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{'source': PosixPath('pdf_library/HMO_SNP_DE_H1036_235_H1036235000SB23.pdf')}
may need advance approval from your plan. This is called a"prior authorization" or "preauthorization." Please contact your PCP or refer to the Evidence of Coverage (EOC) for services that require aprior authorization from the plan . c H1036235000SB23 Summary of Benefits 9H1036235000 Covered Medical and Hospital Bene...
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Covered Medical and Hospital Benefits (cont.) N/A WHAT YOU PAY ON THIS HUMANA PLAN •$0 copay for each Advanced level hearing aid up to 1per ear every 3years. Hearing aid purchase includes: •Unlimited follow-up provider visits during first year following TruHearing hearing aid purchase •60-day trial period •...
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TruHearing hearing aid purchase •60-day trial period •3-year extended warranty •80 batteries per aid for non-rechargeable models You must see aTruHearing provider to use this benefit. Call 1-844-255-7144 to schedule an appointment (for TTY, dial 711). DENTAL SERVICES Medicare-covered dental $0 copay Routine d...
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Routine dental Dental services are subject to our standard claims review procedures which could include dental history to approve coverage. Dental benefits under this plan may not cover all American Dental Association procedure codes. Information regarding each plan is available at Humana.com/sb ....
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Network dentists have agreed to provide services at contracted fees (the in-network fee schedules, or INFS). If amember visits aparticipating network dentist, the member will not receive abill for charges more than the negotiated fee schedule on covered services (coinsurance payment still applies). ...
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on covered services (coinsurance payment still applies). Use the HumanaDental Medicare network for the Mandatory Supplemental Dental. The provider locator can be found at DEN142 •$0 copay for scaling and root planing (deep cleaning) up to 1per quadrant every 3years. •$0 copay for comprehensive oral eval...
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occlusal adjustment, scaling for moderate inflammation up to 1 every 3years. •$0 copay for bridges, complete dentures, crown recementation, denture recementation, panoramic film or diagnostic x-rays, partial dentures up to 1every 5years. •$0 copay for crown, root canal, root canal retreatment up to 1per tooth...
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tooth per lifetime. •$0 copay for bitewing x-rays, intraoral x-rays up to 1set(s) per year. •$0 copay for adjustments to dentures, denture rebase, denture reline, denture repair, emergency diagnostic exam, tissue conditioning up to 1per year. •$0 copay for emergency treatment for pain, fluoride treatment, oral ...
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surgery, periodic oral exam, prophylaxis (cleaning) up to 2per year. •$0 copay for periodontal maintenance up to 4per year. •$0 copay for amalgam and/or composite filling, necessary anesthesia with covered service, simple or surgical extraction up to unlimited per year. •$5000 maximum benefit coverage amount per...
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and comprehensive benefits. You do not need areferral to receive covered services from plan providers. Certain procedures, services and drugs may need advance approval from your plan. This is called a"prior authorization" or "preauthorization." Please contact your PCP or refer to the Evidence of Coverage (EOC) for se...
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plan . c 10 Summary of Benefits H1036235000SB23 H1036235000 Covered Medical and Hospital Benefits (cont.) N/A WHAT YOU PAY ON THIS HUMANA PLAN Humana.com >Find aDoctor > from the Search Type drop down select Dental >under Coverage type select All Dental Networks > enter zip code >from the network drop dow...
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network drop down select HumanaDental Medicare. VISION SERVICES Medicare-covered vision services $0 copay Medicare-covered diabetic eye exam $0 copay Medicare-covered glaucoma screening $0 copay Medicare-covered eyewear (post-cataract) $0 copay Routine vision The provider locator for routine vision can...
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vision can be found at Humana.com >Find aDoctor > select Vision care icon >Vision coverage through Medicare Advantage plans. VIS733 •$0 copay for routine exam up to 1per year. •$300 maximum benefit coverage amount per year for contact lenses or eyeglasses-lenses and frames, fitting for eyeglasses-lenses a...
