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SBOSB0322021Summary of BenefitsHumana Gold Plus SNP-DE H1951-033 (HMO D-SNP)New OrleansNew Orleans AreaOur service area includes the following parish(es) in Louisiana: Assumption, Jefferson,Lafourche, Orleans, Plaquemines, St. Bernard, St. Charles, St. James, St. John the Baptist,Terrebonne.GNHH4HIEN 21 CH1951033000SB21
Pre-Enrollment ChecklistBefore making an enrollment decision, it is important that you fully understand our benefits and rules. If youhave any questions, you can call and speak to a customer service representative at 1-800-833-2364 (TTY:711).Understanding the BenefitsReview the full list of benefits found in the Evidence of Coverage (EOC), especially for those servicesthat you routinely see a doctor. Visit Humana.com/medicare or call 1-800-833-2364 (TTY: 711) toview a copy of the EOC.Review the provider directory (or ask your doctor) to make sure the doctors you see now are in thenetwork. If they are not listed, it means you will likely have to select a new doctor.Review the pharmacy directory to make sure the pharmacy you use for any prescription medicines isin the network. If the pharmacy is not listed, you will likely have to select a new pharmacy for yourprescriptions.Understanding Important RulesBenefits, premiums and/or copayments/co-insurance may change on January 1, 2022.Except in emergency or urgent situations, we do not cover services by out-of-network providers(doctors who are not listed in the provider directory).This plan is a dual eligible special needs plan (D-SNP). Your ability to enroll will be based on verificationthat you are entitled to both Medicare and medical assistance from a state plan under Medicaid. Thisplan may enroll dual eligibles who are FBDE, SLMB Plus, QMB Plus and QMB.
2021Summary of BenefitsHumana Gold Plus SNP-DE H1951-033 (HMO D-SNP)New OrleansNew Orleans AreaOur service area includes the following parish(es) in Louisiana: Assumption, Jefferson,Lafourche, Orleans, Plaquemines, St. Bernard, St. Charles, St. James, St. John theBaptist, Terrebonne.H1951 SB MAPD HMO 033000 2021 MH1951033000SB21
the health and drug services it covers - in this easy-to-use guide.Humana Gold Plus SNP-DE H1951-033 (HMO D-SNP) is a Coordinated Care plan with a Medicarecontract and a contract with the Louisiana Department of Health and Hospitals (DHH) MedicaidProgram. Enrollment in this Humana plan depends on contract renewal.The benefit information provided is a summary of what we cover and what you pay. It doesn'tlist every service that we cover or list every limitation or exclusion. For a complete list of serviceswe cover, ask us for the "Evidence of Coverage".As a member you must select an in-network doctor to act as your Primary Care Provider (PCP). Humana GoldPlus SNP-DE H1951-033 (HMO D-SNP) has a network of doctors, hospitals, pharmacies and other providers. Ifyou use providers who aren’t in our network, the plan may not pay for these services. You have access toCare Managers. Care Managers are nurses or care coordinators who support your health and well-being byproviding additional services including: acute and chronic-care management, telephonic and in-person healthsupport; assistance in coordinating Medicare and Medicaid benefits, educational resources and workshopsand support for families and caregivers.To be eligibleHow to reach us:To enroll in Humana Gold Plus SNP-DE H1951-033 (HMOD-SNP), a Dual Eligible Special Needs Plan, you must beentitled to Medicare Part A and enrolled in Medicare PartB, live in our service area and also receive certain levelsof assistance from the Louisiana Department of Healthand Hospitals (DHH) Medicaid Program. If you receiveboth Medicare and Medicaid benefits, this means youare a dual eligible.If you have questions about your benefits oryour level of eligibility for assistance fromMedicaid, you should contact Humana'sCustomer Care department or your stateMedicaid office for further details.Humana Gold Plus SNP-DE H1951-033 (HMO D-SNP)may enroll dual eligibles who are FBDE, SLMB Plus, QMBPlus and QMB.Plan name:Humana Gold Plus SNP-DE H1951-033 (HMO D-SNP)More about Humana Gold Plus SNP-DEH1951-033 (HMO D-SNP)If you’re not a member of this plan, call toll free:1-800-833-2364 (TTY: 711).October 1 - March 31:Call 7 days a week from 8 a.m. - 8 p.m.April 1 - September 30:Call Monday - Friday, 8 a.m. - 8 p.m.Or visit our website: