving  text  messages,  you  have  the  ability  to  manage  your  healthcare  needs  virtually  anywhere,  any,me.  

Use  the  MyHumana  Mobile  app  and  website  to:  •  View  medical,  dental,  vision,  and  pharmacy  claims  •  View  your  plans  and  coverage  details  •  Receive  medica,on  reminders  •  Research  drug  prices  •  Locate  providers  in  your  network  •  Refill  your  RightSource®  prescrip,ons  

Global Emergency Assistance

 

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•  Medical referrals. •  Assistance with hospital admission. •  Medical evacuation to nearest facility with adequate level of

care. •  Continuous medical monitoring. •  Transportation of relative or friend to accompany patient. •  Care of minors. •  Patient repatriation (to home or rehabilitation facility). •  Medical and non-medical escort. •  Transportation of mortal remains.

Global Emergency Assistance  

Other services:

•  Pre-trip planning.

•  Assistance with medical prescriptions.

•  Assistance with lost documents and luggage.

•  Assistance with eyeglasses and contact lenses.

•  Trauma consultation.

•  Translation services references.

•  Legal references.

Global Emergency Assistance  

Assist  America®  mobile  app

Humana PR – No. de Referencia 01-AA-HUM-02061G

Pedir Ayuda

AYUDA* con presionar un solo botón

*Las llamadas son contestadas en ESPAÑOL desde cualquier parte del mundo.

Con indicador de cobertura automático.

•  No cash limits.

•  No age limitations.

•  No pre-existing conditions limitations.

•  No geographical exclusions.

•  No sports exclusions.

•  No exclusions for alcohol use or mental illness.

•  No exclusions due to terrorist attack situations.

•  Calls answered in Spanish 24/7, 365 days

•  Paramedics, nurses, and doctors on site

Advantages

Assist America® Pays without limits or additional charges

Enrollment  Wizard  Employer  Portal  

•  Enroll  or  cancel  members  •  Update  employee  or  dependents  demographic  informa,on  •  Verify  eligibility  •  Prepare  plan  cer,fica,ons    •  Request  ID  Card  duplicates  •  Renew  your  group  membership  •  Receive  and  reconcile  your  invoice  •  Send  new  hire  informa,on  •  Receive  enrollment  reports