A Choice of Individual Arizona Health Insurance Plan Options
HumanaOne offers two Arizona health insurance plan options: an Individual Health Plan and an HSA-qualified High Deductible Health Plan. Both plans offer a variety of annual deductible levels to fit the individual’s budget.
To choose a plan, prospective members should consider how much they spent in the past on premiums, copayments, coinsurance, and prescription drugs. Of all the Humana One plans in Arizona, the Portrait Plan is the one we recommend the most to our clients.
About Humana’s Individual Health Plan
The HumanaOne Individual Health Plan includes coverage for preventive care, hospitalization, and emergency services. Members can also choose from the following benefit options to enhance their Individual Health Plan:
- Zero deductible prescription option – Pharmacy benefits begin immediately without having to meet a separate prescription drug deductible.
- Office visit copayment option* – In-network office visits for illness or injury are paid at 100 percent after a copayment (limited to four visits per year, except in AZ and UT).
Introducing HumanaOne® Portrait™ … the personal health plan with concierge-level service and benefits you’d expect from big employers.
- A valued addition to your overall financial plan
- Pays benefits for covered hospital inpatient and outpatient services, emergency room care, preventive care, and even prescription drugs
- Extensive PPO network which more than likely includes the doctors, hospitals and pharmacies you now use
Arizona Portrait Share 80 Plus Rx and Unlimited Office Visit Copay
Basic Coverage Options
Deductibles
- HumanaOne Portrait personal health plan offers benefits like those you’d expect from big companies. There’s a low $1,000 or $2,500 annual deductible for in-network single coverage, and a $2,000 or $5,000 deductible for in-network family coverage.
Coinsurance
- Once you’ve met your annual deductible, HumanaOne Portrait shares the cost of medical care with you. This plan pays 80 percent for most covered in-network medical services and you pay just 20 percent.
Office Visit Copayment
- Every in-network office visit for covered illness and injury is paid at 100 percent after your copayment.
Prescription Coverage
- Copayments as low as $15 for common prescriptions. Certain drug levels require meeting a separate prescription deductible.
Waiting periods, limitations and exclusions apply.
Optional Portrait Benefits
Lifetime Maximum
- Extend your coverage and get the added protection you need with the $8 million lifetime maximum option.
Zero Deductible Prescription Benefit
- Your pharmacy benefits will begin immediately when you choose our zero dollar deductible pharmacy option.
Life Insurance Coverage Options
- A life insurance rider for $20,000 is available to be purchased with your HumanaOne health plan.
If you would like to purchase a separate life insurance policy from $25,000 to $150,000 along with your HumanaOne health plan, you must apply over the phone.
Supplemental Accident Benefit
- What if you had a minor accident that doesn’t cost a lot? It’s still a long way to go before meeting your deductible. With this benefit you’re covered right away–up to $1000 per incident.
Optional benefits available at an additional cost.