Humana.com/medicare .As a member of this plan, you will not be responsible forcost sharing for plan benefits. The ComprehensiveBenefit Chart shows the benefits you will receive fromHumana and how Medicaid covers your cost sharing forthose plan benefits. The chart also lists some benefitsyou could receive from Medicaid if you are eligible forfull Medicaid benefits. If you are entitled to Medicaidbenefits your care coordinator will work with you toassist you in understanding and accessing the Medicareand Medicaid benefits you may be entitled to.Be sure to show your Medicaid ID card in addition toyour Humana membership card to make your provideraware that you may have additional coverage. Yourservices are paid first by Humana and then by Medicaid.2021If you’re a member of this plan, call toll-free:1-800-457-4708 (TTY: 711).-5-FOR THE MOST CURRENT LOUISIANA MEDICAIDCOVERAGE INFORMATION, PLEASE VISIT THELOUISIANA MEDICAID WEBSITE ATHTTP://NEW.DHH.LOUISIANA.GOV/INDEX.CFM/SUBHOME/1 OR CALL THE MEDICAID HOTLINEAT 1-888-342-6207 (TTY: 711).A healthy partnershipGet more from your plan — with extraservices and resources provided byHumana!Summary of BenefitsH1951033000Let's talk about Humana Gold Plus SNP-DEH1951-033(HMO D-SNP)Find out more about the Humana Gold Plus SNP-DE H1951-033 (HMO D-SNP) plan - including
Monthly plan premium 0You must keep paying your Medicare Part B premium. The Part Bpremium may be covered through your State Medicaid Program.Medical deductibleThis plan does not have a deductible.Pharmacy (Part D) deductibleThis plan does not have a deductible.Maximum out-of-pocketresponsibilityThis plan does not have a maximum out-of-pocket responsibility.Covered Medical and Hospital BenefitsFor members protected by the State Medicaid Program from cost sharing, Medicaid pays coinsurance,copays and deductibles for Original Medicare-covered services. Medicaid coverage may vary based onyour level of Medicaid eligibility. You may be required to pay a Medicaid copay.N/AWHAT YOU PAY ON THISHUMANA PLANMEDICAID USUAL LIMITS ANDCOPAYSACUTE INPATIENT HOSPITAL CAREN/A 0 copayOUTPATIENT HOSPITAL COVERAGEN/AOutpatient surgery atoutpatient hospital 0 copayN/AOutpatient surgery atambulatory surgical center 0 copayN/APrimary care provider (PCP) 0 copayN/ASpecialists 0 copayN/AOur plan covers manypreventive services at no costwhen you see an in-networkprovider including:N/ADOCTOR OFFICE VISITSPREVENTIVE CAREN/A Abdominal aortic aneurysmscreening Alcohol misuse counseling Bone mass measurement Breast cancer screening(mammogram) Cardiovascular disease(behavioral therapy) Cardiovascular screeningsYou do not need a referral to receive covered services from plan providers. Certain procedures, services and drugsmay need advance approval from your plan. This is called a "prior authorization" or "preauthorization." Pleasecontact your PCP or refer to the Evidence of Coverage (EOC) for services that require a prior authorization from theplan.2021-6-Summary of BenefitsH1951033000Monthly Premium, Deductible and Limits
N/AWHAT YOU PAY ON THISHUMANA PLANMEDICAID USUAL LIMITS ANDCOPAYS Cervical and vaginal cancerscreening Colorectal cancer screenings(colonoscopy, fecal occultblood test, flexiblesigmoidoscopy) Depression screening Diabetes screenings HIV screening Medical nutrition therapyservices Obesity screening andcounseling Prostate cancer screenings(PSA) Sexually transmitted infectionsscreening and counseling Tobacco use cessationcounseling (counseling forpeople with no sign oftobacco-related disease) Vaccines, including flu shots,hepatitis B shots,pneumococcal shots "Welcome to Medicare"preventive visit (one-time) Annual Wellness Visit Lung cancer screening Routine physical exam Medicare diabetes preventionprogramAny additional preventive servicesapproved by Medicare during thecontract year will be covered.EMERGENCY CAREEmergency room 0 copayN/AIf you are admitted to thehospital within 24 hours, you donot have to pay your share of thecost for the emergency care.You do not need a referral to receive covered services from plan providers. Certain procedures, services and drugsmay need advance approval from your plan. This is called a "prior authorization" or "preauthorization." Pleasecontact your PCP or refer to the Evidence of Coverage (EOC) for services that require a prior authorization from theplan.2021-7-Summary of BenefitsH1951033000Covered Medical and Hospital Benefits (cont.)