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•Eyeglass lens options may be available with the maximum benefit coverage amount up to 1pair per year. •Maximum benefit coverage amount is limited to one time use per year. MENTAL HEALTH SERVICES Inpatient Your plan covers up to 190 days in alifetime for inpatient mental health care in apsychiatric hospital ...
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health care in apsychiatric hospital $0 copay Outpatient group and individual therapy visits $0 copay SKILLED NURSING FACILITY (SNF) Your plan covers up to 100 days in aSNF $0 copay PHYSICAL THERAPY N/A $0 copay You do not need areferral to receive covered services from plan providers. Certain procedures, servi...
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may need advance approval from your plan. This is called a"prior authorization" or "preauthorization." Please contact your PCP or refer to the Evidence of Coverage (EOC) for services that require aprior authorization from the plan . c H1036235000SB23 Summary of Benefits 11 H1036235000 Covered Medical and Hospital Be...
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N/A WHAT YOU PAY ON THIS HUMANA PLAN AMBULANCE Ambulance $0 copay TRANSPORTATION N/A $0 copay for plan approved location up to 24 one-way trip(s) per year. This benefit is not to exceed 50 miles per trip. The member must contact transportation vendor to arrange transportation and should contact Customer Care t...
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their plan's specific transportation provider. MEDICARE PART BDRUGS Chemotherapy drugs $0 copay Other Part Bdrugs $0 copay Prescription Drug Benefits PRESCRIPTION DRUGS Medicare Part DDrugs See chart below for plan coverage information for prescription drugs $0 Rx Copay Benefit If you qualify for "Extra Help", ...
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prescription drugs on your formulary, for all tiers, and through all stages. Pharmacy options Mail Order Mail Order cost-sharing $0 CenterWell Pharmacy ™, Walmart Mail ,PillPack Other pharmacies are available in our network. To find pharmacy mail order options go to Humana.com/pharmacyfinder Retail Retail co...
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Retail Retail cost-sharing All network retail pharmacies For generic drugs (including 30-day supply 90-day supply* brand drugs treated as generic), either: $0 $0 For all other drugs ,either: $0 $0 Other pharmacies are available in our network. *Some drugs are limited to a30-day supply 12 Summary of Benefits H103...
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*Some drugs are limited to a30-day supply 12 Summary of Benefits H1036235000SB23 H1036235000 To find out if you qualify for "Extra Help," please contact the Social Security Office at 1-800-772-1213 Monday —Friday, 7a.m. —7p.m. TTY users should call 1-800-325-0778. For more information on pharmacy-specific cost-shar...
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pharmacy-specific cost-sharing, please call us or refer to Chapter 6of the Evidence of Coverage for more details. If you reside in along-term care facility, you pay the same as at aretail pharmacy. You may get drugs from an out-of-network pharmacy but may pay more than you pay at an in-network pharmacy. Catastr...
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Catastrophic Coverage After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400 ,you pay nothing for all drugs. Additional Benefits N/A WHAT YOU PAY ON THIS HUMANA PLAN Medicare-covered foot care (podiatry) $0 copay Medicare-covered c...
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Medicare-covered chiropractic services $0 copay MEDICAL EQUIPMENT/SUPPLIES Durable medical equipment (like wheelchairs or oxygen) $0 copay Medical Supplies $0 copay Prosthetics (artificial limbs or braces) $0 copay Diabetic monitoring supplies $0 copay REHABILITATION SERVICES Occupational and speech therapy...
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therapy $0 copay Cardiac rehabilitation $0 copay Pulmonary rehabilitation $0 copay TELEHEALTH SERVICES (in addition to Original Medicare) Primary care provider (PCP) $0 copay Specialist $0 copay Urgent care services $0 copay Substance abuse or behavioral health services $0 copay H1036235000SB23 Summary of Ben...
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Medicaid Benefit Comparison The benefits described in the Covered Medical and Hospital Benefits sections above are covered by Humana Community HMO SNP-DE (HMO D-SNP). Below is acomparison of benefits that some Medicaid eligible individuals could receive directly from the Kentucky Department of Medicaid Services (DMS...
