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Florida health insurance plans from Humana for individuals and

VIEWS: 3 PAGES: 20

									                                                                    Florida
Jagruti Khatri
4700 Dexter Dr.
Suite 100
Plano, TX 75093
Phone: (866) INSU-BUY
Fax: (972) 767-4470
Website: insubuy.com




                                                Simply the right plan for you




  Insured by Humana Insurance Company,
  Humana Health Insurance Company of Florida,
  Inc., HumanaDental Insurance Company
Choose the plan that’s
right for you




                                               Whether you’re self-employed, an early retiree, or work
                                               for a company that doesn’t offer group health insurance,
 The right blend of                            look to HumanaOne for you and your family’s individual
 features and benefits                         insurance needs.
 ❯ Choice of deductibles to ensure you
   get the coverage you need at a price        Our plans make it possible to find the right coverage
   you can afford                              at a price that fits your budget.
 ❯ Large network so you’re covered when
   you’re at home or traveling                 You can also expect:
 ❯ Portability if you move to another state    ❯ Friendly service every time you need answers on
 ❯ Discounts on eye care and vision services     claims, benefits, or payments
 ❯ Optional dental, life, and prescription     ❯ 12-month initial rate guarantee if you stay in the
   drug coverage available on select plans
                                                 same area and keep the same benefits (on select plans)
 ❯ Unique plan designs, like Short Term
   Medical and Annual Max, are available       ❯ Convenient application process over the
   to meet your specific needs                   phone or online (applications are subject to approval)




                                                                                                          1
    HumanaOne PPO plans                                                                                                              Portrait: Share 80 Plus Rx Unlimited
                                                                                                                          Plan pays for services from                Plan pays for services from
                                                                                                                          NETWORK providers                          NON-NETWORK providers
    Deductible options1                •	 individual                                                                      $1,000/$2,500                              $2,000/$5,000
    •	 per	calendar	year
    •	 copayments	do	not	apply         •	 family	(two family members must each meet their individual deductible)          $2,000/$5,000                              $4,000/$10,000
    Deductible carryover               Covered expenses incurred in the last three months of the calendar year and
                                       applied to the deductible will be credited to the next calendar year deductible.
    Office visit copayment                                                                                                $35 primary care/$50 specialist            Not applicable
                                                                                                                          unlimited visits for illness or injury

    Coinsurance                    •	 individual                                                                          $2,000                                     $8,000
    out-of-pocket limit1
    •	 per	calendar	year
    •	 deductibles	and	copayments	 •	 family                                                                              $4,000                                     $16,000
       do not apply
    Preventive care                    •	   preventive	office	visits2,3                                                   80%                                        50% after deductible
                                       •	   child	immunizations	ages	17	-	182,3
                                       •	   Pap	smear2,3
                                       •	   prostate	screening2,3

                                       •	 mammograms                                                                      100%                                       100%

                                       •	 preventive	X-ray2,3                                                             80% after deductible                       50% after deductible
                                       •	 preventive	lab	age	17	and	older2,3

                                       •	 child	health	supervision	services	from	birth	to	age	17	(includes	routine	       80%                                        60%
                                          exams, immunizations, and laboratory tests; maximum 18 visits per child)
    Physician services                 •	 office	visits	(including	allergy	injections)                                    100% after office visit copayment          60% after deductible




                                       •	 diagnostic	lab	and	X-ray4                                                       First $200 per calendar year 100%          60% after deductible
                                       •	 allergy	testing                                                                 then 80% after deductible

                                       •	 allergy	serum                                                                   80% after deductible                       60% after deductible
                                       •	 inpatient	and	outpatient	services
                                       •	 surgery5
    Facility services                  •	 inpatient	and	outpatient	services                                               80% after deductible                       60% after deductible
                                       •	 outpatient	surgery5

                                       •	 emergency	services	                                                             80% after $75 copayment                    60% after $75 copayment
                                          (copayment waived if admitted)                                                  per visit and deductible                   per visit and deductible
    Rx4 prescription drug6             •	 deductible	per	individual                                                                                  Separate $500 deductible*
    •	 medical	out-of-pocket	          •	 copay	for	each	prescription	or	refill
                                                                                                                                                Level 1 Level 2 Level 3 Level 4
       maximum does not apply             (up to 90-day supply; with applicable copay for each 30 day supply)
                                                                                                                                                 $15*     $35     $55    25%
                                                                                                                                              *Level 1 drugs subject to copay, no deductible
                                       •	 copayment	maximum	(applies	to	Level	4	drugs	only)                                                   $2,500 per individual per calendar year
                                       •	 benefit	per	prescription	or	refill                                              100% after prescription copayment 70% after prescription copayment

                                       •	 mail	order	(up	to	90-day	supply)                                                100% after three times retail copay        70% after three times retail copay
    Other medical services             •	   skilled	nursing	facility	(up	to	30	days	per	calendar	year)                    80% after deductible                       60% after deductible
    •	 prior	authorization	required	   •	   hospice7
       in order to be eligible for     •	   home	health	care	(up	to	60	visits	per	calendar	year)
       these benefits                  •	   durable	medical	equipment	
                                       •	   pregnancy	complications	and	sick	baby	services	
                                            (no prior authorization required)

                                       •	 transplant	services                                                             80% after deductible when services         60% after deductible covered
                                                                                                                          are received from a Humana                 expenses are limited to a maximum
                                                                                                                          Transplant Network provider                allowance of $35,000 per transplant
    Lifetime maximum benefit                                                                                                                      $5,000,000 per covered person
    Mental health, chemical and        •	 inpatient	services	                                                             50% after deductible                       50% after deductible
    alcohol dependency2                •	 outpatient	and	office	therapy	sessions
    •	 $2,500	per	calendar	year           (outpatient services not to exceed $500 of the total benefit)
    •	 medical	out-of-pocket	
       maximum does not apply
    Optional benefits                  •	 prescription	drug	deductible                                                    With this option no deductible is required before Rx benefits are payable
    •	 these	are	available	to	add	
       for an additional cost          •	 lifetime	maximum                                                                Increase to $8,000,000 per covered person
    •	 medical	out-of-pocket	
       maximum does not apply to       •	 supplemental	accident	benefit	($500	or	$1,000)                                  First $500 per accident at 100%, then base plan benefits apply or
       drug coverage                      (treatment must be provided within 90 days of the injury)                       First $1,000 per accident at 100%, then base plan benefits apply
2
                Autograph: Share 80 Plus Rx                                                       Monogram: Total Plus Rx
Plan pays for services from               Plan pays for services from           Plan pays for services from              Plan pays for services from
NETWORK providers                         NON-NETWORK providers                 NETWORK providers                        NON-NETWORK providers
$3,500/$5,000/$6,000                      $7,000/$10,000/$12,000                $7,500                                   $15,000