N/AWHAT YOU PAY ON THISHUMANA PLANMEDICAID USUAL LIMITS ANDCOPAYSUrgently needed services 0 copayN/AUrgently needed services areprovided to treat anon-emergency, unforeseenmedical illness, injury or conditionthat requires immediate medicalattention.DIAGNOSTIC SERVICES, LABS AND IMAGINGDiagnostic mammography 0 copayN/ADiagnostic radiology 0 copayN/ALab services 0 copayN/ADiagnostic tests and procedures 0 copayN/AOutpatient X-rays 0 copayN/ARadiation therapy 0 copayN/AMedicare-covered hearing 0 copayN/ARoutine hearingIn-network:N/AHER945 0 copayment for Advancedlevel hearing aid up to 1 per earevery 3 years. 0 copayment for fitting,routine hearing exams up to 1every 3 years. 0 copayment for adjustmentsup to 2 every 3 years. Note: Includes 48 batteries peraid and 3 year warranty. Fitting and adjustments arecovered for 1 year afterTruHearing hearing aidpurchase.TruHearing provider must be used.HEARING SERVICESDENTAL SERVICESThe cost-share indicated below is what you pay for the covered service.Medicare-covered dental 0 copayN/AYou do not need a referral to receive covered services from plan providers. Certain procedures, services and drugsmay need advance approval from your plan. This is called a "prior authorization" or "preauthorization." Pleasecontact your PCP or refer to the Evidence of Coverage (EOC) for services that require a prior authorization from theplan.2021-8-Summary of BenefitsH1951033000Covered Medical and Hospital Benefits (cont.)
N/AWHAT YOU PAY ON THISHUMANA PLANMEDICAID USUAL LIMITS ANDCOPAYSRoutine dentalIn-network:N/ADEN181Dental benefits may not cover all 0 copayment for scaling andAmerican Dental Associationroot planing (deep cleaning) upprocedure codes. Informationto 1 per quadrant every 3 years.regarding each plan is available at 0 copayment forHumana.com/sbcomprehensive oral evaluationor periodontal exam up to 1Use the HumanaDental Medicareevery 3 years.network for the Mandatory 0 copayment for completeSupplemental Dental. The providerdentures, partial dentures up tolocator can be found at1 set(s) every 5 years.Humana.com Find a Doctor 0 copayment for panoramicfrom the Search Type drop downfilm or diagnostic x-rays,select Dental under Coveragerecementation up to 1 every 5Type select All Dental Networks years.enter zip code from the network 0 copayment for bitewingdrop down select HumanaDentalx-rays up to 1 set(s) per year.Medicare. 0 copayment for adjustmentsto dentures, denture reline,intraoral x-rays, root canal upto 1 per year. 0 copayment for amalgamand/or composite filling, crown,emergency treatment for pain,fluoride treatment, oral surgery,periodic oral exam and/oremergency diagnostic exam,prophylaxis (cleaning) up to 2per year. 0 copayment for periodontalmaintenance up to 4 per year. 0 copayment for necessaryanesthesia with coveredservice, simple or surgicalextraction up to unlimited peryear. 2500 maximum benefitcoverage amount per year forpreventive and comprehensivebenefits.VISION SERVICESMedicare-covered vision services 0 copayN/AYou do not need a referral to receive covered services from plan providers. Certain procedures, services and drugsmay need advance approval from your plan. This is called a "prior authorization" or "preauthorization." Pleasecontact your PCP or refer to the Evidence of Coverage (EOC) for services that require a prior authorization from theplan.2021-9-Summary of BenefitsH1951033000Covered Medical and Hospital Benefits (cont.)
