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Humana Health Insurance Policy Review

In this time of health care reform, it is really important that consumers understand the ins and outs of their health insurance policy. My current plan is with Humana One Insurance. It is a group plan that I have through my Illinois employer. Employees have a choice between a HMO and a PPO. I chose the PPO because of the flexibility of the plan. It is a PPO plan with a $2000 deductible. In my opinion, that is about the only negative of my plan- the high deductible. Our deductible was increased from $1000 two years ago after my employer experienced a high increase to the monthly premium. A high premium increase usually happens because of high claims dollars. The insurance company will pay out more in claims than they take in in premiums. Since both my husband and I are covered on this plan, we each have to meet the $2000 deductible. After the deductible is met, the plan pays 90% of covered charges up to $1500.00. After the $1500.00 is met, the plan will pay all covered charges at 100%. Once January 1 comes, we have to start all over again to meet the deductible.

My plan has a $25.00 office visit co-pay. This means whenever I have a doctor's visit, I only pay $25.00 no matter what the services are. However, if I visit a specialist, the co-pay is $40.00. A specialist would include orthopedics, gynecologists, dermatologists, etc.

One of the biggest positives of my plan is the prescription card. Drug costs are extremely high these days. A prescription card limits the amount you have to pay based on different categories of drugs, also called a formulary. If I am prescribed a generic drug, I only pay a $15.00 co-pay for a month's supply no matter what medication it is. If it is a brand-name drug, I pay either $35.00 or $70.00 depending on the formulary. You can't beat having a prescription drug like this card with your medical policy.

Although I have dental coverage through Humana as well, it is a separate policy with a separate monthly premium. It covers cleanings, extractions and basic dental services. Just like my medical policy, we have a choice between a dental HMO or PPO. The PPO offers more flexibility. There is also a Vision policy available with Humana. We waived coverage due to the fact that our current optometrist and ophthalmologist are not a part of the Humana network.

Knowing what your plan covers and doesn't cover is very important when doing a health insurance review. What is also important is staying within the network of the plan. When you use out-of-network providers, your payment is reduced or not paid at all. Become familiar with policy terms and coverage to maximize health-care dollars.



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