$7,000/$10,000/$12,000                    $14,000/$20,000/$24,000               $15,000                                  $30,000                              To be covered, expenses
                                                                                                                                                              must be medically
                                                                                                                                                              necessary and specified
                                                                                                                                                              as covered. Please see
$35 primary care/$50 specialist           Not applicable                        Not applicable                           Not applicable                       your policy for more
limited to 6 combined primary and                                                                                                                             information on medical
specialty care visits
                                                                                                                                                              necessity and other specific
$2,000                                    $8,000                                $0                                       $5,000                               plan benefits.
                                                                                                                                                              1. When you obtain care from
$4,000                                    $16,000                               $0                                       $10,000                                 non-network providers:
                                                                                                                                                                 •	 50 percent of your
                                                                                                                                                                     payment toward the
80%                                       50% after deductible                  100%                                     50% after deductible
                                                                                                                                                                     deductible is credited to
                                                                                                                                                                     the deductible for network
                                                                                                                                                                     providers
                                                                                                                                                                 •	 50 percent of your out-of-
100%                                      100%                                  100%                                     100%                                        pocket costs are credited
                                                                                                                                                                     to the out-of-pocket
80% after deductible                      50% after deductible                  100% after deductible                    50% after deductible                        maximum for network
                                                                                                                                                                     providers
80%                                       60%                                   100%                                     75%                                     Once you meet your
                                                                                                                                                                 deductible and out-of-pocket
                                                                                                                                                                 expense limits, the plan pays
100% after office visit copayment         60% after deductible                  100% after deductible                    75% after deductible
                                                                                                                                                                 100 percent for covered
up to 6 combined primary care and
specialty care visits, then 80% after                                                                                                                            services.
deductible                                                                                                                                                    2. Benefit payable after 90-day
                                                                                                                                                                 waiting period for preventive
First $200 per calendar year 100%         60% after deductible                                                                                                   care and 12-month waiting
then 80% after deductible                                                                                                                                        period for mental health.
                                                                                                                                                              3. Benefit maximum for
80% after deductible                      60% after deductible
                                                                                                                                                                 preventive care is limited to
                                                                                                                                                                 $300 per person per calendar
                                                                                                                                                                 year, subject to applicable
80% after deductible                      60% after deductible                  100% after deductible                    75% after deductible                    coinsurance.
                                                                                                                                                              4. MRI, CAT, EEG, EKG, ECG,
80% after $75 copayment                   60% after $75 copayment               100% after $125 copayment                75% after $125 copayment                cardiac catheterization or
per visit and deductible                  per visit and deductible              per visit and deductible                 per visit and deductible                pulmonary function studies
                                                                                                                                                                 are subject to applicable
                         Separate $1,000 deductible*                                                    Separate $1,000 deductible*
                                                                                                                                                                 coinsurance after deductible.
                     Level 1 Level 2 Level 3 Level 4                                                Level 1 Level 2 Level 3 Level 4                           5. Outpatient benefits payable
                      $15*     $35     $55    25%                                                    $15*     $40     $65    25%
                                                                                                                                                                 after 90-day waiting period
                   *Level 1 drugs subject to copay, no deductible                                 *Level 1 drugs subject to copay, no deductible
                                                                                                                                                                 for nonemergency removal of
                   $2,500 per individual per calendar year                                         $2,500 per individual per calendar year                       tonsils and/or adenoids, and
100% after prescription copayment 70% after prescription copayment              100% after prescription copayment 70% after prescription copayment               after 180-day waiting period
                                                                                                                                                                 for nonemergency surgical
100% after three times retail copay      70% after three times retail copay     100% after three times retail copay      70% after three times retail copay      treatment for bunions,
                                                                                                                                                                 varicose veins, hemorrhoids
80% after deductible                      60% after deductible                  100% after deductible                    75% after deductible
                                                                                                                                                                 or hernia (does not apply to
                                                                                                                                                                 strangulated or incarcerated
                                                                                                                                                                 hernia).
                                                                                                                                                              6. If a non-network pharmacy
                                                                                                                                                                 is used you must pay 100
80% after deductible when services        60% after deductible covered          100% after deductible when          75% after deductible covered                 percent of the actual charges
are received from a Humana                expenses are limited to a maximum     services are received from a Humana expenses are limited to a maximum            and file a claim with Humana
Transplant Network provider               allowance of $35,000 per transplant   Transplant Network provider         allowance of $35,000 per transplant          for reimbursement. The
                       $5,000,000 per covered person                                                   $2,000,000 per covered person                             covered person will also be
                                                                                                                                                                 responsible for 30% of the
50% after deductible                      50% after deductible                  50% after deductible                     50% after deductible                    actual charge made by the
                                                                                                                                                                 dispensing pharmacy, after
                                                                                                                                                                 the applicable copayment.
                                                                                                                                                              7. Counseling for the hospice
                                                                                                                                                                 patient and immediate family
With this option $500 deductible is required before Rx benefits are payable     Not available with this plan
                                                                                                                                                                 is limited to 15 visits per
Increase to $8,000,000 per covered person                                       Increase to $5,000,000 per covered person                                        family per lifetime. Medical
                                                                                                                                                                 Social Services limited to
First $500 per accident at 100%, then base plan benefits apply or               First $500 per accident at 100%, then base plan benefits apply or                $100 per family
First $1,000 per accident at 100%, then base plan benefits apply                First $1,000 per accident at 100%, then base plan benefits apply                 per lifetime.                 3
    HumanaOne HSA–qualified HDHP plans                                                                                                      Autograph: Total Plus Rx / HSA
                                                                                                                              Plan pays for services from             Plan pays for services from
                                                                                                                              NETWORK providers                       NON-NETWORK providers
     Deductible options1                •	 individual                                                                         $1,500/$2,500/$3,500/$5,000             $3,000/$5,000/$7,000/$10,000
     •	 per	calendar	year
     •	 copayments	do	not	apply         •	 family2                                                                            $3,000/$5,000/$7,000/$10,000            $6,000/$10,000/$14,000/$20,000
     Coinsurance                        •	 individual                                                                         Not applicable                          $6,000
     out-of-pocket limit1
     •	 deductibles	and	                •	 family                                                                             Not applicable                          $12,000
        copayments do not apply
     Preventive care                    •	   preventive	office	visits3,4                                                      100%                                    50% after deductible
                                        •	   child	immunizations	ages	17	-	183,4
                                        •	   Pap	smear3,4
                                        •	   prostate	screening3,4

                                        •	 mammograms                                                                         100%                                    100%

                                        •	 preventive	X-ray3,4                                                                100% after deductible                   50% after deductible
                                        •	 preventive	lab	age	17	and	older3,4

                                        •	 child	health	supervision	services	from	birth	to	age	17	(includes	routine	          100%                                    70%
                                           exams, immunizations, and laboratory tests; maximum 18 visits per child)
     Physician services                 •	   office	visits                                                                    100% after deductible                   70% after deductible
                                        •	   diagnostic	lab	and	X-ray
                                        •	   allergy	injections,	testing	and	serum
                                        •	   inpatient	and	outpatient	services
                                        •	   surgery
     Facility services                  •	 inpatient	and	outpatient	services                                                  100% after deductible                   70% after deductible
                                        •	 outpatient	surgery5
                                        •	 emergency	services	
     Prescription drug                  •	 retail	or	mail	order	benefit	for	each	prescription	or	refill                       100% after deductible                   70% after deductible6
     Other medical services             •	   skilled	nursing	facility	(up	to	30	days	per	calendar	year)                       100% after deductible                   70% after deductible
     •	 Prior	authorization	required	   •	   hospice8
        in order to be eligible for     •	   home	health	care	(up	to	60	visits	per	calendar	year)
        these benefits                  •	   durable	medical	equipment	
                                        •	   pregnancy	complications	and	sick	baby	services
                                             (no prior authorization required)

                                        •	 transplant	services                                                                100% after deductible when          70% after deductible covered
                                                                                                                              services are received from a Humana expenses are limited to a maximum
                                                                                                                              Transplant Network provider         allowance of $35,000 per transplant
     Lifetime maximum benefit                                                                                                                        $5,000,000 per covered person
     Mental health, chemical            •	 inpatient	services	                                                                50% after deductible                    50% after deductible
     and alcohol dependency3            •	 outpatient	and	office	therapy	sessions
     •	 $2,500	per	calendar	year           (outpatient services not to exceed $500 of the total benefit)
     Optional benefits                  •	 lifetime	maximum                                                                   Increase to $8,000,000 per covered person
     •	 these	are	available	to	add	
        for an additional cost          •	 supplemental	accident	benefit	($500	or	$1,000)                                     First $500 per accident at 100%, then base plan benefits apply or
                                           (treatment must be provided within 90 days of the injury)                          First $1,000 per accident at 100%, then base plan benefits apply

    To be covered, expenses must be medically necessary and specified as covered. Please see your policy for more information on
    medical necessity and other specific plan benefits.
    1.   When you obtain care from non-network providers:                                                 5.   Outpatient benefits payable after 90-day waiting period for nonemergency
         •	     50 percent of your payment toward the deductible is credited to the                            removal of tonsils and/or adenoids, and after 180-day waiting period for
                deductible for network providers                                                               nonemergency surgical treatment for bunions, varicose veins, hemorrhoids or
         •	     50 percent of your out-of-pocket costs are credited to the out-of-pocket                       hernia (does not include strangulated or incarcerated hernia).
                maximum for network providers                                                             6.   If a non-network pharmacy is used you must pay 100 percent of the actual
         Once you meet your deductible and out-of-pocket expense limits, the plan pays                         charges and file a claim with Humana for reimbursement.
         100 percent for covered services.                                                                7.   This value-added feature is not insurance. There is no coverage for retail and/or
    2.   For other than single coverage, the family deductible applies. The single                             mail order prescription drugs unless stated in the policy.
         deductible applies to single coverage policies only.                                             8.   Counseling for the hospice patient and immediate family is limited to 15 visits per
    3.   Benefit payable after 90-day waiting period for preventive care and 12-month                          family per lifetime. Medical Social Services limited to $100 per family per lifetime.
         waiting period for mental health.
    4.   Benefit maximum for preventive care is limited to $300 per person per calendar
         year, subject to applicable coinsurance.




