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Humana Plans for Individuals and Small Groups
Jaime Pericás VP Commercial Sales November 12, 2015
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Puerto Rico Chamber of Commerce ObamaCare 2016
Humana Complete Series 700
PPO Small Group Product (2-‐100)
Humana PR Group Size Criteria 2016: New Enrollment
100 50 2
Bloc A
Bloc B
Bloc C
Bloc D
Enrolled Payroll
Enrolled
Enrolled
Enrolled Payroll
Payroll
Payroll
Employees Product
Complete
Complete
Complete
Max / Maximum
48 plan combinaQons
PlaQnum (47) Bronze (1)
Rx-‐3 MAC B Rx-‐4 MAC C Rx-‐5 MAC B
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Humana Complete …
11/12/15
2016 New Benefits (PrevenFve Services)
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PrevenFve services • Screening for colorectal cancer in adults 40 years +
PrevenFve services • Breast cancer mammography screenings every one (1) to two (2) years for women over 40 years, biannual for women between fiMy (50) and seventy-‐four (74) years.
Lung cancer screening: annual screening for lung cancer with low-‐dose computed tomography in adult ages 55 to 80 years who have a 30 pack-‐year smoking history
2016 New Benefits (PrevenFve Services)
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Preeclampsia prevenQon: Recommends the use of low-‐dose aspirin (81 mg/d) as prevenQve medicaQon aWer 12 weeks of gestaQon high risk women. Doctor prescripQon required
Healthy diet and physical acQvity counseling to prevent cardiovascular disease in adults with cardiovascular risk factors.
Dental caries prevenQon: applicaQon of fluoride on infants and children up to 5 years of age
Basic copay/coinsurance selecQon
Service Copays / Coinsurance General PracQQoner $5/$8/$10
Specialist $10/$12/$15/$20/$25
Sub-‐specialist $10/$12/$15/$20/$25
Ambulatory facility $25/$50/$75/ $125/ $150/$175
HospitalizaQon $50/$100/$150 $250/$300/$350
ER $25/$35/$50/$75/ $100
USA ER $25/$35/$50/$75/ $100
Lab / X-‐Ray 20%/25%/30%/35%/ 40%/50%
Specialty tests 25%/30%/35%/ 40%/50%
Services DP DP0 DP1 DP2 DP3 DP4
PrevenQve 0% 0% 0% 0% 0% 0%
RestoraQve X 25% 25% 25% 25% 25%
Prosthesis X X 50% $800 limit
50% $800 limit
50% $1,000 limit
50% $1,000 limit
PeriodonQcs X X X 50% $800 limit
25% $800 limit
25% $800 limit
OrthodonQcs X X X 50% $1,000 limit
50% $1,000 limit X
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OpQonal benefits: Dental
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OpQonal benefits: Vision Care Coverage
• Frames
• Single, bifocal, or trifocal lenses.
• Tints, UV protecQon, scratch resistant, and “progressives” for frames
• Daily, extended use, and disposable contact lenses.
• Seven benefit designs to choose from.
• EyeMed network of 35,000 parQcipaQng providers, including ophtometrists, ophtalmologists, opQcians, and retailers such as LensCraWers® PearleVision®, and JCPenney.
Includes:
Humana Individual
Individual HMO
Plans Basic Age Rate DeducQbles
PlaQnum Plus $96.44 $0
PlaQnum $91.44 $200 / $400
Gold $82.57 $725 / $1,450
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Humana Individual product design Three plans, same benefits
Labs and X-‐Rays 25%
Specialized tests 50%
OutpaQent Services
ü EKG-‐ Unlimited ü Neurological tests-‐ Unlimited ü Nuclear tests-‐ Unlimited ü MRI – Unlimited ü CT Scan – Unlimited ü Sonograms – Unlimited ü Lithotripcy – unlimited
ü EEG– one per policy year ü SPECT -‐ one per policy year ü Polisomnography -‐ one per policy year ü PET Scan – one per anatomic region
Pharmacy Coverage RX-‐4 MAC C
Drug Qers Copay/Coinsurance Level 1 $10
Level 2 $25
Level 3 $35
Level 4 35%
Benefits
Required AddiQonal
IniQal Oral Exam Prophylaxis
Radiology Sealants up to 14 years of age
Fluoride treatment up to 19 years of age
Space maintainers
Space maintainer re-‐cemenQng Pulp vitality tests
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Dental Coverage (DP)
Covered 100%
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AddiQonal benefits at no addiQonal cost
Vision care discounts
Online drug pre-‐authorizaQon tool
Natural and alternaQve care discounts
Travel Assistance services
Mobile app
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www.aetnaandhumana.com