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each benefit listed below, you can see what the Kentucky Department of Medicaid Services (DMS) covers and what our plan covers. All Medicaid benefits are subject to Medicaid eligibility guidelines and requirements, and are available only to full dual eligible individuals. If you have questions about your Medicaid el...
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Medicaid eligibility and what benefits you are entitled to, review your member handbook or contact the Kentucky Department of Medicaid Services (DMS) at 1-800-635-2570. BENEFIT MEDICAID BENEFIT OUR PLAN BENEFIT Acute inpatient hospital care Covered Covered Ambulance Covered Covered Ambulatory surgical center Cover...
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Ambulatory surgical center Covered Covered Dentures Not Covered Covered Diagnostic services/labs/imaging Covered Covered Doctor office visits (Primary care provider (PCP)/specialists Covered Covered Emergency care Covered Covered Eyeglasses Not Covered Covered Hearing aids Not Covered Covered Home and communit...
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Home and community based waiver service programs Covered Not Covered Inpatient hospital, nursing facility and intermediate care facility services in institutions for mental diseases (MD), age 65 and older Covered Covered with limitations Inpatient psychiatric services, under age 21 Covered Covered with limitati...
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under age 21 Covered Covered with limitations Intermediate care facility for intellectual disabilities (ICF-IDD) Covered Not Covered Intermediate care facility services for individuals with intellectual disabilities Covered Covered with limitations 14 Summary of Benefits H1036235000SB23 H1036235000 BENEFIT MEDI...
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BENEFIT MEDICAID BENEFIT OUR PLAN BENEFIT Mental health services (outpatient group therapy and individual therapy visit) Covered Covered Nursing facility services, other than in an institution for mental diseases Covered Covered with limitations Outpatient hospital coverage Covered Covered Personal emergency ...
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Personal emergency response system (PERS) Not Covered Covered Physical therapy Covered Covered Prescription drugs –Medicare Part Bdrugs Covered Covered Prescription drugs –outpatient prescription drugs; Medicare covered &non-Medicare covered Covered Covered Preventive care (e.g., flu vaccine, diabetic scree...
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Preventive care (e.g., flu vaccine, diabetic screenings) Covered Covered Routine non-emergency medical transportation Covered Covered Skilled nursing facility Covered Covered Urgently needed services Covered Covered H1036235000SB23 Summary of Benefits 15 H1036235000 More benefits with your plan Enjoy some of...
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More benefits with your plan Enjoy some of these extra benefits included in your plan . This is asummary of what we cover. It doesn't list every service that we cover or list every limitation or exclusion. The Evidence of Coverage (EOC) provides acomplete list of coverage and services. Visit Humana.com/medicare t...
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1-800-833-2364 . Humana Flex Allowance $1000 annual allowance on aprepaid card to use toward out of pocket costs for the plan's preventive and comprehensive dental, vision, or hearing services including copays. Members can use this benefit at participating providers where the primary business is Dental Care, Vi...
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Services, or Hearing Services and Visa® is accepted. Cannot be used for procedures such as cosmetic dentistry and teeth whitening. Unused amount expires at the end of the plan year. Allowance amounts cannot be combined with other benefit allowances. Limitations and restrictions may apply. Humana Healthy Opti...
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Humana Healthy Options Allowance $150 automatically loaded on aprepaid card every month to use toward the purchase of food, over-the-counter (OTC) products, and home supplies from anational network of retailers. The card may also be used to pay for non-medical transportation, general supports for living (such a...
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supports for living (such as rent assistance, internet, and utilities), social needs, aging support and assistive devices, pest control, and pet care and supplies. Unused funds will roll over to the next month and expire at the end of the plan year. Allowance amounts cannot be combined with other benefit allowa...
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allowances. Limitations and restrictions may apply. Humana Spending Account Card The allowances listed below will be loaded onto this prepaid card. Each allowance is separate from any other allowance listed. Allowances shown are accessed by using this card. Allowance amounts cannot be combined with other bene...