4
                   Autograph: Total / HSA
Plan pays for services from           Plan pays for services from
NETWORK providers                     NON-NETWORK providers
$2,000/$3,000/$4,000/$5,200           $4,000/$6,000/$8,000/$10,400

$4,000/$6,000/$8,000/$10,400          $8,000/$12,000/$16,000/$20,800
Not applicable                        $6,000

Not applicable                        $12,000

100%                                  50% after deductible                HSA-qualified plans
                                                                          When you select an HSA-qualified High
                                                                          Deductible Health Plan (HDHP), you can open
100%                                  100%                                a Health Savings Account (HSA), a personal
100% after deductible                 Not covered                         fund in which you set aside money for
                                                                          qualified healthcare expenses.
100%                                  70%
                                                                          An HSA is a tax-free* way to budget and
100% after deductible                 70% after deductible                pay for your deductible and other qualified
                                                                          medical expenses. Even if you don’t use any
                                                                          healthcare services now, your HSA funds
                                                                          will be there if you need them in the future.
100% after deductible                 70% after deductible
                                                                          Unused funds roll-over year to year.

Discounts available7                  Not covered                         And, it’s easy to use. HumanaOne can
                                                                          provide convenient access to banking
100% after deductible                 70% after deductible
                                                                          partners where you can establish your HSA
                                                                          account. Or, if you prefer, you can select
                                                                          your own bank.
                                                                          * Varies by state, please contact your tax advisor
100% after deductible when          70% after deductible covered            for tax deductibility.
services are received from a Humana expenses are limited to a maximum
Transplant Network provider         allowance of $35,000 per transplant
                       $2,000,000 per covered person
Not covered                           Not covered



Increase to $5,000,000 per covered person

First $500 per accident at 100%, then base plan benefits apply or
First $1,000 per accident at 100%, then base plan benefits apply




                                                                                                                               5
    HumanaOne Annual Max plans                                                                                                                              Annual Max 75/55
                                                                                                                                     Plan pays for services from              Plan pays for services fr
                                                                                                                                     NETWORK providers                        NON-NETWORK provi
    Deductible options1                               •	 individual                                                                  $1,000/$2,000/$3,000                     $2,000/$4,000/$6,000
    •	 per	calendar	year
    •	 copayments	do	not	apply                        •	 family	(three family members must each meet their individual deductible)    $3,000/$6,000/$9,000                     $6,000/$12,000/$18,0

    Annual maximum options
    •	 per	calendar	year                                                                                                                       $100,000 or $250,000 paid by plan per covered pe
    •	 all	covered	services	apply

    Outpatient services maximum options                                                                                                          $5,000 paid by plan for $100,000 annual maximu
    •	 per	calendar	year
    •	 reduces	annual	maximum                                                                                                              $5,000 or $10,000 paid by plan for $250,000 annual m

    Coinsurance
    out-of-pocket limit1                              •	 individual                                                                  $3,500                                   $10,000
    •	 per	calendar	year
    •	 deductibles	and	copays	                        •	 family                                                                      $7,000                                   $20,000
       do not apply
    Preventive care                                   •	 preventive	office	visits	age	17	and	older2,3                                75%                                      Not covered
                                                      •	 child	immunizations	age	17	to	182,3

                                                      •	 Pap	smear	and	mammogram                                                     100%                                     55% after deductible

                                                      •	 prostate	screening                                                          75%                                      55% after deductible
                                                      •	 colorectal	cancer	screening	(includes	exam	and	lab	tests)

                                                      •	 child	health	supervision	services	birth	to	age	17	(includes	exam,	          75%                                      55%
                                                         development assessment, immunization, and lab tests)

                                                      •	 preventive	lab	age	17	and	older2,3                                          75% after deductbile                     Not covered

                                                      •	 preventive	X-ray   2,3
                                                                                                                                     75% after deductible                     Not covered
    Physician services                                                                                   Deductible
                                                      •	 office	visits	for	illness	or	injury             $1,000 or $2,000            100% after office visit copay of $35 55% after deductible
                                                         (including allergy injections)                                              for primary care and $50 for specialty
                                                                                                                                     care up to 3 combined visits, then
                                                                                                                                     75% after deductible

                                                                                                         $3,000                      75% after deductible                     55% after deductible
                                                      •	 diagnostic	lab	and	X-ray    4
                                                                                                         $1,000 or $2,000            First $100 per calendar year 100%        55% after deductible
                                                      •	 allergy	testing                                                             then 75% after deductible5

                                                                                                         $3,000                      75% after deductible                     55% after deductible
                                                      •	   allergy	serum                                 $1,000, $2,000 and $3,000   75% after deductible                     55% after deductible
                                                      •	   inpatient	and	outpatient	services
                                                      •	   surgery6
                                                      •	   emergency	services
    Facility services                                 •	 inpatient	and	outpatient	services                                           75% after deductible                     55% after deductible
                                                      •	 outpatient	surgery6

                                                      •	 emergency	services	                                                         75% after $125 copay per visit           55% after $125 copay
                                                         (copayment waived if admitted)                                              and deductible                           and deductible
    Rx4 prescription drug7                            •	 benefit	maximum	(per	covered	person	per	calendar	year)                                                    $2,500 paid by plan

                                                      •	 deductible	per	covered	person                                                                        Separate $500 deductible*
                                                      •	 copay	for	each	prescription	or	refill
                                                         (up to 90-day supply; with applicable copay for each 30 day supply)                             Level 1 Level 2 Level 3 Level 4
                                                                                                                                                          $15*     $40     $65    25%
                                                                                                                                                       *Level 1 drugs subject to copay, no deductible
                                                      •	 benefit	per	prescription	or	refill
                                                                                                                                     100% after prescription copay            70% after prescription
                                                      •	 mail	order	(up	to	90-day	supply)
                                                                                                                                     100% after three times retail copay      70% after three times r
    Other medical services                            •	   skilled	nursing	facility	(up	to	30	days	per	calendar	year)                75% after deductible                     55% after deductible
    •	 prior	authorization	required	in	order	to	be	   •	   hospice
       eligible for these benefits                    •	   home	health	care	(up	to	30	visits	per	calendar	year)
                                                      •	   durable	medical	equipment	
                                                      •	   pregnancy	complications	and	sick	baby	services	
                                                           (no prior authorization required)

                                                      •	 transplant	services                                                         75% after deductible when services       55% after deductible co
                                                                                                                                     are received from a Humana               expenses are limited to
                                                                                                                                     Transplant Network provider              allowance of $35,000 p
    Lifetime maximum benefit                                                                                                                                $2,000,000 per covered person
    Behavioral health (mental health,                 •	 inpatient	services	                                                         Not covered                              Not covered
    chemical and alcohol dependency)                  •	 outpatient	and	office	therapy	sessions
    Optional benefits                                 •	 supplemental	accident	benefit	($500	or	$1,000)                              First $500 per accident at 100%, then base plan benefits app
    •	 these	are	available	to	add	for	an	                (treatment must be provided within 90 days of the injury)                   First $1,000 per accident at 100%, then base plan benefits ap
       additional cost

6
                                        Annual Max 50/30
 rom             Plan pays for services from           Plan pays for services from           Here’s how it works:
 iders           NETWORK providers                     NON-NETWORK providers                 Annual Max plans have calendar year dollar limits, or caps, that
0                $1,000/$2,000/$3,000                  $2,000/$4,000/$6,000                  keep premiums affordable and deductibles low. When you select
000              $3,000/$6,000/$9,000                  $6,000/$12,000/$18,000                your Annual Max plan, it’s important to remember that you are
                                                                                             responsible for expenses that exceed these calendar year dollar
erson                      $100,000 or $250,000 paid by plan per covered person
                                                                                             limits. Create an Annual Max plan that’s right for you:

                                                                                                    Choose your deductible. You decide which option
um                           $5,000 paid by plan for $100,000 annual maximum
                                                                                                    works best for you.
maximum                $5,000 or $10,000 paid by plan for $250,000 annual maximum
                                                                                                    Select your annual maximum amount. This is the
                 $3,500                                $10,000                                      total amount your plan will pay for covered services each
                 $7,000                                $20,000                                      calendar year. You can select an annual maximum of
                                                                                                    $100,000 or $250,000.
                 50%                                   Not covered
                                                                                                    Know your outpatient services annual maximum.
                 100%                                  30% after deductible                         The total amount your plan pays for outpatient services
                 50%                                   30% after deductible                         is $5,000 each calendar year. If you select the $250,000
                                                                                                    annual maximum option, you have the option to increase
                 50%                                   30%                                          this limit to $10,000.

