1. 2016 Humana Individual–Medical Plan Designs

2. Humana Individual On-X Plans available
Network Summary:
Knoxville PPOx
Knoxville: East Tennessee Children's Hospital, Fort Sanders Regional Hospital, Omni Community Health, Park West Medical Center and the University of Tennessee Medical Center
Kingston: Omni Community Health at Kingston
Tazewell: Claiborne County Hospital
Oak Ridge: Methodist Medical Center of Oak Ridge
Oneida: Omni Community Health Oneida, Pioneer Community Hospital of Scott
Harriman: Roane Medical Center
Lenoir City: Fort Loudoun Medical Center
Morristown: Morristown Hamblen Healthcare Center
Sevierville: LeConte Medical Center

3. Humana Individual On-X Plans available
Network Summary
Memphis PPOx
Collierville: Baptist Memorial Hospital -- Collierville
Covington: Baptist Memorial Hospital – Covington
Germantown: Baptist Rehabilitation -- Germantown
Memphis: Delta Medical Center, St. Jude’s Children’s Research Hospital, Shelby County Healthcare Corporation, Baptist Memorial Children’s Hospital, Baptist Memorial Hospital for Women, Baptist Memorial Hospital, Baptist Memorial Restorative Care Hospital, Saint Francis Hospital, Saint Francis Hospital Bartlett
Ripley: Lauderdale Community Hospital
Southhaven, MS: Baptist Memorial Hospital – Desoto
Tipton: Baptist Memorial Hospital - Tipton

4. Humana Individual On-X Plans available
Network Summary
Nashville PPOx
Ashland City: Centennial Medical Center at Ashland
Clarksville: Gateway Medical Center, Clarkesville VA CBOC
Franklin: Williamson Medical Center
Gallatin: Sumner Regional Medical Center
Hartsville: Trousdale Medical Center
Hendersonville: Hendersonville Medical Center
Hermitage: Summit Medical Center
Madison: Skyline Medical Campus
Nashville: Centennial Medical Center, Skyline Medical Center, Southern Hills Medical Center
Springfield: Northcrest Medical Center
Smyrna: Stonecrest Medical Center
All PPOx Networks use the Select Rx network = CVS, Walmart, Sam’s Club, Humana Pharmacy, Publix

5. Humana Individual On-X Plans available

6. Humana Individual On-X Plans available
All of these PPOx networks offer the following plan options:
Catastrophic (called “Basic” ): For under 30 years of age or if an individual qualifies for a hardship exemption; high deductible but includes 3 Primary Care Physician (PCP) copays
Bronze: High deductible Health Plan & H.S.A. eligible. Lowest price for plans eligible for Advanced Premium Tax Credit (APTC)
Silver: Copay plan. Available in Base plan, and Cost Share Reduction Plans (CSR): % Federal Poverty Level (FPL), % FPL, % FPL)
Gold: Copay plan
Note: Humana will not offer a Platinum plan in 2016.

7. 2016 H1 Medical Products – Enhancements
Main changes to Humana PPOx plans in TN
Easier access to care:
CVS Minute Clinic (retail clinic) and Concentra Urgent care clinics available as in-network nationwide (where available)
Lower PCP copays and Generic RX copays on our Silver Cost Share Reduction Plans (our best selling plans)
$0 Rx deductible on Silver & Gold plans = Easier access to medication = easier medication adherence
Easier to Understand plans:
Embedded deductibles (individual protection) on all 2016 PPOx plans in TN
Other important changes:
New ER benefit: ER copay + Deductible + Coinsurance
In general: “you pay a $250 copay for every emergency room visit. You also pay all emergency room charges until you reach your deductible. Once you reach your deductible, you pay 20% coinsurance until you reach your maximum out-of-pocket.”
CSR plans have lower copay portion
ER copay not waived if patient admitted to hospital

8. 2016 Medical Products – Enhancements
Example:
NEW in 2016
Silver Base (Silver 1)
CSR % FPL (Silver 1-02)
CSR % FPL (Silver 1-03)
CSR % FPL (Silver 1-04)
PCP copay
$20
$15
$10 $5
Retail Clinic copay
$30
$25
Urgent Care Copay
$40
ER (copay + ded + coins)
$250 copay + ded + coins
$200 copay + ded + coins
$150 copay + ded + coins
Tier 1 & 2 Rx
$10/$20
$5/$15
$5/$10
$4/$8
Tier 3, 4, 5 Rx
$50/50%/50%
$45/50%/50%
$35/50%/50%
$25/50%/50%

9. 2016 Medical Products – Changes
Example of 2016 ID Card Design:

10. 2016 Medical Products – Changes

11. 2015-2016 Side by Side Plan Comparison
Metal Tier (Plan)
Catastrophic
Bronze HDHP
Silver Copay
Silver 1
CSV 73%
Silver 1-02
CSV 87%
Silver 1-03
CSV 94%
Silver 1-04
Version
2015
2016
Plan Details
Formulary
Rx5
MOOP
$6,600
$6,850
$6,300
$6,450
$4,750
$1,450
$1,500
$750
Medical
Deductible
$4,600
$3,800
$3,250
$900
$500
Coinsurance
100%
80%
PCP Copay
$35
$25
Ded
$20
$15
$10 $5
Retail Clinic
$30
Specialist Copay
$40
Urgent Care Copay
$50
ER Copay***
Ded/
Coins
**$250+
**$200+
**$150+
OV Limit 3 -
Unlimited
Pharmacy
Integrated with Medical Ded. $0
$1,000
$250
Tier 1 $4
Tier 2 $8
Tier 3
$45
Tier 4
50%
Tier 5
Represents Individual, In-Network cost sharing.
Family Deductible & MOOP are 2x Individual value.
CSV = Cost Share Variation.
*** ER Benefit = ER copay + ded + coins

12. 2015-2016 Side by Side Plan Comparison Continued
Metal Tier (Plan)
Gold Copay
Version
2015
2016
Plan Details
Formulary
Rx5
MOOP
$3,500
Medical
Deductible
$2,500
$2,250
Coinsurance
20%
PCP Copay
$25
$20
Retail Clinic
$30
Specialist Copay
$35
$40
Urgent Care Copay
$50
ER Copay****
Ded/Coins
**$250 +
OV Limit
Unlimited
Pharmacy
$500 $0
Tier 1 $5
Tier 2
$10
Tier 3
Tier 4
35%
Tier 5
Represents Individual, In-Network cost sharing.
Family Deductible & MOOP are 2x Individual value.
*** ER Benefit = ER copay + ded + coins