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other benefit allowances. Limitations and restrictions may apply. *Healthy Options Allowance *Humana Flex Allowance Special Supplemental Benefits for the Chronically Ill (SSBCI) Humana Flexible Care Assistance Humana Flexible Care Assistance is available to members with chronic health conditions, who are pa...
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health conditions, who are participating in care management services, and meet program criteria. Eligible members may receive medical expense assistance and other additional benefits, either primarily health related or non-primarily health related, to address the member's unique individual needs. Benefits are l...
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limited up to $1,000 per year and must be coordinated and authorized by acare manager. There is no cost to participate. Acupuncture $0 copay for acupuncture visits up to 12 visit(s) per year. Chiropractic services Routine chiropractic: $0 copay per visit for up to 12 visits. 16 Summary of Benefits H103623500...
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Smoking cessation program To further assist in your effort to quit smoking or tobacco product use, we cover one additional counseling quit attempt within a12-month period as a service with no cost to you. This is in addition to the two counseling attempts provided by Medicare and includes up to four face-to-fac...
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four face-to-face visits. This service can be used for either preventive measures or for diagnosis with atobacco related disease. Routine foot care $0 copay per visit for up to 6visits Papa Pals $0 copayment for members to be connected with atrusted college student that offers assistance with other instrum...
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other instrumental activities of daily living (IADLs). Support may be in person or virtually for up to 60 hours per year (minimum of one hour per visit). Humana Well Dine ®Meal Program Humana's meal program for members with certain special needs plan (SNP) specific conditions or following an inpatient stay...
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inpatient stay in the hospital or nursing facility. Personal Emergency Response System The personal emergency response system provides help in emergency situations. On The Go Mobile personal help button or an On the Go Mobility personal help button, both function in and out of the home. On The Go uses ...
{'source': PosixPath('pdf_library/HMO_SNP_DE_H1036_235_H1036235000SB23.pdf')}
two way voice communication &five location seeking technologies to send help quickly to wherever the member is located. On the Go Mobility personal help button offers fall detection remotely activated/deactivated, up to 5 days of battery life, location services, and wandering. Personal Home Care $0 copa...
{'source': PosixPath('pdf_library/HMO_SNP_DE_H1036_235_H1036235000SB23.pdf')}
$0 copay for aminimum of 4hours per day, up to amaximum of 80 hours per year for certain in-home support services to assist individuals with disabilities and/or medical conditions in performing activities of daily living (ADLs) and Instrumental Activities of Daily living (IADLs) within the home by a qualified a...
{'source': PosixPath('pdf_library/HMO_SNP_DE_H1036_235_H1036235000SB23.pdf')}
qualified aide. Amember must be receiving assistance with aminimum of one ADL to receive assistance with any IADL. Authorization may be required. Contact the plan for details. Rewards and Incentives Go365 by Humana ®aRewards and Incentive program for completing certain preventive health screenings and healt...
{'source': PosixPath('pdf_library/HMO_SNP_DE_H1036_235_H1036235000SB23.pdf')}
health and wellness activities. Wigs (related to chemotherapy treatment) Up to an unlimited maximum benefit per year. SilverSneakers ®fitness program Basic fitness center membership including fitness classes. 17 H1036_SB_MAPD_HMO_235000_2023_M Summary of Benefits H1036235000SB23 To find out more about the cov...
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handbook. View it online at http://www.medicare.gov or get acopy by calling 1-800-MEDICARE (1-800-633-4227), 24 hours aday, seven days aweek. TTY users should call 1-877-486-2048. Humana has been approved by the National Committee for Quality Assurance (NCQA) to operate as aSpecial Needs Plan (SNP) until 12/31/2023...
{'source': PosixPath('pdf_library/HMO_SNP_DE_H1036_235_H1036235000SB23.pdf')}
Needs Plan (SNP) until 12/31/2023 based on areview of Humana's Model of Care. Your provider may choose to submit to the Kentucky Department of Medicaid Services (DMS) for consideration of additional secondary payment for an amount applied to deductibles, coinsurance, or copayments. If you are Cost Share Protected, p...