                 50% after deductible                  Not covered
                                                                                                    Understand your prescription drug maximum
                                                                                                    After meeting your prescription deductible and paying
                 50% after deductible                  Not covered
                                                                                                    applicable copayments, the 75/55 plan pays 100 percent
                 50% after deductible                  30% after deductible                         for all covered prescriptions up to $2,500 per calendar year.

                                                                                                        Important information about annual maximums:
                                                                                                        ❯ Each person on the policy has their own annual maximums.
                 50% after deductible                  30% after deductible                             ❯	 Annual maximums reset every January.
                                                                                                        ❯ You are entirely responsible for any charges that exceed
                                                                                                            your annual maximums.
                 50% after deductible                  30% after deductible                             ❯	 Expenses applied toward the outpatient services will also be
                                                                                                            applied to, and reduce, your annual maximum amount.
                                                                                                        ❯		 Annual maximums are unique to this plan; HumanaOne
                                                                                                            offers other plans without an annual maximum.
                 50% after deductible                  30% after deductible


y per visit      50% after $125 copayment              30% after $125 copayment               To be covered, expenses must be medically necessary and
                 per visit and deductible              per visit and deductible
                                                                                              specified as covered. Please see your certificate for more
                 Discounts available8                  Not covered                            information on medical necessity and other specific
                                                                                              plan benefits.
                                                                                              1. When you obtain care from non-network providers:
                                                                                                 •	 your payment toward the deductible is NOT credited to the deductible for
                                                                                                     network providers
 copay                                                                                           •	 your out-of-pocket costs are NOT credited to the out-of-pocket maximum for
                 Not covered                           Not covered                                   network providers
retail copay                                                                                  2. Benefit payable after 12-month waiting period for preventive care.
                 50% after deductible                  30% after deductible                   3. Benefit maximum for preventive care is limited to $300 per person per calendar
                                                                                                 year, subject to applicable coinsurance.
                                                                                              4. MRI, CAT, EEG, EKG, ECG, cardiac catheterization or pulmonary function studies
                                                                                                 are subject to applicable coinsurance after deductible.
                                                                                              5. This is a combined maximum to include diagnostic lab/x-ray/interpretation, in a
overed           50% after deductible when services    30% after deductible covered              clinic or outpatient location.
 a maximum       are received from a Humana            expenses are limited to a maximum      6. Outpatient benefits payable after 90-day waiting period for nonemergency
per transplant   Transplant Network provider           allowance of $35,000 per transplant       removal of tonsils and/or adenoids, and after 180-day waiting period for
                                        $2,000,000 per covered person                            nonemergency surgical treatment for bunions, varicose veins, hemorrhoids or
                                                                                                 hernia (does not apply to strangulated or incarcerated hernia).
                 Not covered                           Not covered
                                                                                              7. If a non-network pharmacy is used you must pay 100 percent of the actual
                                                                                                 charges and file a claim with Humana for reimbursement. The covered person
ply or           First $500 per accident at 100%, then base plan benefits apply or
pply             First $1,000 per accident at 100%, then base plan benefits apply                will also be responsible for 30 percent of the actual charge made by the
                                                                                                 dispensing pharmacy, after the applicable copayment.
                                                                                              8. This value-added feature is not insurance. There is no coverage for retail and/or
                                                                                                 mail order prescription drugs unless stated in the policy.                        7
    HumanaOne Short Term Medical plans                                                                                                           Short Term 100/75
    These plans are available for a minimum of 30 days and maximum of twelve months                                        Plan pays for services from           Plan pays for services from
    Pre-existing conditions are not covered under this plan                                                                NETWORK providers                     NON-NETWORK providers
     Deductible options1                •	 individual                                                                      $1,000/$2,500/$5,000                  $2,000/$5,000/$10,000
     •	 per	benefit	period
                                        •	 family	(two family members must each meet their individual deductible)          $2,000/$5,000/$10,000                 $4,000/$10,000/$20,000

     Coinsurance                        •	 individual                                                                      Not applicable                        $5,000
     out-of-pocket limit1
     •	 per	benefit	period
     •	 deductibles	do	not	apply        •	 family                                                                          Not applicable                        $10,000
     Preventive care                    •	   preventive	office	visits	age	17	and	older                                     Not covered                           Not covered
                                        •	   child	immunizations	age	17	to	18
                                        •	   Pap	smear
                                        •	   prostate	screening
                                        •	   preventive	X-ray
                                        •	   preventive	lab	age	17	and	older

                                        •	 child	health	supervision	services	from	birth	to	age	17	                         100%                                  75%
                                           (includes routine exam, developmental assessment,
                                           immunization, and lab tests)

                                        •	 mammogram	age	35	and	older                                                      100% after deductible                 75% after deductible
                                        •	 colorectal	cancer	screening	(includes	exam	and	lab	tests)
     Physician services                 •	   office	visits	(including	allergy	injections)                                  100% after deductible                 75% after deductible
                                        •	   diagnostic	lab	and	X-ray3
                                        •	   allergy	testing
                                        •	   allergy	serum
                                        •	   inpatient	and	outpatient	services
                                        •	   surgery
     Facility services                  •	 inpatient	and	outpatient	services                                               100% after deductible                 75% after deductible
                                        •	 outpatient	surgery
                                        •	 emergency	services
     Prescription drug4                 •	 deductible	per	individual                                                       Integrated with medical               Integrated with medical
     •	 mail	order	not	available
                                        •	 benefit	per	prescription	or	refill                                              100% after deductible                 75% after deductible
     Other medical services             •	   skilled	nursing	facility	(up	to	30	days	per	benefit	period)                   100% after deductible                 75% after deductible
     •	 prior	authorization	required	   •	   home	health	care	(up	to	40	visits	per	benefit	period)
        in order to be eligible for     •	   durable	medical	equipment	
        these benefits                  •	   pregnancy	complications	and	sick	baby	services	
                                             (no prior authorization required)

                                        •	 hospice                                                                         Not covered                           Not covered

                                        •	 transplant	services                                                             100% after deductible when            75% after deductible covered
                                                                                                                           services are received from a Humana   expenses are limited to a maximum
                                                                                                                           Transplant Network provider           allowance of $35,000 per transplant
     Lifetime maximum benefit                                                                                                                    $2,000,000 per covered person
     Mental health, chemical and        •	 inpatient	services	                                                             Not covered                           Not covered
     alcohol dependency                 •	 outpatient	and	office	therapy	sessions
    Your certificate is not renewable and does not include a 12-month rate guarantee.
    To be covered, expenses must be medically necessary and specified as covered. Please see your certificate for more information on
    medical necessity and other specific plan benefits.
    1. When you obtain care from non-network providers:                                                3. MRI, CAT, EEG, EKG, ECG, cardiac catheterization or pulmonary function studies are
       •	 your payment toward the deductible is NOT credited to the deductible for                        subject to applicable coinsurance after deductible.
          network providers                                                                            4. If a non-network pharmacy is used you must pay 100 percent of the actual charges
       •	 your out-of-pocket costs are NOT credited to the out-of-pocket maximum for                      and file a claim with Humana for reimbursement.
          network providers
    2. Only available for plans six months or less in duration.