N/AWHAT YOU PAY ON THISHUMANA PLANMEDICAID USUAL LIMITS ANDCOPAYSMedicare-covered diabetic eyeexam 0 copayN/AMedicare-covered glaucomascreening 0 copayN/AMedicare-covered eyewear(post-cataract) 0 copayN/ARoutine visionIn-network:N/AVIS733 0 copayment for refraction,routine exam up to 1 per year. 300 maximum benefitcoverage amount per year forcontact lenses oreyeglasses-lenses and frames,fitting for eyeglasses-lensesand frames. Eyeglasses include ultravioletprotection and scratch resistantcoating.The provider locator for routinevision can be found atHumana.com Find a Doctor from the Search Type drop downselect Vision Vision coveragethrough Medicare Advantageplans.MENTAL HEALTH SERVICESInpatientYour plan covers up to 190 daysin a lifetime for inpatient mentalhealth care in a psychiatrichospitalOutpatient group and individualtherapy visits 0 copayN/A 0 copayN/A 0 copayN/A 0 copayN/A 0 copayMust be medically necessarySKILLED NURSING FACILITY (SNF)Your plan covers up to 100 daysin a SNFPHYSICAL THERAPYAMBULANCEAmbulanceYou do not need a referral to receive covered services from plan providers. Certain procedures, services and drugsmay need advance approval from your plan. This is called a "prior authorization" or "preauthorization." Pleasecontact your PCP or refer to the Evidence of Coverage (EOC) for services that require a prior authorization from theplan.2021- 10 -Summary of BenefitsH1951033000Covered Medical and Hospital Benefits (cont.)
N/AWHAT YOU PAY ON THISHUMANA PLANMEDICAID USUAL LIMITS ANDCOPAYS 0 copay for up to unlimitedone-way trips to plan approvedlocations. Not to exceed 50 milesper trip.The member must contacttransportation vendor to tion Drug BenefitsWHAT YOU PAY ON THISHUMANA PLANMEDICAID USUAL LIMITS ANDCOPAYSChemotherapy drugs 0 copayN/AOther Part B drugs 0 copayN/ASee chart below for plan coverageinformation for prescription drugsLouisiana Medicaid providescoverage for Medicare Excludeddrugs or otherwise restricteddrugs or classes of drugs, or theirmedical uses to all Medicaidrecipients including full benefitdual eligible beneficiaries underthe Medicare Prescription DrugBenefit – Part D. All existingPharmacy Program limits,co-payments and reimbursementpolicies apply to the Part Dexcluded prescriptions paid by theMedicaid Program.N/AMEDICARE PART B DRUGSPRESCRIPTION DRUGSMedicare Part D DrugsYou do not need a referral to receive covered services from plan providers. Certain procedures, services and drugsmay need advance approval from your plan. This is called a "prior authorization" or "preauthorization." Pleasecontact your PCP or refer to the Evidence of Coverage (EOC) for services that require a prior authorization from theplan.2021- 11 -Summary of BenefitsH1951033000Covered Medical and Hospital Benefits (cont.)