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Share Protected, providers are required by federal regulation to accept Humana Community HMO SNP-DE (HMO D-SNP) primary payment and the Kentucky Department of Medicaid Services (DMS) secondary payment as payment in full for covered Medicare Part Aand Part Bservices –even when the Medicaid payment is zero or a provid...
{'source': PosixPath('pdf_library/HMO_SNP_DE_H1036_235_H1036235000SB23.pdf')}
provider chooses to not submit to Medicaid. If you are cost-share protected by the Kentucky Department of Medicaid Services (DMS), Humana Community HMO SNP-DE (HMO D-SNP) providers aren't allowed to collect or bill you for services and items covered under Medicare Part Aand Part B, including deductibles, coinsurance...
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is zero or aprovider chooses to not submit to Medicaid. If aprovider asks you to pay, that's against the law. You may however be responsible for asmall Medicaid copayment. If you are cost-share protected and you are billed or asked to pay the provider for deductibles, coinsurance, or copayments on covered Medicare ...
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copayments on covered Medicare Part Aand Part Bservices tell your provider you are cost-share protected and can't be charged. If you have already made payment you have the right to arefund. If your provider will not stop billing, you can call us at 1-800-457-4708 or you can call Medicare at 1-800-Medicare (1-800-633-...
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1-877-486-2048). Humana or Medicare can ask your provider to stop billing you and refund any payment you have made. Telehealth services shown are in addition to the Original Medicare covered telehealth. Your cost may be different for Original Medicare telehealth. Limitations on telehealth services, also referred t...
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are not asubstitute for emergency care and are not intended to replace your primary care provider or other providers in your network. Any descriptions of when to use telehealth services are for informational purposes only and should not be construed as medical advice. Please refer to your evidence of coverage for add...
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and should not be construed as medical advice. Please refer to your evidence of coverage for additional details on what your plan may cover or other rules that may apply. Plans may offer supplemental benefits in addition to Part Cbenefits and Part Dbenefits. You can see our plan's provider and pharmacy directory at...
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humana.com/finder/search or call us at the number listed at the beginning of this booklet and we will send you one. You can see our plan's drug guide at our website at humana.com/medicaredruglist or call us at the number listed at the beginning of this booklet and we will send you one. Find out more Notes Notes...
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GHHLNNXEN 0522 Important________________________________________________ At Humana, it is important you are treated fairly. Humana Inc. and its subsidiaries do not discriminate or exclude people because of their race, color, national origin, age, disability, sex, sexual orientation, gender, gender identity, ancestry...
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religion, or language. Discrimination is against the law. Humana and its subsidiaries comply with applicable federal civil rights laws. If you believe that you have been discriminated against by Humana or its subsidiaries, there are ways to get help. •You may file acomplaint, also known as agrievance: Discriminati...
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Discrimination Grievances, P.O. Box 14618, Lexington, KY 40512-4618. If you need help filing agrievance, call 1-877-320-1235 or if you use a TTY ,call 711 . •You can also file acivil rights complaint with the U.S. Department of Health and Human Services ,Office for Civil Rights electronically through their Compla...
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for Civil Rights electronically through their Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf ,or at U.S. Department of Health and Human Services , 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD) .Complaint forms are avai...
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•California residents: You may also call California Department of Insurance toll-free hotline number: 1-800-927-HELP (4357) ,to file agrievance. Auxiliary aids and services, free of charge, are available to you. 1-877-320-1235 (TTY: 711) Humana provides free auxiliary aids and services, such as qualified sign lang...
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interpretation, and written information in other formats to people with disabilities when such auxiliary aids and services are necessary to ensure an equal opportunity to participate. H1036235000SB23 Summary of Benefits 21 H1036235000 22 Summary of Benefits H1036235000SB23 H1036235000 Humana Community HMO SNP-DE (HMO...