8
                        Short Term 80/60
Plan pays for services from           Plan pays for services from
NETWORK providers                     NON-NETWORK providers
$5002/$1,000/$2,500/$5,000            $1,000/$2,000/$5,000/$10,000

$1,000/$2,000/$5,000/$10,000          $2,000/$4,000/$10,000/$20,000

$2,000                                $8,000


$4,000                                $16,000
Not covered                           Not covered                           HumanaOne’s Short Term Medical plans can help
                                                                            protect you and your family if you find yourself
                                                                            without health insurance. You can choose the
                                                                            plan you need and have coverage for unexpected
                                                                            illness, injuries and accidents until you receive
80%                                   60%
                                                                            permanent coverage.

                                                                            It’s an ideal choice if you’re:
80% after deductible                  60% after deductible
                                                                              ❯	a student or recent graduate
80% after deductible                  60% after deductible                    ❯	between jobs
                                                                              ❯	waiting for employer benefits to begin
                                                                              ❯	without coverage due to job or life changes
                                                                              ❯	a part-time, temporary or seasonal employee
80% after deductible                  60% after deductible
                                                                              ❯	retired and waiting for Medicare eligibility
                                                                            And the best part is that if you are eligible you
Integrated with medical               Integrated with medical
                                                                            can receive coverage as quickly as the day after
80% after deductible                  60% after deductible                  applying. You don’t have to wait weeks for the
80% after deductible                  60% after deductible                  coverage you need today.




Not covered                           Not covered

80% after deductible when services    60% after deductible covered
are received from a Humana            expenses are limited to a maximum
Transplant Network provider           allowance of $35,000 per transplant
                       $2,000,000 per covered person
Not covered                           Not covered




                                                                                                                                9
     HumanaOne Individual
     Dental Insurance


                                      You can choose any dentist, but you can save up to 30 percent on
                                      out-of-pocket costs when you visit one of more than 120,000 dentist
                                      locations in the PPO network. Visit Humana.com to find a dentist.




                                      Annual deductible          $50 individual / $150 family
                                      Preventive services        •		 oral	examinations	                                   100% no deductible
                                                                 •		 routine	cleanings
     Visit MyDentalIQ.com to                                     •		 x-rays
                                                                 •		 sealants	
     find out how to improve                                     •		 topical	fluoride	treatment
     your oral health. Following      Basic services             •		 emergency	care	for	pain	relief                       50% after deductible
                                      •	 six	month	waiting	      •		 thumb	sucking	and	harmful	habit	appliances
     a few simple steps could            period applies          •		 space	maintainers	
                                                                 •		 amalgam,	composite	fillings	(front/anterior	teeth)
     possibly help lower your total                              •		 oral	surgery	
     healthcare costs over time.                                 •		 routine	extractions
                                                                 •		 non-cast	stainless	steel	crowns
                                                                 •		 partial	or	complete	denture	repairs/adjustments
                                      Major services             •		 endodontics	(root	canals)	                           50% after deductible
                                      •	 twelve	month	waiting	   •		 periodontics	
                                         period applies          •		 crowns	
                                                                 •		 inlays	and	onlays
                                                                 •	 partial	or	complete	dentures	
                                                                 •		 denture	relines/rebases	
                                                                 •		 removable	or	fixed	bridgework
                                      Orthodontia                Members can receive up to 20 percent discount if they visit an orthodontist from
                                                                 the HumanaDental PPO Network and ask for the discount.
                                      Annual maximum             $1,000 per covered person




10
HumanaOne Individual
Term Life Insurance

With HumanaOne term life, you can buy a higher amount of
insurance protection at a lower cost. You own the policy and
maintain	control,	providing	more	flexibility	for	your	family.	




    Coverage amounts1      •		 Amounts	start	at	$25,000	and	can	go	up	to	a	maximum	
                               of $150,000
    Term levels            •		 Ages	18-65	for	a	10-year	level	premium	term
                                                                                                 How much life insurance
                           •	 Ages	18-60	for	a	15-year	level	premium	term
                           •	 Ages	18-55	for	a	20-year	level	premium	term
                                                                                                 do you need?
    Rate guarantee         •		 Rates	are	guaranteed	for	the	full	term	of	the	policy              One rule of thumb for recommended
    Renewals               •		 HumanaOne Term Life Insurance is guaranteed renewable to          coverage is a life insurance amount
                               age 95. Premiums after the initial level premium period will      equal to up to 10 times annual
                               increase annually, but are also guaranteed.
                                                                                                 income, according to the American
1
     By applying for life insurance and health insurance simultaneously you will automatically
     be approved for up to $150,000 in life insurance coverage if you are approved for health
                                                                                                 Council for Life Insurers. No one
     insurance coverage.                                                                         guideline applies to everyone,
                                                                                                 however, because financial situations
                                                                                                 and goals vary from person to person,
                                                                                                 and family to family.

                                                                                                 To estimate the amount of life
                                                                                                 insurance you may need, you can use
                                                                                                 our online life insurance calculator at
                                                                                                 www.humana-one.com/life-insurance/
                                                                                                 term-life-insurance.asp and select
                                                                                                 “life insurance calculator.”




                                                                                                                                           11
     Medical limitations and exclusions
     This is an outline of the limitations and exclusions for HumanaOne individual health plans. It is designed for convenient reference. Consult the policy for a
     complete list of limitations and exclusions. Your policy is guaranteed renewable as long as premiums are paid. Other termination provisions apply as listed in
     the policy.

     Eligibility
     The issue ages for HumanaOne individual health plans are two months to 64.5 years. The maximum age for a dependent child is until the end of the calendar
     year that the dependent turns 25, as long as the dependent lives in the household of the policyholder or is a full- or part-time student.

     Coverage may be available for a non-dependent child who does not live in the policyholder’s household until the end of the calendar year that the
     non-dependent child turns 30, as long as the non-dependent child is unmarried, has no dependents of his/her own, resides in the state of Florida or is a
     full- or part-time student, and is not covered under any other health insurance.

     Pre-existing conditions
     A pre-existing condition is a sickness or injury which was diagnosed or treated, or which produced signs or symptoms that would cause an ordinarily prudent
     person to seek medical advice, care or treatment, during the 24-month period before the covered person’s effective date of coverage. Routine follow-up care to
     determine the reoccurrence of breast cancer does not constitute medical advice, care or treatment. Benefits for pre-existing conditions are not payable until the
     covered person’s coverage has been in force for 12 consecutive months with us. We will waive the pre-existing conditions limitation for those conditions disclosed
     on the application provided benefits relating to those conditions are not excluded. Conditions specifically excluded by rider are never covered.