| Plan pays for services from NETWORK providers |
Plan pays for services from NON-NETWORK providers |
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| Deductible options 1 · per calendar year · copayments do not apply |
· individual
· family (two family members must each meet their individual |
$1,000 or $2,500
$2,000 or $5,000 |
$2,000 or $5,000
$4,000 or $10,000 |
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| 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 unlimited visits for illness or injury | Not applicable | |||||
| Coinsurance out-of-pocket limit 1 · per calendar year · deductibles and copayments do not apply |
· individual
· family |
$2,000
$4,000 |
$8,000
$16,000 |
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| Preventive care | · preventive office visits2,3 · Pap smear2,3 · prostate screening2,3 · child immunizations to age 18 · mammogram · preventive lab and X-ray2,3 |
80%
100% 80% 80% after deductible |
50% after deductible
50% after deductible 60% after deductible 50% after deductible |
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| Physician services | · office visits (including allergy injections)
· diagnostic lab and X-ray4 · allergy serum |
100% after office visit copayment
First $200 per calendar year 100% then 80% after deductible 80% after deductible |
60% after deductible
60% after deductible 60% after deductible |
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| Facility services | · inpatient and outpatient services · outpatient surgery5 · emergency services |
80% after deductible
80% after $75 copayment |
60% after deductible
60% after $75 copayment |
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| Rx4 prescription drug6 · medical out-of-pocket maximum does not apply |
· deductible per individual · copay for each prescription or refill (up to 90-day supply; with applicable copay for each 30 day supply) |
Separate $500 deductible*
*Level 1 drugs subject to copay, no deductible |
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| · copayment maximum (applies to Level 4 drugs only) | $2,500 per individual per calendar year | ||||||
| · benefit per prescription or refill
· mail order (up to 90-day supply) |
100% after prescription copayment 100% after three times retail copay |
70% after prescription copayment 70% after three times retail copay |
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| Other medical services · prior authorization required in order to be eligible for these benefits |
· skilled nursing facility (up to 30 days per calendar year) · hospice7 · home health care · durable medical equipment · pregnancy complications and sick baby services (no prior authorization required) · transplant services |
80% after deductible
80% after deductible when services are received from a Humana Transplant Network provider |
60% after deductible
60% after deductible covered expenses are limited to a maximum allowance of $35,000 per transplant |
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| Lifetime maximum benefit | $5,000,000 per covered person | ||||||
| Mental health, chemical and alcohol dependency2 · $2,500 per calendar year · medical out-of-pocket maximum does not apply |
· inpatient services · outpatient and office therapy sessions (outpatient services not to exceed $500 of the total benefit) |
50% after deductible | 50% after deductible | ||||
| Optional benefits · these are available to add for an additional cost · medical out-of-pocket maximum does not apply to drug coverage |
· prescription drug deductible
· lifetime maximum · supplemental accident benefit ($500 or $1,000) |
With this option no deductible is required before Rx benefits are payable Increase to $8,000,000 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 |
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| Optional Dental Benefits | ||
Dental Traditional PlusThe Dental Traditional Plus plan meets all of your dental needs, with coverage for preventive, basic, and major services. You can choose any dentist, but you can save up to 30% on out-of-pocket costs when you visit one of the more than 125,000 participating network dentists. You can find a participating dentist by using our Dentist Finder. |
Dental Preventive PlusThe Dental Preventive Plus plan covers the most common preventive and basic services at an affordable price. YOu can choose any dentist from our extensive PPO network of more than 125,000 dentist locations. Use our Dentist Finder to see if your dentist is an in-network provider. |
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| 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: · 50 percent of your payment toward the deductible is credited to the deductible for network providers · 50 percent of your out-of-pocket costs are credited to the out-of-pocket maximum for network providers Once you meet your deductible and out-of-pocket expense limits, the plan pays 100 percent for covered services. 2. Benefit payable after 90-day waiting period for preventive care and 12-month waiting period for mental health. 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. Outpatient benefits payable after 90-day waiting period for nonemergency removal of tonsils and/or adenoids, and after 180-day waiting period for nonemergency surgical treatment for bunions, varicose veins, hemorrhoids or hernia (does not apply to strangulated or incarcerated hernia) 6. 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 will also be responsible for 30% of the actual charge made by the dispensing pharmacy, after the applicable copayment. 7. Counseling for the hospice patient and immediate family is limited to 15 visits per family per lifetime. Medical Social Services limited to $100 per family per lifetime. |
| Payments 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. |
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| This document contains a general summary of benefits, exclusions and limitations. Please refer to the policy 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 will govern. | |
Arizona Autograph Share 80 Plus Rx and Copay
Basic Humana One Autograph Coverage Options
Deductibles
- HumanaOne Autograph personal health plan lets you customize your deductible for the right balance of cost and coverage. Single in-network deductibles range from $1,500 to $6,000, and family in-network deductibles from $3,000 to $12,000.
