Humana One FAQ

Humana

Eligibility

The issue age for insurance through Humana One is two weeks to 64 ½ years. For every state, the maximum age for a dependent child is 26 years. The minimum issue age for a dependent child is two weeks. The minimum issue age for a child only policy is two months. If you are a current Humana One member, please call customer service for eligibility details or to add a dependent.



For Short Term Medical plans
The issue age for a Short Term Medical plan is 30 days to 64 years and 11 months. For most states, the maximum age for a dependent child is 24 years if the child is a full-time student and 18 years if the child is not a full-time student. The minimum issue age for any dependent child on a short term medical health insurance policy (including child only policies) is 30 days.
Short Term Medical plans are currently available in the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Nebraska, New Mexico, Ohio, Oklahoma, Texas and Wisconsin.

You must be approved through medical underwriting when applying for a Humana One individual health plan. In general, you may be eligible if:

  • You are generally in good health;
  • Your height and weight is proportionate for someone of your age and gender;
  • You are not pregnant or expecting a child (including fathers);
  • You currently have an active or pending policy with Humana.

Important information about pre-existing conditions

Unfortunately, not everyone qualifies for individual health insurance. People who have been diagnosed with, or treated for the conditions listed below may be denied coverage. Failure to disclose any health information may result in your policy being modified or terminated as of the original effective date.

  • AIDS/HIV
  • Cancer
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Crohn’s Disease
  • Diabetes
  • Emphysema
  • Heart Attack, Stroke, Angioplasty
  • Hepatitis or Liver Disease
  • Fibromyalgia
  • Depression, if hospitalization required
  • Organ or Tissue Transplant
  • Anorexia or Bulimia

This list is not inclusive; other conditions may apply. Coverage may also be denied to individuals who are severely obese, severely underweight, or who are undergoing or awaiting the results of diagnostic tests, treatments, surgery, biopsies, or lab work. In addition, coverage cannot be provided to expectant parents or children less than two weeks old.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) Eligibility Information

Residents of the states of Arizona, Florida, Nevada, Ohio*, Tennessee, Utah, and Virginia may be eligible for a non-medically underwritten plan under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). To qualify for a non-medically underwritten plan, individuals must meet specific criteria. Qualified individuals are eligible for guaranteed issue coverage without medical underwriting or preexisting condition waiting periods.

In order to be considered eligible for a non-medically underwritten plan, all of the following conditions must be met:

  • You must have at least 18 months of continuous creditable coverage without any significant breaks (greater than 63 days);
  • Your most recent health coverage (link to FAQs page) was under a group health plan, governmental plan, or church plan, or health insurance coverage offered in connection with any such plan; or
  • (Florida residents only) Your most recent prior creditable coverage was under an individual plan issued in the State of Florida by a health insurer or HMO where the coverage was terminated due to the insurer or HMO becoming insolvent or discontinuing the offering of individual coverage in the State of Florida, or due to the insured no longer living in the service area in the State of Florida of the insurer or HMO that provides coverage through a network plan in the State of Florida;
  • Your most recent health coverage was not cancelled due to non-payment of premium or because of fraud, (Florida residents only) unless such nonpayment of premiums or fraud was due to acts of an employer or person other than you;
  • You must have accepted COBRA or State Continuation coverage if offered, and exhausted such coverage.

You are NOT eligible for a non-medically underwritten plan if any of the following apply:

  • You are eligible for coverage under another group plan;
  • You are eligible for Medicare Part A or Part B;
  • You are eligible for a State plan under Title 19 and do not have other health insurance coverage;
  • (Florida residents only) You are eligible for a conversion policy or contract issued by an authorized insurer or HMO offered to an individual who is no longer eligible for coverage under either an insured or self-insured employer plan.

If you think you may be eligible for a non-medically underwritten plan and would like more information on available plan benefits and rates, please contact us.

*Enrollment limits are in effect in the state of Ohio. Please contact your Department of Insurance for more information.

Humana One Individual Plan Specific Questions

In this section we will look at the Humana One Portrait, Autograph, and Monogram plans individually and try to answer as many questions as possible.  If you have additional questions please call us at 888 803 5917 or fill out this contact form.

Portrait health plan FAQs

Will Humana One Portrait pay benefits if I need medical care in another city?

Yes — Your health plan goes with you. Because of our extensive network, you’ll more than likely be able to access in-network services across the continental United States.

Can I see the same physicians who already treat me?

You have the freedom to see the provider of your choice. You will receive the most savings from your plan when visiting a provider in-network, but you’re still covered if you choose to visit an out-of-network provider. See if your doctor is in Humana’s network with our physician finder.

How long can I rely on Humana One Portrait coverage to be there?

As long as you need it; as long as premiums are paid your Humana One Portrait plan is guaranteed renewable*

What happens after I’m approved for Humana One Portrait coverage?

You’ll receive a Health Plan Guide containing the information you need to start using your HumanaOne Portrait plan with confidence. In addition, you can call our customer care consultants or go online at any time.

Do I have to purchase a Humana One health insurance plan in order to obtain individual dental insurance?

The Humana One optional dental benefit is only available in conjunction with a Humana One health insurance plan. However, Humana One also provides individual dental insurance that is independent of a Humana health insurance plan through Humana One Dental.

* Except for certain events as listed in the policy.

Autograph health plans FAQs

How are the Humana One Autograph series of plans customized to my financial situation?

These plans have a wide range of choices in deductibles, cost-sharing options and prescription drug benefits so they can fit both your needs and your budget.

Will Humana One Autograph plans pay benefits if I need medical care in another city?

Yes – Your health plan goes with you. With our extensive network, you’ll more than likely be able to access in-network services across the continental united states.

Can I see the same physicians who already treat me?

You have the freedom to see the provider of your choice. You will receive the most savings from your plan when visiting a provider in-network, but you’re still covered if you choose to visit an out-of-network provider. See if your doctor is in Humana’s network with physician finder.

Can I change to a different Humana One personal health plan at a later date?
Yes, you can — although it may require underwriting approval depending on which changes you make.

What happens after I’m approved for Humana One Autograph personal health plan coverage?

You’ll receive a Health Plan Guide containing the information you need to start using your Humana One Autograph plan with confidence. In addition, you can call our customer care consultants or go online at any time.

How do Autograph plans pair with a Health Savings Account (HSA) to save me money?

An Autograph plan with a higher deductible may cost you less — and you can put the money you save on premiums into your tax-advantaged HSA to help pay your deductible or other qualified expenses.

Am I eligible to set up an HSA?

You may be if you are covered by a qualified high-deductible plan, and not covered by any other health insurance plan nor claimed as a dependent on someone else’ tax return.

How can I open an HSA?

We can provide convenient access to banking partners who can help you establish your HSA. Of course, if your own financial institution offers an HSA, you may prefer to use theirs.

Monogram health plan FAQs

How does Monogram differ from higher-priced health insurance?

Many higher-priced insurance plans are designed for people who want to be covered for future medical care. Monogram is more affordable because of the higher deductible. It provides a safety net of coverage if you ever need it.

Can I afford the cost of Monogram?

Your daily cost for Monogram may be comparable to what you might spend on your cell phone, lattes and other expenses you probably seldom think about.

What is the advantage of using doctors, hospitals and pharmacies that are in-network?

You save money. Humana gets a discount for these medical providers and we pass these savings on to you.