     Other expenses not covered                                     by, complicated by, or exacerbated by obesity,       Additional expenses not covered in the
     Unless stated otherwise no benefits are payable for           including but not limited to surgical procedures.     following HumanaOne plans:
     expenses arising from:                                  18.   Nicotine habit or addiction; educational or           Autograph: Share 80 Plus Rx, Portrait: Share 80
     1. Services not medically necessary or which are              vocation therapy, services and schools; light         Plus Rx Unlimited, Monogram: Total Plus Rx,
          experimental, investigational or for                     treatment for Seasonal Affective Disorder             and Autograph: Total Plus Rx / HSA
          research purposes.                                       (S.A.D.); alternative medicine; marital counseling;
                                                                   genetic testing, counseling or services; sleep        1. Any drug, medicine or device which is not
     2. Services not authorized or prescribed by a
                                                                   therapy or services rendered in a premenstrual             FDA approved.
          healthcare practitioner or for which no charge
          is made.                                                 syndrome clinic or holistic medicine clinic.          2. Contraceptives other than oral, including implant
                                                             19.   Foot care services.                                        systems and devices regardless of the purpose for
     3. Services while confined in a hospital or other
                                                                                                                              which prescribed.
          facility owned or operated by the United States    20.   Charges for nonmedical purposes or used for
          government, provided by a person who ordinarily          environmental control or enhancement (whether         3. Medications, drugs or hormones to
          resides in the covered person’s home or who              or not prescribed by a healthcare practitioner).           stimulate growth.
          is a family member, or that are performed in       21.   Health clubs or health spas, aerobic and              4. Legend drugs not recommended or deemed
          association with a service that is not covered           strength conditioning, work hardening programs             necessary by a healthcare practitioner or drugs
          under the policy.                                        and related material and products for these                prescribed for a noncovered injury or sickness.
     4. Charges in excess of the maximum allowable fee             programs; personal computers and related or           5. Drugs prescribed for intended use other than for
          or which exceed any policy benefit maximum.              similar equipment; communication devices other             indications approved by the FDA or recognized
     5. Expenses incurred before the effective date or             than due to surgical removal of the larynx or              off-label indications through peer-reviewed
          after the date coverage terminated.                      permanent lack of function of the larynx.                  medical literature, experimental or investigational
                                                             22.   Hair prosthesis, hair transplants or implants              use drugs.
     6. Cosmetic procedures and any related
          complications except as stated in the policy.            and wigs.                                             6. Over the counter drugs (except insulin) or
                                                             23.   Temporomandibular joint disorder, craniomaxillary          drugs available in prescription strength without
     7. Custodial or maintenance care.
                                                                   disorder, craniomandibular disorders and any               a prescription.
     8. Infertility services.
                                                                   treatment for jaw, joint or head and neck             7. Drugs used in treatment of nail fungus.
     9. Pregnancy and well-baby expenses.
                                                                   neuromuscular disorder unless diagnostic and/         8. Prescription refills exceeding the number specified
     10. Elective medical or surgical procedures;                  or surgical procedures are medically necessary             by the healthcare practitioner or dispensed more
          sterilization, including tubal ligation and              to treat conditions caused by congenital or                than one year from the date of the original order.
          vasectomy; reversal of sterilization; abortion;          developmental deformity, disease or injury.           9. Vitamins, dietary products and any other
          gender change or sexual dysfunction.
                                                             24.   Services or supplies received in connection                nonprescription supplements.
     11. Vision therapy; all types of refractive                   with a sickness or bodily injury arising out of,      10. Inpatient services when in an observation
          keratoplasties or any other procedures,                  or sustained in the course of, any occupation,             status or when the stay is due to behavioral,
          treatments or devices for refractive correction;         employment or activity for compensation, profit            social maladjustment, lack of discipline or
          eyeglasses; contact lenses; hearing aids;                or gain, for which benefits are paid under                 other antisocial actions not a result of a
          dental exams.                                            Workers’ Compensation. This exclusion does not             mental disorder.
     12. Hearing and eye exams; routine physical                   apply to services or supplies received by a covered
          examinations for occupation, employment,                                                                       Additional expenses not covered in the
                                                                   person qualifying as a sole proprietor, officer
          school, travel, purchase of insurance or                 or partner under the laws of that state, and          following HumanaOne plans:
          premarital tests.                                        such benefits are not paid under any Workers’         Autograph: Total / HSA
     13. Services received in an emergency room unless             Compensation plan, provided he or she will not        1.   Mental health including mental disorders,
          required because of emergency care.                      receive benefits under a Workers’
                                                                                                                              alcohol and chemical dependency.
     14. Dental services (except for dental injury),               Compensation plan.
          appliances or supplies, unless you purchase the    25.   Attempted suicide or intentionally self-inflicted     2.   Spinal manipulations and spinal
          dental option.                                           injury, whether sane or insane.                            adjustment modalities.
     15. War or any act of war, whether declared or          26.   Charges covered by other medical payments             3.   Prescription drugs except drugs provided or
          not; commission or attempt to commit a civil or          insurance.                                                 administered while confined in a hospital or
          criminal battery or felony.                        27.   Organ transplants not approved based                       skilled nursing facility, by a home health agency
     16. Standby physician or assistant surgeon, unless            on established criteria or investigational,                or by a healthcare practitioner during an
          medically necessary; private duty nursing;               experimental or for research purposes, except as           office visit, or as stated in the policy.
          communication or travel time; lodging or                 stated in the policy.                                 4.   Inpatient services when in an observation
          transportation, except as stated in the policy.    28.   Charges incurred for a hospital stay beginning             status or when the stay is due to behavioral,
     17. Any treatment for the purpose of reducing                 on a Friday or Saturday unless due to emergency
          obesity, or any use of obesity reduction                                                                            social maladjustment, lack of discipline or
                                                                   care or surgery is performed on the day admitted.
          procedures to treat sickness or injury caused                                                                       other antisocial actions not a result of a
                                                                                                                              mental disorder.

12
Annual Max plan limitations and exclusions
This is an outline of the limitations and exclusions for the HumanaOne Annual Max plans. It is designed for convenient reference. Consult the certificate for a
complete list of limitations and exclusions. Your certificate is guaranteed renewable as long as premiums are paid. Other termination provisions apply as listed
in the certificate.

Eligibility
The issue ages for HumanaOne individual health plans are two months to 64.5 years. The maximum age for a dependent child is 25 years if the child is a
full-time student and 19 years if the child is not a full-time student.

Pre-existing conditions
A pre-existing condition is a sickness or bodily injury which was diagnosed or treated, or which produced signs or symptoms during the 5-year period before
the covered person’s effective date of coverage. Benefits for pre-existing conditions are not payable until the covered person’s coverage has been in force for
12 consecutive months with us. We will waive the pre-existing conditions limitation for those conditions disclosed on the enrollment form provided benefits
relating to those conditions are not excluded. Conditions specifically excluded by rider are never covered.
Other Expenses not Covered                                      medically necessary; private duty nursing;                    social maladjustment, lack of discipline or other
Unless stated otherwise no benefits are payable for             communication or travel time; lodging or                      antisocial actions.
expenses arising from:                                          transportation except as stated in the certificate.     28.   Attempted suicide or intentionally self-inflicted
1. Services not medically necessary or which are          18.   Any treatment for the purpose of reducing                     injury, whether sane or insane.
     experimental, investigational or for research              obesity or any use of obesity reduction                 29.   Charges covered by other medical payments
     purposes.                                                  procedures to treat sickness or bodily injury                 insurance.
                                                                caused by, complicated by or exacerbated by             30.   Organ transplants not approved based
2. Services not authorized or prescribed by a
                                                                obesity, including but not limited to surgical                on established criteria or investigational,
     healthcare practitioner or for which no charge
                                                                procedures.                                                   experimental or for research purposes.
     is made.
                                                          19.   Nicotine habit or addiction; educational or             31.   Charges incurred for a hospital stay beginning
3. Services while confined in a hospital or other
                                                                vocational therapy, services and schools; light               on a Friday or Saturday unless due to emergency
     facility owned or operated by the United States
                                                                treatment for Seasonal Affective Disorder                     care or surgery is performed on the day admitted.
     government, provided by a person who ordinarily
                                                                (S.A.D.); alternative medicine; marital counseling;
     resides in the covered person’s home or who
                                                                genetic testing, counseling or services, sleep
     is a family member, or that are performed in
                                                                therapy or services rendered in a premenustral
                                                                                                                        Additional expenses not covered in the
     association with a service that is not covered                                                                     following HumanaOne plans:
                                                                syndrome clinic or holistic medicine clinic.
     under the certificate.
                                                          20.   Foot care services.                                     Annual Max 50/30
4. Charges in excess of the maximum allowable fee
     or which exceed any benefit maximum, calendar        21.   Any treatment for mental health, including but
                                                                                                                        1.    Prescription drugs except drugs provided or
     year certificate plan maximum or lifetime                  not limited to prescription drugs.
                                                                                                                              administered while confined in a hospital, skilled
     maximum.                                             22.   Charges for non-medical purposes or used for                  nursing facility, by a healthcare practitioner
5. Services provided by a Chiropractor, including but           environmental control or enhancement (whether                 during an office visit or by a home health care
     not limited to exams, x-rays, laboratory, spinal           or not prescribed by a healthcare practitioner).              agency.
     manipulations and spinal adjustment modalities.      23.   Health clubs or health spas, aerobic and
6. Expenses incurred before the effective date or               strength conditioning, work hardening programs
                                                                                                                        Additional expenses not covered in the
     after the date coverage is terminated.                     and related material and products for these
                                                                programs, personal computers and related or             following HumanaOne plans:
7. Cosmetic procedures and any related
                                                                similar equipment; communication devices other          Annual Max 75/55
     complications except as stated in the certificate.
                                                                than due to surgical removal of the larynx or
8. Custodial or maintenance care.                                                                                       1.    Any drug, medicine or device which is not FDA
                                                                permanent lack of function of the larynx.
9. Infertility services.                                                                                                      approved.
                                                          24.   Hair prosthesis; hair transplants or wigs.
10. Pregnancy and well-baby expenses.                                                                                   2.    Contraceptives, including oral and transdermal,
                                                          25.   Temporomanibular joint disorder, crainomaxillary              whether medication or device.
11. Elective medical or surgical procedures;                    disorder, craniomandibular disorders and any
     sterilization, including tubal ligation and                                                                        3.    Medications, drugs or hormones to stimulate
                                                                treatment for jaw, joint or head and neck or
     vasectomy; reversal of sterilization; abortion;                                                                          growth.
                                                                intraoral prosthetic devices or surgical procedures
     gender change or sexualdysfunction.                        for cosmetic purposes, unless diagnostic and/           4.    Legend drugs not recommended or deemed
12. Vision therapy; all types of refractive                     or surgical procedures are medically necessary                necessary by a healthcare practitioner or drugs
     keratoplastics or any other procedures,                    to treat conditions caused by congenital or                   prescribed for a non-covered bodily injury or
     treatments or devices for refractive correction;           developmental deformity, disease or bodily injur.             sickness.
     eyeglasses; contact lenses, hearing aids; dental     26.   Bodily injury and sickness arising out of the           5.    Drugs prescribed for intended use other than for
     exams.                                                     course of any occupation employment or                        indications approved by the FDA or recognized
13. Hearing, except as specified in this certificate,           activity for compensation profit or gain, whether             off-label indications through peer-reviewed
     and eye exams; routine physical examinations for           or not benefits are available under Workers’                  medical literature; experimental or investigational
     occupation, employment, school, travel, purchase           Compensation. This exclusion does not apply to                use drugs.
     of insurance or premarital tests.                          a covered person qualifying as a sole proprietor,       6.    Over the counter drugs (except insulin) or drugs
14. Services received at an emergency room unless               officer or partner under state law, and such                  available in prescription strength without a
     required because of emergency care.                        benefits are not covered under any Workers’                   prescription.
15. Dental services (except for dental injury),                 Compensation plan, provided the covered person          7.    Drugs used in treatment of nail fungus.
     appliances or supplies.                                    is not covered under a Workers’ Compensation            8.    Prescription refills exceeding the number specified
16. War or any act of war, whether declared or                  plan, except for certain professions or activities as         by the healthcare practitioner or dispensed more
     not, commission or attempt to commit a civil or            stated in the certificate.                                    than 1 year from the date of the original order.
     criminal battery or felony.                          27.   Inpatient services when in an observation               9.    Vitamins, dietary products and any other
17. Standby physician or assistant surgeon, unless              status or when the stay is due to behavioral,                 non-prescription supplements.