Coinsurance
- Once you have met the annual deductible of your choice, your HumanaOne Autograph plan will pay 80 or 100 percent of most covered in-network medical costs based on the plan you choose.
Office Visit Copayment
- With certain HumanaOne Autograph plans, up to six covered in-network office visits for illness or injury are paid at 100% after a copayment.
Prescription Coverage
Prescription Coverage
Certain HumanaOne Autograph plans offer a prescription drug benefit that covers eligible costs after a $1,000 deductible is met. Other HumanaOne Autograph plans either have no prescription drug benefit or will apply your prescription costs to your medical deductible.
View these other HumanaOne Autograph plans
Humana One Autograph Plus RX HSA| Autograph Total HSA
| Plan pays for services from NETWORK providers |
Plan pays for services from NON-NETWORK providers |
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| Deductible options 1 · per calendar year · copayments do not apply |
· individual
· family (two family members must each meet their individual |
$3,500, $5,000 or $6,000
$7,000, $10,000 or $12,000 |
$7,000, $10,000 or $12,000
$14,000, $20,000 or $24,000 |
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| 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 limited to 6 combined primary and specialty care visits |
Not applicable | |||||
| Coinsurance out-of-pocket limit 1 · per calendar year · deductibles and copayments do not apply |
· individual
· family |
$2,000
$4,000 |
$8,000
$16,000 |
||||
| Preventive care | · preventive office visits2,3 · Pap smear2,3 · prostate screening2,3 · child immunizations to age 18 · mammograms · preventive lab and X-ray2,3 |
80%
100% 80% 80% after deductible |
50% after deductible
50% after deductible 60% after deductible 50% after deductible |
||||
| Physician services | · office visits (including allergy injections)
· diagnostic lab and X-ray4 · allergy serum |
100% after office visit copayment up to 6 combined primary and specialty care visits, then 80% after deductible
First $200 per calendar year 100% then 80% after deductible 80% after deductible |
60% after deductible
60% after deductible 60% after deductible |
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| Facility services | · inpatient and outpatient services · outpatient surgery5 · emergency services |
80% after deductible
80% after $75 copayment |
60% after deductible
60% after $75 copayment |
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| Rx4 prescription drug6 · medical out-of-pocket maximum does not apply |
· deductible per individual · copay for each prescription or refill (up to 90-day supply, with applicable copay for each 30 day supply) |
Separate $1,000 deductible*
*Level 1 drugs subject to copay, no deductible |
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| · copayment maximum (applies to Level 4 drugs only) | $2,500 per individual per calendar year | ||||||
| · benefit per prescription or refill
· mail order (up to 90-day supply) |
100% after prescription copayment 100% after three times retail copay |
70% after prescription copayment 70% after three times retail copay |
|||||
| Other medical services · prior authorization required in order to be eligible for these benefits |
· skilled nursing facility (up to 30 days per calendar year) · hospice7 · home health care · durable medical equipment · pregnancy complications and sick baby services (no prior authorization required) · transplant services |
80% after deductible
80% after deductible when services are received from a Humana Transplant Network provider |
60% after deductible
60% after deductible covered expenses are limited to a maximum allowance of $35,000 per transplant |
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| Lifetime maximum benefit | $5,000,000 per covered person | ||||||
| Mental health, chemical and alcohol dependency2 · $2,500 per calendar year · medical out-of-pocket maximum does not apply |
· inpatient services · outpatient and office therapy sessions (outpatient services not to exceed $500 of the total benefit) |
50% after deductible | 50% after deductible | ||||
| Optional benefits · these are available to add for an additional cost · medical out-of-pocket maximum does not apply to drug coverage |
· prescription drug deductible
· lifetime maximum benefit · supplemental accident benefit ($500 or $1,000) |
With this option $500 deductible is required before Rx benefits are payable Increase to $8,000,000 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 |
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