Humana Walmart Rx Plan (PDP) - Crowe & Associates
SBOSB0152017Summary of BenefitsHumana Walmart Rx Plan (PDP)States of CT, MA, RI, VTOther pharmacies are available in our network.GNHH4HIEN 17S5884149000SB17
2017Summary of BenefitsHumana Walmart Rx Plan (PDP)S5884-149States of CT, MA, RI, VTOther pharmacies are available in our network.S5884 SB PDP PDP 149000 2017 AcceptedS5884149000SB17
Our service area includes the following state(s): Connecticut, Massachusetts, Rhode Island,Vermont.
S5884149000Let’s talk about Humana Walmart RxPlan (PDP)Find out more about the Humana Walmart Rx Plan (PDP) plan - including the drugservices it covers - in this easy-to-use guide.Humana Walmart Rx Plan (PDP) is a stand-alone prescription drug plan with a Medicarecontract. Enrollment in this Humana plan depends on contract renewal.The benefit information provided is a summary of what we cover and what you pay. Itdoesn’t list every service that we cover or list every limitation or exclusion. For acomplete list of services we cover, ask us for the “Evidence of Coverage” or you willreceive one after you enroll.To be eligibleTo join Humana Walmart Rx Plan (PDP),you must be entitled to Medicare Part A,and/or be enrolled in Medicare Part Band live in our service area.Plan name:Humana Walmart Rx Plan (PDP)offers a pharmacy network withpreferred cost sharing at selectpharmacies. You may pay moreat other pharmacies.Humana Walmart Rx Plan (PDP)How to reach us:If you’re a member of this plan, calltoll-free: 1-800-281-6918 (TTY: 711).If you’re not a member of this plan,call toll free: 1-800-706-0872 (TTY:711).A healthy partnershipGet more from your plan — withextra services and resourcesprovided by Humana!October 1 - February 14:Call 7 days a week from 8 a.m. - 8 p.m.February 15 - September 30:Call Monday - Friday, 8 a.m. - 8 p.m.Or visit our website:Humana-medicare.com.This document is available in other formats such as Braille and large print. This information is available forfree in other languages. Please contact a licensed Humana sales agent at 1-800-706-0872 (TTY: 711).Esta información está disponible gratuitamente en otros idiomas. Póngase en contacto con un agente deventas certificado de Humana al 1-800-706-0872 (TTY: 711).2017-5-Summary of Benefits
S5884149000Monthly Premium, Deductible and LimitsMonthly premium 17If you have Part B, you must keep paying your Medicare Part Bpremium.Pharmacy (Part D) deductible 400 only applies to Tier 3,Tier 4,Tier 5.Prescription Drug BenefitsPRESCRIPTION DRUGSInitial coverage (after you pay your deductible, if applicable)You pay the following until your total yearly drug costs reach 3,700. Total yearly drug costs are the totaldrug costs paid by both you and our plan.TierPreferred Retail Standard Retail Preferred MailPharmacyPharmacyOrderStandard MailOrder1 (Preferred Generic) 1 copay 10 copay 1 copay 10 copay2 (Generic) 4 copay 20 copay 4 copay 20 copay3 (Preferred Brand)20% of cost25% of cost20% of cost25% of cost4 (Non-Preferred Drug)35% of cost50% of cost35% of cost50% of cost5 (Specialty)25% of cost25% of cost25% of cost25% of cost1 (Preferred Generic) 3 copay 30 copay 0 copay 30 copay2 (Generic) 12 copay 60 copay 8 copay 60 copay3 (Preferred Brand)20% of cost25% of cost20% of cost25% of cost4 (Non-Preferred Drug)35% of cost50% of cost35% of cost50% of cost30-day supply90-day supplySpecialty drugs are limited to a 30 day supply.Cost sharing may change depending on the pharmacy you choose, when you enter another phase of thePart D benefit and if you qualify for “Extra Help.” To find out if you qualify for “Extra Help,” please contactthe Social Security Office at 1-800-772-1213 Monday — Friday, 7 am. — 7 p.m. TTY users should call1-800-325-0778. For more information on the additional pharmacy-specific cost-sharing and the phasesof the benefit, please call us or access our “Evidence of Coverage” online.If you r e Federal civil rights laws and does not discriminate on the basis of race, color, national origin,age, disability, or sex. Humana does not exclude people or treat them differently because of race, color,national origin, age, disability, or sex.Humana: Provides free aids and services to people with disabilities to communicate effectively with us, such as:– Qualified sign language interpreters– Written information in other formats Provides free language services to people whose primary language is not English when those services arenecessary to provide meaningful access, such as:– Qualified interpreters– Information written in other languagesIf you need these services, contact Dr. Michelle Griffin, PhD.If you believe that Humana has failed to provide these services or discriminated in another way on the basisof race, color, national origin, age, disability, or sex, you can file a grievance with:Dr. Michelle M. Griffin, PhD (FACHE)Civil Rights/LEP/ADA/Section 1557 Compliance Officer: 500 W. Main Street -10th floor Louisville, Kentucky40202 Phone: 1-877-320-1235 Fax: 877-320-1269Email: Mgriffin5@humana.com or Accessibility@humana.comYou can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Dr. MichelleGriffin PHD, Civil Rights/LEP/ADA/Section 1557 Compliance Officer is available to help you at the contactinformation listed above.You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office forCivil Rights electronically through the Office for Civil Rights Complaint Portal, available athttps://ocrportal.hhs.gov/ocr/portal/lobby.jsf , or by mail or phone at:U.S. Department of Health and Human Services200 Independence Avenue, SWRoom 509F, HHH BuildingWashington, D.C. 202011-800-368-1019 800-537-7697 (TDD)Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html .GHHJP8DEN
Multi-Language Interpreter ServicesEnglish: ATTENTION: If you speak English, language assistance services, free of charge, are availableto you. Call 1-800-281-6918 (TTY: 711).Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos deasistencia lingüística. Llame al 1-800-281-6918 (TTY: 711).(Chinese):1-800-281-6918 TTY:711(Vietnamese):1-800-281-6918 (TTY: 711).(Korean):(TTY: 711)1-800-281-6918Tagalog (Tagalog – Filipino):1-800-281-6918 (TTY: 711).1-800-281-6918 (711).Kreyòl Ayisyen (French Creole): ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponibgratis pou ou. Rele 1-800-281-6918 (TTY: 711).Français (French): ATTENTION : Si vous parlez français, des services d’aide linguistique vous sontproposés gratuitement. Appelez le 1-800-281-6918 (ATS : 711).Polski (Polish): UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej.Zadzwoń pod numer 1-800-281-6918 (TTY: 711).Português (Portuguese): ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos,grátis. Ligue para 1-800-281-6918 (TTY: 711).Italiano (Italian): ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi diassistenza linguistica gratuiti. Chiamare il numero 1-800-281-6918 (TTY: 711).Deutsch (German): ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachlicheHilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-281-6918(TTY: -281-6918.(7111-800-281-6918 (TTY: 711)(Arabic):1-800-281-6918.(711Y0040 TRANSLT1PDP 17a Accepted)
Humana Walmart Rx Plan (PDP)S5884149000 ENGStates of CT, MA, RI, VTHumana.comS5884149000SB17
Let’s talk about Humana Walmart Rx Plan (PDP) Find out more about the Humana Walmart Rx Plan (PDP) plan - including the drug services it covers - in this easy-to-use guide. Humana Walmart Rx Plan (PDP) is a stand-alone prescription drug plan with a Medicare contract. Enrollment in this
Humana Plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc. License # 00235-0008, Humana
MyHumana at Humana.com or by calling 1-800-233-4013. Humana group dental plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, Humana Health Benefit Plan of Louisiana, The Dental Concern, Inc., Humana Medical
2016 SUMMARY OF BENEFITS – 5 SECTION 1 (continued) Who can join? To join Humana Walmart Rx Plan (PDP), you must be entitled to Medicare Part A, and/or be enrolled in Medicare Part B, and live in our service
PDP-4304 PDP-4314 Register Your Product on www.pioneerelectronics.com. ii EN English Safety Precautions Safety Precautions . Should this product require service in the U.S.A. and you wish to locate the nearest Pioneer Authorized Independent Service Company, or if you wish to purchase replacement parts, operating instructions, service manuals .
Humana group dental plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance . CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or DentiCare, Inc. (d/b/a CompBenefits) This is not a complete disclosure of plan qualifications and limitations. Your agents will .
Why choose a Humana network provider? Humana Medicare PPO network providers must take payment from Humana for treating plan members. Network providers coordinate with Humana, which makes it easier to share information. Patients may have a better experience when providers share information this way. Humana supplies in-network .
Personal Development Plan (PDP) This worksheet is designed to help you gather information on all 8 Factors and 16 Traits of your natu-ral behavior that you will use in completing your Personal Development Plan (PDP). For your conve-nience, the PDP is included at the end of this document and also as a separate download file at www.
Spring Lake Elementary Schools Curriculum Map 2nd Grade Reading The following CCSS’s are embedded throughout the year, and are present in units applicable: CCSS.ELA-Literacy.SL.2.1 Participate in collaborative conversations with diverse partners about grade 2 topics and texts with peers and adults in small and larger groups. CCSS.ELA-Literacy.SL.2.2 Recount or describe key ideas or .
