Humana One North Carolina

NEW Humana One Health Plans Available For North Carolina

You have a choice of HumanaOne Individual Health Insurance Plans in North Carolina. Whether you’re looking for a plan with all the bells and whistles or just want low cost protection, you could find what you need with HumanaOne.

  • Ideal coverage for people who:
    • - want benefits like those provided by big employers
    - prefer to minimize risk in their lives
  • Personalized, concierge-level service
  • We pay 80% of most covered in-network medical costs and emergency room visits.
  • We pay 100% of in-network doctor visits for covered illness and injury after copayment and prescription medications once you reach your separate prescription deductible.

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

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 Benefits

Dental Traditional Plus

    Keep your smile looking healthy with access to more than 100,000 dentist locations:
    • Coverage for preventive care, basic and major services
    • Teeth whitening
    • Discounts on orthodontia services
    • Learn more about Dental Traditional Plus.

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.
  • Ideal coverage for people who:
    • - seek the right combination of features and benefits that fit their lifestyle
    - like to take charge of their own well-being.
    - may have new careers, new family members and other changing needs
  • Includes plans that can be combined with a Health Savings Account for potential tax advantages
  • Choose from plans that pay 80 or 100 percent of the covered cost for most in-network care once you reach your deductible.

Introducing HumanaOne® Autograph™ … the personal health plan with the right balance of features and benefits that fit your lifestyle.

  • Choose the level of protection you want, at a cost that fits your budget
  • Pays benefits for covered hospital inpatient and outpatient services, emergency room care, preventive care, and certain plans also cover prescription drugs
  • Extensive PPO network which more than likely includes the doctors, hospitals and pharmacies you now use

Basic 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

    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.

Waiting periods, limitations and exclusions apply.

  • Ideal coverage for people who:
    • - want low cost protection just in case an accident happens
    - are healthy and seldom visit doctors but need coverage for annual exams
    - recent college graduates or graduate students
  • Affordable monthly cost for protection anywhere in the continental U.S.
  • We pay 100 percent of most covered, in-network medical costs once you’ve reached your annual deductible.
  • Includes benefits for preventive care and prescription medications

Introducing HumanaOne® monogram™ … our most affordable personal health plan that provides a safety net of coverage.

  • Low-cost protection just in case of an unforeseen medical event.
  • Includes a preventive care benefit that helps cover your annual exams and physicals
  • With our extensive network, you’ll more than likely be covered anywhere a medical emergency strikes.

Basic Coverage Options

Deductibles

    HumanaOne monogram personal health plan lets you select a single annual in-network deductible of $7,500 or a family in-network deductible of $15,000.

Coinsurance

    When you reach your annual deductible, HumanaOne monogram pays 100 percent of most covered in-network medical costs after that.

Prescription Coverage

    Includes a prescription drug benefit with copayments as low as $15 for common prescriptions. Certain drug levels require meeting a separate prescription deductible.

Waiting periods, limitations and exclusions apply.

Medical Limitations and Exclusions

This is an outline of the limitations and exclusions for the HumanaOne Individual Health Plan. It is designed for convenient reference. Consult the policy for a complete list of limitations and exclusions.

Pre-existing conditions

A pre-existing condition is a sickness or injury for which medical advice, diagnosis, care or treatment was received or recommended within the one-year period immediately preceding the effective date. Benefits for pre-existing conditions are not payable until the covered person’s coverage has been in force for 12 consecutive months with us.We will waive the pre-existing conditions limitation for those conditions disclosed on the application provided benefits relating to those conditions are not excluded. Conditions specifically excluded by rider are never covered.