Depending on the level of Extra Help you receive, you'll pay one of the following cost-share amounts eachtime you fill your drug.Pharmacy optionsPreferred cost-sharingMail order: Humana Pharmacy Retail: To find the preferred cost-share retail pharmacies near you, goto Humana.com/pharmacyfinderStandard cost-sharingMail order: Walmart MailRetail: All other network retail pharmacies30-day supply90-day supplyFor generic drugs (includingbrand drugs treated as generic),either:For all other drugs, either: 0 copay; or 1.30 copay; or 3.70 copay; 0 copay; or 1.30 copay; or 3.70 copay; 0 copay; or 4 copay; or 9.20 copay; 0 copay; or 4 copay; or 9.20 copay;Specialty drugs are limited to a 30 day supply.Cost sharing may change depending on the pharmacy you choose, when you enter another phase of thePart D benefit and if you qualify for "Extra Help." To find out if you qualify for "Extra Help," please contactthe Social Security Office at 1-800-772-1213 Monday — Friday, 7 a.m. — 7 p.m. TTY users should call1-800-325-0778. For more information on the additional pharmacy-specific cost-sharing and the phasesof the benefit, please call us or access our "Evidence of Coverage" online.If you reside in a long-term care facility, you pay the same as at a standard retail pharmacy.You may get drugs from an out-of-network pharmacy but may pay more than you pay at an in-networkpharmacy.Days' Supply AvailableUnless otherwise specified, you can get your Part D drug in the following days' supply amounts: One month supply (up to 30 days)* Two month supply (31-60 days) Three month supply (61-90 days)*Long term care pharmacy (one month supply 31 days)Catastrophic CoverageAfter your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy andthrough mail order) reach 6,550, you pay nothing for all drugs.2021- 12 -Summary of BenefitsH1951033000Deductible This plan does not have a deductible.
WHAT YOU PAY ON THISHUMANA PLANMEDICAID USUAL LIMITS ANDCOPAYSMedicare-covered foot care(podiatry) 0 copayN/AMedicare-covered chiropracticservices 0 copayN/ADurable medical equipment(like wheelchairs or oxygen) 0 copayN/AMedical Supplies 0 copayN/AProsthetics (artificial limbs orbraces) 0 copayN/ADiabetic monitoring supplies 0 copayN/APhysical, occupational andspeech therapy 0 copayN/ACardiac rehabilitation 0 copayN/AMEDICAL EQUIPMENT/SUPPLIESREHABILITATION SERVICESPulmonary rehabilitation 0 copayTELEHEALTH SERVICES (in addition to Original Medicare)N/APrimary care provider (PCP) 0 copayN/ASpecialist 0 copayN/AUrgent care services 0 copayN/ASubstance abuse or behavioralhealth services 0 copayN/AAdditional Medicaid Covered ServicesDual eligible members who meet financial criteria for full Medicaid coverage may also be eligible to receiveall Medicaid services not covered by Medicare. Humana Gold Plus SNP-DE H1951-033 (HMO D-SNP) mayalso offer coverage for these services. The benefits described below are covered by Medicaid. The benefitsdescribed in the Covered Medical and Hospital Benefits section of the Summary of Benefits are covered byMedicare. For each benefit listed below, you can see what the Louisiana Department of Health MedicaidServices Program covers and what our plan covers. What you pay for covered services may depend onyour level of Medicaid eligibility. If you have questions about your Medicaid eligibility and what benefitsyou are entitled to call: 1-888-342-6207 (TTY: 711).2021- 13 -Summary of BenefitsH1951033000Additional Benefits
WHAT YOU PAY ON THISHUMANA PLANMEDICAID STATE PLANDenturesSee "Dental" benefit in the"Covered Medical and HospitalBenefits" chart above 0 copay Medicaid recipients 21 years ofage or older Examinations and X-rays arecovered if in conjunction withthe construction of aMedicaid-authorized denture Covers dentures, denturerelines, and denture repairs All services other than repairrequire prior authorization Limited to one complete orpartial denture per arch in aneight-year periodDental ServicesN/AVarious dental services arecovered for Medicaid recipientsages 0-21 Specific policy guidelines applyEyeglassesSee "Vision" benefit in the"Covered Medical and HospitalBenefits" chart aboveNot CoveredHearing AidsSee "Hearing" benefit in the"Covered Medical and HospitalBenefits" chart aboveNot CoveredPRODUCTS AND