HumanaOne® Autograph™ - 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, and preventive care; certain plans also cover prescription drugs
- Large network that more than likely includes the doctors, hospitals, and pharmacies you use now
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Plan pays for services from
NETWORK providers |
Plan pays for services from
NON-NETWORK providers |
Deductible options 1
• per calendar year
• copayments do not apply |
• individual
• family2 |
$1,500, $2,500, $3,500, $5,000
$3,000, $5,000, $7,000, $10,000 |
$3,000, $5,000, $7,000, $10,000
$6,000, $10,000, $14,000, $20,000 |
Coinsurance
out-of-pocket limit 1
• deductibles and
copayments do not apply |
• individual
• family |
Not applicable
Not applicable |
$6,000
$12,000 |
| Preventive care |
• preventive office visits3
• child immunizations to age 183
• prostate screening
• Pap smear and mammogram
• colorectal cancer screenings
• preventive lab and X-ray3
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100% |
70% after deductible |
| Physician services |
• office visits
• diagnostic lab and X-ray
• allergy injections, testing and serum
• inpatient and outpatient services
• surgery4 |
100% after deductible |
70% after deductible |
| Facility services |
• inpatient and outpatient services
• outpatient surgery4
• emergency services |
100% after deductible
100% after deductible |
70% after deductible
100% after deductible |
| Prescription drug |
• retail or mail order benefit for each prescription or refill |
100% after deductible |
70% after deductible5 |
Other medical services
• Prior authorization
required in order to be
eligible for these benefits |
• skilled nursing facility (up to 30 days per admission)
• hospice6
• home health care (up to 60 visits per calendar year)
• durable medical equipment
• pregnancy complications and sick baby services
(no prior authorization required)
• transplant services |
100% after deductible
100% after deductible when services are received from a Humana Transplant Network provider |
70% after deductible
70% after deductible covered expenses are limited to a maximum allowance of $35,000 per transplant |
| Lifetime maximum benefit |
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Unlimited |
| Basic mental health3 |
• inpatient services
• outpatient and office therapy sessions |
50% after deductible |
50% after deductible |
| Severe mental health |
• inpatient services (up to 40 days per calendar year)
• outpatient and office therapy sessions
(up to 40 days per calendar year) |
100% after deductible |
70% after deductible |
Chemical and alcohol
dependency |
• inpatient services
• outpatient and office therapy sessions |
100% after deductible |
70% after deductible |
Optional benefits
• these are available to add
for an additional cost |
• supplemental accident benefit ($500 or $1,000)
(treatment must be provided within 90 days of the injury) |
First $500 per accident at 100%, then base plan benefits apply or First $1,000 per accident at 100%, then base plan benefits apply |
| Dental |
Protect your healthy smile with affordable, easy-to-use optional dental benefits from one of the nation's largest dental insurers. For a low monthly premium, you can use more than 130,000 network providers. And if you're approved for a medical plan, you're approved for dental benefits - just choose the type of coverage that meets your needs:
• Traditional Plus includes coverage for preventive, basic, and major services. You can go to network or non-network dentists, but you'll pay less when you choose dentists in the network. Learn more about Dental Traditional Plus
• Preventive Plus covers the most common preventive and basic services. Discounts are available for major services and basic services the plan doesn't cover. Enrollment in this plan requires a minimum one-year contract. Learn more about Dental Preventive Plus |
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.
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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. For other than single coverage, the family deductible applies. The single
deductible applies to single coverage policies only.
3. Benefit payable after 90-day waiting period for preventive care and
12 month waiting period for basic mental health.
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4. 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).
5. If a non-network pharmacy is used you must pay 100 percent of the
actual charges and file a claim with Humana for reimbursement.
6. 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. |
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.
To view Medical Limitations and Exclusions or Dental Limitations and Exclusions please download a summary of benefits. |