Other expenses not covered

Unless stated otherwise no benefits are payable for expenses arising from:

  1. Services not medically necessary or which are experimental, investigational or for research purposes.
  2. Services not authorized or prescribed by a healthcare practitioner or for which no charge is made.
  3. Services while confined in a hospital or other facility owned or operated by the United States government, provided by a person who ordinarily resides in the covered person’s home or who is a family member, or that are performed in association with a service that is not covered under the policy.
  4. Charges in excess of the maximum allowable fee or which exceed any policy benefit maximum.
  5. Expenses incurred before the effective date or after the date coverage terminated.
  6. Cosmetic procedures and any related complications except as stated in the policy.
  7. Custodial or maintenance care.
  8. Any drug, medicine or device which is not FDA approved.
  9. Medications, drugs or hormones to stimulate growth, except as stated in the policy.
  10. Legend drugs not recommended or deemed necessary by a healthcare practitioner or drugs prescribed for a non-covered injury or sickness.
  11. Drugs prescribed for intended use other than for indications approved by the FDA or recognized off-label indications through peer-reviewed medical literature; experimental or investigational use drugs.
  12. Over the counter drugs (except insulin) or drugs available in prescription strength without a prescription.
  13. Drugs used in treatment of nail fungus.
  14. Prescription refills exceeding the number specified by the healthcare practitioner or dispensed more than one year from the date of the original order.
  15. Vitamins, dietary products and any other nonprescription supplements.
  16. Infertility services.
  17. Pregnancy and well-baby expenses.
  18. Elective medical or surgical procedures; sterilization, including tubal ligation and vasectomy; reversal of sterilization; abortion; gender change or sexual dysfunction.
  19. Vision therapy; all types of refractive keratoplasties or any other procedures, treatments or devices for refractive correction; eyeglasses; contact lenses; hearing aids; dental exams.
  20. Hearing and eye exams; routine physical examinations for occupation, employment, school, travel, purchase of insurance or premarital tests.
  21. Services received in an emergency room unless required because of emergency care.
  22. Dental services (except for dental injury), appliances or supplies.
  23. War or any act of war, whether declared or not; commission or attempt to commit a civil or criminal battery or felony.
  24. Standby physician or assistant surgeon, unless medically necessary; private duty nursing; communication or travel time; lodging or transportation, except as stated in the policy.
  25. Any treatment for the purpose of reducing obesity, or any use of obesity reduction procedures to treat sickness or injury caused by, complicated by, or exacerbated by obesity, including but not limited to surgical procedures.
  26. Nicotine habit or addiction; educational or vocation therapy, services and schools; light treatment for Seasonal Affective Disorder (S.A.D.); alternative medicine; marital counseling; genetic testing, counseling or services; sleep therapy or services rendered in a premenstrual syndrome clinic or holistic medicine clinic.
  27. Foot care services.
  28. Charges for nonmedical purposes or used for environmental control or enhancement (whether or not prescribed by a healthcare practitioner).
  29. Health clubs or health spas, aerobic and strength conditioning, work hardening programs and related material and products for these programs; personal computers and related or similar equipment; communication devices other than due to surgical removal of the larynx or permanent lack of function of the larynx.
  30. Hair prosthesis, hair transplants or implants and wigs.
  31. Injury or sickness arising out of or in the course of any occupation, employment or activity for compensation, profit or gain for which benefits are paid or payable under North Carolina Workers’ Compensation Act.This exclusion does not apply to a covered person qualifying as a sole proprietor, officer or partner under state law, and such benefits are not paid under the North Carolina Workers’ Compensation plan, provided the covered person is not covered under a Workers’ Compensation plan, except for certain professions or activities as stated in the policy.
  32. Inpatient services when in an observation status or when the stay is due to behavioral, social maladjustment, lack of discipline or other antisocial actions not a result of a mental disorder.
  33. Attempted suicide or intentionally self-inflicted injury, whether sane or insane.
  34. Charges covered by other medical payments insurance.
  35. Organ transplants not approved based on established criteria or investigational, experimental or for research purposes.
  36. Charges incurred for a hospital stay beginning on a Friday or Saturday unless due to emergency care or surgery is performed on the day admitted.