DEVICESTRANSPORTATIONNon-Emergency MedicalTransportation ServicesSee "Transportation" benefit in the 0 copay"Covered Medical and Hospital Transportation must be to aBenefits" chart aboveMedicaid covered service Recipients under 17 years oldmust be accompanied by anattendantINPATIENT LONG TERM CARE SERVICESInpatient Hospital, NursingFacility and Intermediate CareFacility Services in Institutionsfor Mental Diseases (IMD), age65 and olderNot covered 0 copay A patient liability is owed ifthere is incomeInpatient Psychiatric Services,under age 21See "Mental Health" benefit in the"Covered Medical and HospitalBenefits" chart above 0 copay2021- 14 -Summary of BenefitsH1951033000BENEFIT
0 copay A patient liability is owed ifthere is incomeNot CoveredNursing Facility Services, otherthan in an Institution for MentalDiseasesSee "Skilled Nursing" benefit in the 0 copay"Covered Medical and Hospital There is a copay for SNF afterBenefits" chart abovethe first 20 days. However, ifeligible for Long Term Care,Medicaid will pay.HOME AND COMMUNITY BASED WAIVER SERVICESDual eligible members, who meet the financial criteria for full Medicaid coverage, may also be eligible toreceive Waiver services. Waiver services are limited to individuals who meet additional waiver eligibilitycriteria (medical necessity). For information on waiver services and eligibility, contact Louisiana Medicaid at1-877-456-1146 (TTY: 711).**Exemptions. The following categories of recipients are not required to pay a copayment orcoinsurance:(a) Individuals under the age of 21 years.(b) Pregnant women – for pregnancy – related services, including services for medical conditions thatmay complicate the pregnancy. This exemption includes the six week period following the end of thepregnancy.(c) Individuals receiving services in an inpatient hospital setting, long-term care facility, or other medicalinstitution if, as a condition of receiving services in the institution, that individual is required to spendall of his or her income for medical care costs with the exception of the minimal amount required forpersonal needs.(d) Individuals who require emergency services after the sudden onset of a medical condition which, ifleft untreated, would place their health in serious jeopardy.(e) Individuals receiving services or supplies related to family planning.The Additional Medicaid Covered Services table above reflects Medicaid services available on a fee forservice basis for dual eligibles who meet the eligibility requirements for full Medicaid benefits.The Medicaid information included in this section is current as of 7/1/2020.ALL MEDICAID COVERED SERVICES ARE SUBJECT TO CHANGE AT ANY TIME. FOR THE MOST CURRENTMEDICAID COVERAGE INFORMATION, PLEASE VISIT THE LOUISIANA MEDICAID WEBSITE AThttp://new.dhh.louisiana.gov/index.cfm/subhome/1 OR CALL THE MEDICAID HOTLINE AT1-888-342-6207 (TTY: 711).2021- 15 -Summary of BenefitsH1951033000Intermediate Care FacilityServices for Individuals withIntellectual Disabilities
H1951033000More benefits with your planEnjoy some of these extra benefits included in your plan.COVID-19 Testing and TreatmentOver-the-Counter (OTC) mail order 0 copay for testing and treatmentservices for COVID-19. 300 every quarter (3 months) forapproved select over-the-counter healthand wellness products from HumanaPharmacy mail delivery.Health Essentials KitKit includes over the counter itemsuseful for preventing the spread ofCOVID-19 and other viruses.Limit one per year.Personal Emergency ResponseSystemThe personal emergency responsesystem provides help in emergencysituations. The medical alert servicecomes with an installed in-homecommunication device and a wearablebutton. You have the choice between apush button unit (with or withoutAutoAlert fall detection) or a wrist unit(without AutoAlert).Healthy Foods Card 75 every month to spend atparticipating retailers toward thepurchase of approved healthy food.Chiropractic servicesRoutine chiropractic: 0 copay per visit for up to 12 visitsSmoking cessation programTo further assist in your effort to quitsmoking or tobacco product use, wecover one additional counseling quitattempt within a 12-month period as aservice with no cost to you. This is inaddition to the two counseling attemptprovided by Medicare and includes up tofour face-to-face visits. This service canbe used for either preventive measuresor for diagnosis with a tobacco relateddisease.Wigs (related to chemotherapytreatment)Up to an unlimited maximum benefit peryear.SilverSneakers fitness programBasic fitness center membershipincluding fitness classes.Routine foot care 0 copay per visit for up to 6 visitsHumana Well Dine Meal ProgramHumana's meal program for membersfollowing an inpatient stay in thehospital or nursing facility.2021- 16 -Summary of Benefits