Important information about Annual Max plans–This HumanaOne PPO Annual Max plan has calendar year policy limits for all covered
services, for outpatient services, and for pharmacy services (where applicable). Expenses applied to the outpatient and pharmacy calendar
year limits will also be applied to the all covered services calendar year limit. Any costs incurred for services above the calendar year limits are
the member’s responsibility. Humana has other plans available that do not have calendar year limits, see your state-specific benefit summary
for details.
                                                                                                                                                                                    13
     Short Term Medical limitations and exclusions
     This is an outline of the limitations and exclusions for HumanaOne Short Term Medical plans. It is designed for convenient reference. Consult the certificate for
     a complete list of limitations and exclusions. Your certificate is not renewable.
     Eligibility
     The issue ages for HumanaOne individual health plans are 30 days to 64 years 11 months. The maximum age for a dependent child is 25 years if the child is a
     full-time student and 19 years if the child is not a full-time student.
     Pre-existing conditions
     No benefits are payable for any pre-existing condition. A pre-existing condition is a sickness or bodily injury which was diagnosed or treated, or which
     produced signs or symptoms during the 5-year period before the covered person’s effective date of coverage.
     HIPAA eligibility
     If you recently lost group coverage through your employer and you have a pre-existing medical condition, a short term plan may not be ideal for you. If you
     purchase a short term plan instead of electing COBRA, you’ll become ineligible for other guarantee-issue plans that are available through your state.

     Other expenses not covered                               21. Vitamins, dietary products and any other                    and related material and products for these
   Unless stated otherwise no benefits are payable for            non-prescription supplements.                               programs, personal computers and related or
   expenses arising from:                                     22. Infertility services.                                       similar equipment; communication devices other
   1. Conditions which first manifested during a prior                                                                        than due to surgical removal of the larynx or
                                                              23. Pregnancy and well-baby expenses.
        Short Term Medical policy or certificate issued                                                                       permanent lack of function of the larynx.
                                                              24. Elective medical or surgical procedures;
        by us.                                                                                                          37.   Hair prosthesis; hair transplants or wigs.
                                                                  sterilization, including tubal ligation and
   2. Services for a condition for which claims were                                                                    38.   Temporomanibular joint disorder, crainomaxillary
                                                                  vasectomy; reversal of sterilization; abortion;
        submitted under a prior Short Term Medical                                                                            disorder, craniomandibular disorders and any
                                                                  gender change or sexual dysfunction.
        policy or certificate issued by us.                                                                                   treatment for jaw, joint or head and neck.
                                                              25. Vision therapy; all types of refractive
   3. Services not medically necessary or which are                                                                     39.   Surgical treatment for hernia or removal of tonsils
                                                                  keratoplastics or any other procedures,
        experimental, investigational or for research                                                                         and/or adenoids unless the condition requires
                                                                  treatments or devices for refractive correction;
        purposes.                                                                                                             emergency care.
                                                                  eyeglasses; contact lenses, hearing aids;
   4. Services not authorized or prescribed by a                  dental exams.                                         40.   Surgical treatment for bunions, varicose veins
        healthcare practitioner or for which no charge                                                                        or hemorrhoids.
                                                              26. Hearing except as specified in this certificate,
        is made.
                                                                  and eye exams; routine physical examinations for      41.   Bodily injury and sickness arising out of the
   5. Services while confined in a hospital or other              occupation, employment, school, travel, purchase            course of any occupation employment or activity
        facility owned or operated by the United States           of insurance or                                             for compensation profit or gain,
        government, provided by a person who ordinarily           premarital tests.                                           whether or not benefits are available under
        resides in the covered person’s home or who                                                                           Workers’ Compensation.
                                                              27. Services received at an emergency room unless
        is a family member, or that are performed in
                                                                  required because of emergency care.                   42.   Inpatient services when in an observation
        association with a services that is not covered
                                                              28. Dental services, except as specified in this                status or when the stay is due to behavioral,
        under the certificate.
                                                                  certificate, appliances or supplies.                        social maladjustment, lack of discipline or other
   6. Charges in excess of the maximum allowable fee                                                                          antisocial actions.
                                                              29. War or any act of war, whether declared or
        or which exceed any benefit maximum.
                                                                  not, commission or attempt to commit a civil or       43.   Attempted suicide or intentionally self-inflicted
   7. Hospice services.                                                                                                       injury, whether sane or insane.
                                                                  criminal battery or felony.
   8. Expenses incurred before the effective date.                                                                      44.   Charges covered by other medical
                                                              30. Standby physician or assistant surgeon, unless
   9. Expense incurred after the date coverage                    medically necessary; private duty nursing;                  payments insurance.
        is terminated except as provided under the                communication or travel time; lodging or              45.   Organ transplants not approved based
        Extension of Benefits.                                    transportation except as stated in the certificate          on established criteria or investigational,
   10. Cosmetic procedures and any related                        or intraoral prosthetic devices or surgical                 experimental or for research purposes.
        complications except as stated in the                     procedures for cosmetic purposes, unless              46.   Charges incurred for a hospital say beginning on
        certificate.                                              diagnostic and/or surgical procedures are                   a Friday or Saturday unless due to emergency
   11. Custodial or maintenance care.                             medically necessary to treat conditions caused by           care or surgery is performed on the day admitted.
   12. Preventive care services except as stated in the           congenital or developmental deformity, disease or
        certificate.                                              bodily injury.                                        Extension of Benefits:
                                                              31. Any treatment for the purpose of reducing             Extension of Benefits provision will apply (for no
   13. Any drug, medicine or device which is not
                                                                  obesity or any use of obesity reduction               additional premium) with Short Term Medical plans
        FDA approved.
                                                                  procedures to treat sickness or bodily injury         under the following conditions:
   14. Contraceptives, including oral and transdermal,                                                                  1. You have met your deductible and are totally
        whether medication or device.                             caused by complicated by or exacerbated by
                                                                  obesity, including but not limited to surgical              disabled, coverage for the disabling condition
   15. Medications, drugs or hormones to                                                                                      continues, but not beyond the earliest of the
                                                                  procedures.
        stimulate growth.                                                                                                     following dates: a) The date on which you are no
                                                              32. Nicotine habit or addiction; educational or
   16. Legend drugs not recommended or deemed                                                                                 longer continuously confined in a hospital;
                                                                  vocational therapy, services and schools; light
        necessary by us or drugs prescribed for a                                                                             b) the date your provider certifies you are no
                                                                  treatment for Seasonal Affective Disorder
        non-covered bodily injury or sickness.                                                                                longer totally disabled; c) the date any maximum
                                                                  (S.A.D.); alternative medicine; marital counseling;
   17. Drugs prescribed for intended use other than for                                                                       benefit or your individual lifetime maximum is
                                                                  genetic testing, counseling or services, sleep
        indications approved by the FDA or recognized                                                                         met; d) the last day of a 12 consecutive month
                                                                  therapy or services rendered in a premenstrual
        off-label indications through peer-reviewed                                                                           period following the expiration of your plan; e)
                                                                  syndrome clinic or holistic medicine clinic.
        medical literature; experimental or investigational                                                                   the earliest date permitted by law.
                                                              33. Foot care services.
        use drugs.                                                                                                      2. You have met your deductible and are being
                                                              34. Any treatment for mental health, including but              treated for complications of, or need follow-up
   18. Over the counter drugs (except insulin) or drugs
                                                                  not limited to prescription drugs.                          treatment for, a sickness that commenced or a
        available in prescription strength without a
        prescription.                                         35. Charges for non-medical purposes or used for                bodily injury sustained while the certificate was
                                                                  environmental control or enhancement (whether               in effect. A $1,000 maximum benefit may be
   19. Drugs used in treatment of nail fungus.
                                                                  or not prescribed by a healthcare practitioner).            available for expenses incurred during a period
   20. Prescription refills exceeding the number specified
                                                              36. Health clubs or health spas, aerobic and                    of not more than 60 days beyond the expiration
        by the healthcare practitioner or dispensed more
                                                                  strength conditioning, work hardening programs              date of coverage.
14      than 1 year from the date of the original order.
Dental limitations and exclusions
This is an outline of the limitations and exclusions for the HumanaOne individual dental plan. It is designed for convenient reference.
Consult the policy for a complete list of limitations and exclusions.
Unless stated otherwise, no benefits are payable for expenses arising from:


