Medical
The Florida Aquarium offers three (3) medical plans through Humana. To find participating providers go to www.humana.com and click on “Find a Doctor”, choose the Premier plan type, and click continue. Then, narrow down your search based on location and provider type.
The chart below provides a brief overview of the medical plans. This chart is intended only to highlight the benefits available and should not be relied upon to fully determine your coverage. If the below illustration of benefits conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage.
HMO Premier 2500
HMO Premier 500
PPO 1000
IN-NETWORK:
HMO Premier
HMO Premier
National POS
Plan Year or Calendar Year Basis
Plan Year
Plan Year
Plan Year
Deductible (Individual / Family)
$2,500 / $6,500
$500 / $1,000
$1,000 / $2,000
Coinsurance
100% / 0%
90% / 10%
80% / 20%
Maximum Out-of-Pocket (Individual/Family)
$6,500 / $13,000
$4,000 / $8,000
$5,000 / $10,000
Deductible, Coinsurance & Copayments
Deductible, Coinsurance & Copayments
Maximum Out-of-Pocket Includes
Deductible & Copayments
Lifetime Major Medical Maximum
Unlimited
Unlimited
Unlimited
PREVENTIVE CARE:
Wellness Immunizations Mammography/Colonoscopy Mental/Behavior Health COPAYMENTS: Referral Required
Covered 100%
Covered 100%
Covered 100%
No
No
No
Telemedicine, Office Visits/Consultations for Illness/Injury
$35 copayment
$20 copayment
$35 copayment
Specialist Visits
$60 copayment
$35 copayment
$60 copayment
Deductible, then 10% coinsurance
Deductible, then 20% coinsurance
Inpatient Hospital - Facility Fees
Deductible
Deductible, then 10% coinsurance
Deductible, then 20% coinsurance
Outpatient Surgery - Facility Fees
Deductible
Emergency Room
$250 copayment
$150 copayment
$350 copayment
$35 Copayment
$35 Copayment
$35 Copayment
Urgent Care
OUTPATIENT DIAGNOSTIC SERVICES:
Lab Services (free standing lab)
Covered 100% Covered 100% $300 copayment
Covered 100% Covered 100% $300 copayment
Covered 100% Covered 100% $300 copayment
X-Ray Services (free standing facility)
Complex Diagnostic
PRESCRIPTIONS*:
Retail (30 day supply)
$10 / $30 / $50 / 25% $10 / $30 / $50 / 25% $10 / $45 / $90 / 25%
Mail Order (90 day supply)
2.5x retail
2.5x retail
2.5x retail
OUT-OF-NETWORK: Deductible (Individual / Family)
$3,000 / $6,000
Maximum Out-of-Pocket (Individual/Family)
$15,000 / $30,000
In-Network Only
In-Network Only
Lifetime Major Medical Maximum
Unlimited
Coinsurance
50% / 50%
5
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