17Find out moreYou can see our plan's provider and pharmacy directory at our website athumana.com/finder/search or call us at the number listed at the beginning ofthis booklet and we will send you one.You can see our plan's drug guide at our website athumana.com/medicaredruglist or call us at the number listed at the beginningof this booklet and we will send you one.To find out more about the coverage and costs of Original Medicare, look in the current “Medicare & You”handbook. View it online at http://www.medicare.gov or get a copy by calling 1-800-MEDICARE (1-800-633-4227),24 hours a day, seven days a week. TTY users should call 1-877-486-2048.Humana has been approved by the National Committee for Quality Assurance (NCQA) to operate as a SpecialNeeds Plan (SNP) until 12/31/2023 based on a review of Humana's Model of Care.Telehealth services shown are in addition to the Original Medicare covered telehealth. Your cost may be differentfor Original Medicare telehealth.Limitations on telehealth services, also referred to as virtual visits or telemedicine, vary by state. These servicesare not a substitute for emergency care and are not intended to replace your primary care provider or otherproviders in your network. Any descriptions of when to use telehealth services are for informational purposes onlyand should not be construed as medical advice. Please refer to your evidence of coverage for additional detailson what your plan may cover or other rules that may apply.Plans may offer supplemental benefits in addition to Part C benefits and Part D benefits.Humana.com
Important!At Humana, it is important you are treated fairly.Humana Inc. and its subsidiaries do not discriminate or exclude people because of their race, color, nationalorigin, age, disability, sex, sexual orientation, gender, gender identity, ancestry, marital status or religion.Discrimination is against the law. Humana and its subsidiaries comply with applicable Federal Civil Rightslaws. If you believe that you have been discriminated against by Humana or its subsidiaries, there are waysto get help. You may file a complaint, also known as a grievance:Discrimination Grievances, P.O. Box 14618, Lexington, KY 40512-4618.If you need help filing a grievance, call 1-877-320-1235 or if you use a TTY, call 711. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Officefor Civil Rights electronically through their Complaint Portal, available athttps://ocrportal.hhs.gov/ocr/portal/lobby.jsf , or at U.S. Department of Health and Human Services,200 Independence Avenue, SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019,800-537-7697 (TDD). Complaint forms are available at https://www.hhs.gov/ocr/office/file/index.html. California residents: You may also call California Department of Insurance toll-free hotline number:1-800-927-HELP (4357), to file a grievance.Auxiliary aids and services, free of charge, are available to you.1-877-320-1235 (TTY: 711)Humana provides free auxiliary aids and services, such as qualified sign language interpreters, video remoteinterpretation, and written information in other formats to people with disabilities when such auxiliary aidsand services are necessary to ensure an equal opportunity to participate.Language assistance services, free of charge, are available to you.1-877-320-1235 (TTY: 711)GCHJV5REN 0220
Humana Gold Plus SNP-DE H1951-033(HMO D-SNP)H1951033000 ENGNew Orleans AreaHumana.comH1951033000SB21
the health and drug services it covers -in this easy-to-use guide. Humana Gold Plus SNP-DE H1951-033 (HMO D-SNP) is aCoordinated Care plan with aMedicare . Humana.com Find aDoctor from the Search Type drop down select Dental under Coverage Type select All Dental Networks enter zip code from the network