1. The course of any occupation or employment           8. Any service related to altering vertical              17. Expenses incurred prior to the effective date or
   for compensation, profit or gain, for which              dimension; restoration or maintenance of                 after the date coverage is terminated, except
   benefits are provided or payable under any               occlusion; splinting teeth; replacing tooth              for any extension of benefits.
   Workers’ Compensation or Occupational                    structures lost as a result of abrasion, attrition   18. Services provided by a person who ordinarily
   Disease Act or Law; or where such coverage               or erosion; or bite registration or bite analysis.       resides in the covered person’s home or who is
   was available, regardless of whether the             9. Bone grafts, regeneration, augmentation or                a family member.
   coverage was actually applied for.                       preservative procedures in edentulous sites.         19. Charges in excess of the reimbursement limit
2. Services and supplies for which no charge is         10. Implants, including any crowns or prosthetic             for the service or supply.
   made, or for which the covered person would              device attached to it; precision or semi-            20. Treatment as a result of an intentionally
   not be required to pay in the absence of                 precision attachments; overdentures and any              self-inflicted	injury	or	bodily	illness,	while	sane	
   insurance.                                               endodontic treatment associated with it; or              or insane.
3. Services furnished by or payable under any               other customized attachments.                        21. Local anesthetics, irrigation, nitrous oxide,
   plan or law through any Government or any            11. Infection control.                                       bases, pulp caps, temporary dental services,
   political subdivision.                               12. Fees for treatment by other than a dentist,              study models, treatment plans, occlusal
4. Services furnished by any hospital or institution        except as stated in the policy.                          adjustments, or tissue preparation associated
   owned or operated by the United States               13. Any hospital, surgical or treatment facility,            with impression or placement of a restoration,
   Government, unless legally required to pay.              or for services of an anesthesiologist or                charged as a separate service.
5. War or any act of war, whether declared or               anesthetist.                                         22. Repair and replacement of orthodontic
   not;	or	any	act	of	international	armed	conflict	     14. Prescription drugs or pre-medications, whether           appliances.
   or	any	conflict	involving	armed	forces	of	any	           dispensed or prescribed.
   international authority.
                                                        15. Any service not listed as a covered expense.
6. Completion of forms or failure to keep an
                                                        16. Any service not considered a dental necessity,
   appointment with a dentist.
                                                            does not offer a favorable prognosis, does not
7. Cosmetic dentistry, except as stated in                  have uniform professional endorsement, or is
   the policy.                                              experimental or investigational in nature.


Payments (medical and dental)–Network providers agree to accept amounts negotiated with Humana as payment in full. The member is responsible for
any required deductible, coinsurance, or other copayments. Plan benefits paid to non-network providers are based on maximum allowable fees, as defined in
your policy.

Non-network providers may balance bill you for charges in excess of the maximum allowable fee. You will be responsible for charges in excess of the maximum
allowable fee in addition to any applicable deductible, coinsurance, or copayment. Additionally, any amount you pay the provider in excess of the maximum
allowable fee will not apply to your out-of-pocket limit or deductible.

Network primary care and specialist physicians and other providers in Humana’s networks are not the agents, employees or partners of Humana or any of
its affiliates or subsidiaries. They are independent contractors. Humana is not a provider of medical services. Humana does not endorse or control the clinical
judgement or treatment recommendations made by the physicians or other providers listed in–network directories or otherwise selected by you.

Important information about Association plans: Applies to Annual Max and Short Term Medical plans only–The Association, Peoples’ Benefit Alliance, is
a membership organization that provides educational information and discounts on goods and services to its members. Membership in the Peoples’ Benefit Alliance
is required, at an additional cost, in order to be eligible to apply for a Short Term or Annual Max health plan.

Florida’s	cost	and	performance	data	is	available	electronically	at	http://www.floridacomparecare.gov/




                                               For information on plans available to HIPAA
                                              eligible individuals, please call (800) 382-3050.
                                                                                 (866) INSU-BUY




                                                                                                                                                                            15
                                                         Jagruti Khatri
                                                         4700 Dexter Dr.
                                                         Suite 100
                                                         Plano, TX 75093
                                                         Phone: (866) INSU-BUY
                                                         Fax: (972) 767-4470
                                                         Website: insubuy.com




              Insured by Humana Insurance Company, Humana Health Insurance Company of Florida, Inc., HumanaDental Insurance Company
                                Applications are subject to approval. Waiting periods, limitations and exclusions may apply.
                                 The HumanaOne brand of individual products are insured by subsidiaries of Humana, Inc.

This document contains a general summary of benefits, exclusions and limitations. Please refer to the policy/certificate for the actual terms and
conditions that apply. In the event there are discrepancies with the information given in this document, the terms and conditions of the
policy/certificate will govern.
FL-51530-HO 6/09
Policy/certificate numbers: FL-70129 8/2002, et al.; FL-70141-HD et al.; FL-70136 et al.; SSF-71020-01 10/2008.; SSF-71019-01 10/2008

								
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