Humana's Retiree Medical Solution

University of Ky Medicare

Presenter Reno Altschul

Date August 26, 2005

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Benefit Comparisons

UK Medicare Carve Out In-Network

Humana Gold Choice In-Network

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Max Out Of Pocket

$1500 individual $3000 Family Does not include

deductible No maximum lifetime

$5000 Does not include

deductible No maximum lifetime

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How Physicians Are Selected

Any provider Any Medicare Participating Provider

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Physician Visits

20% coinsurance after $500 deductible

Primary Care 100% after $10 co-payment

Specialist Care 100% after $20 co-payment

Primary Care includes diagnostic procedures, lab tests and x-rays, routine physical, medical supplies, and physical, speech, occupational therapy received during an office visit

Specialist Care includes diagnostic procedures, lab test, x-rays, medical supplies, physical, speech, occupational therapy, and Medicare covered services for chiropractic and podiatry, received during an office visit

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Preventive Care

20% coinsurance after deductible

100% with $0 co-payment (if other services are billed as routine preventive, the appropriate co-payment/coinsurance will apply based on the type of service and place of treatment)

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Preventive Services

Bone Mass Measurement(1 per year) Colorectal Screening (1 per year) Diabetes Self-Management (1 per year) Nutritional Therapy (Diabetic or ESRD Patients) Pap Smears and Pelvic Exam Screening (1 per year) Prostate Cancer Screening (I per year) Mammography Screening (1 per year) Immunization (1per year)

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Urgent Treatment Center

20% coinsurance after deductible

100% after $20 co-payment per visit

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Ambulance

20% coinsurance after deductible

100% after $50 co-payment per date of service

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Skilled Nursing Facility

20% coinsurance after deductible, 100 day limit per plan year

100% covered from days 1-100 per benefit period

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Emergency Room

20% coinsurance after deductible

100% after $50 co-payment per visit 9not waived for admission)

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Outpatient (non-surgical)

20% coinsurance after deductible

100% after $20-$50 co-payment per visit, based on where services received

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Outpatient (surgical)

20% coinsurance after deductible

100% after $25-50 co-payment per visit, based on where services received

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Hospital Services Inpatient

20% coinsurance after deductible

100% after $100 co-payment per day (days 1-5) per admission

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Outpatient Therapy

20% coinsurance after deductible, 30 visit limit per plan year on physical therapy

$20 co-payment all settings, includes cardiac, occupational, physical, and speech therapies. No visit limitations as long as medically necessary.

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Prescription Drug Coverage

$8.00 Generic $20.00 Preferred $40.00 Non-Preferred

$10.00 Level One $20 Level Two $40 Level Three 25% coinsurance Level

Four Once the member’s true

out of pocket cost for levels 1-4 reaches $3600, the member pays the greater of $2.00 for a generic or a preferred drug that is a multiple source drug, and $5.00 for all other drugs, or 5% coinsurance. Rx coverage is unlimited.

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Mental/Nervous (Outpatient)

20% coinsurance after deductible, 20 day limit per plan year (in combination with Substance Abuse)

100% after $20 co-payment per visit (not in combination with Substance Abuse, which is 100% after $10-$50 co-payment based on place of treatment)

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Mental/Nervous Inpatient

20% coinsurance after deductible, 31 day limit per plan year (in combination with Substance Abuse)

100% after $100 co-payment per admission (days 1-5) 190 day lifetime limit (not in combination with Substance Abuse)

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Durable Medical Equipment/Prosthetics

20% coinsurance after deductible, 100 day limit per plan year

20% coinsurance (Medicare fee schedule)

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Home Health Care

20% coinsurance after deductible, 100 day limit per plan year

100% covered