CoverageFirstSM health plan Plan overview

CoverageFirstSM is a health plan that combines coverage for basic healthcare with protection for a major unexpected illness or injury. The plan includes a "benefit allowance" that covers many services from in-network providers before you start paying toward your deductible.

CoverageFirst is ideal for health plan members who have claims at or below $500 a year.

 

Encouraging good healthcare decisions

CoverageFirst works differently from other plans. It pays your expenses up front while encouraging you to make good financial decisions about your healthcare.

Instead of meeting a deductible right away, you get a $500 allowance that pays for your basic healthcare services. For many people, that's all they need in a year. Here's how it works:
  • CoverageFirst pays your first $500 of healthcare costs — except for your copayments — before you start paying toward a deductible, as long as the costs are for covered services from in-network providers
  • Once the allowance is spent, you have a deductible to meet
  • After you meet the deductible, you and Humana share in the cost of most additional eligible medical expenses until you've met an annual out-of-pocket maximum amount
  • You pay nothing for preventive care office visits, even after your $500 is gone; copayments don't count toward the deductible or out-of-pocket maximum, and you can't use the $500 allowance to cover copayments
  • The plan includes a "safety net" — an out-of-pocket maximum to limit your costs in case of a serious illness or injury
  • Premiums are generally lower than those of many other plans

How it works example — single coverage

Lynn chooses a CoverageFirst plan with:
  • $500 allowance
  • $3,000 deductible
  • 100 percent coinsurance (in-network)

Lynn goes to the doctor and finds out she has to have some moles removed from her back. Lynn's minor surgery takes place in the doctor's office.

  • Doctor's office visit - $50 (Lynn pays a $25 copayment)
  • Outpatient surgery - $400 (Lynn pays a $40 copayment)

How Lynn uses CoverageFirst

  • Total cost of medical services: $450
  • Deduct Lynn's total copayments: (-$65)
  • Remaining cost of medical services: $385

Summary

CoverageFirst pays the remaining $385. Lynn now has $115 remaining in her CoverageFirst allowance. She has not yet paid anything toward her deductible.

How it works example — family coverage

Greg chooses a CoverageFirst plan. Each covered member has:

  • $500 allowance
  • $2,500 deductible
  • 80 percent coinsurance (in-network)
  • $3,000 out-of-pocket maximum (does NOT include the deductible)

Greg is injured in a fall. He goes to the emergency room and spends three days in the hospital. Later, he has a follow-up visit with a specialist.

  • Hospital care: $10,000 (Greg pays $750 in copayments)
  • One specialist visit: $150 (Greg pays $50 copayment)

How Greg uses CoverageFirst

  • Total cost of medical services: $10,150
  • Deduct Greg's total copayments: (-$800)
  • Remaining cost of medical services: $9,350
  • CoverageFirst pays $500 of remaining cost: $8,850
  • Greg is now responsible for his deductible (-$2,500)
  • Remaining cost of medical services: $6,350
  • Greg's plan pays 80 percent of remaining cost, leaving Greg to pay 20 percent. $6,350 x 20% = $1,270

Summary

Greg's out-of-pocket maximum is $3,000. He has met $1,270 (his deductible did not apply to the out-of-pocket maximum). Greg must pay $1,730 more in medical costs until he reaches his out-of-pocket maximum. Then his plan will start paying 100 percent of the remaining medical costs for the rest of his plan year.


 

Plan tools to maximize your value

MyHumana tools

Visit your secure Website on Humana.com to:
  • View details about your health plan
  • Keep track of your healthcare spending and claims
  • See how close you are to meeting your deductible
  • Use Humana's MyChoice ToolsSM to estimate costs for procedures
  • Check your spending account balance

To access these tools and more, Log in to MyHumana .

If you haven't signed up for your secure Website yet, Register for MyHumana today.

MyHumana Mobile

Humana's mobile resources are designed to support the on-the-go needs of consumers and empower healthcare decisions at the point of service. Resources featured in MyHumana Mobile include: an urgent care finder, a spending account balance viewer, and ID card details. Use your existing MyHumana login to access the resources on your mobile device's browser.

Learn more about MyHumana Mobile

Printable Humana ID card

To get printable proof of your Humana coverage, simply fill out the online form in our Humana ID Card Viewer

Humana Commercial Preauthorization and Notification Lists

These dated documents provide a complete list of services that require preauthorization or prior authorization. Some employer groups for which Humana provides administrative services only (self-insured and employer-sponsored programs) may customize their plans with different requirements.

January 22, 2011, Commercial Preauthorization and Notification List
(265 KB) Download PDF
English

January 24, 2010, Commercial Preauthorization and Notification List
(97 KB) Download PDF
English

July 10, 2009, Commercial Preauthorization and Notification List
(92 KB) Download PDF
English

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