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Humana Health Care Plans with Prescription Drug Coverage

Beginning Jan. 1, 2021, MSU will be partnering with Humana Insurance Company to provide a new retiree health care plan with prescription drug coverage. With the rising cost of health care and prescription drug coverage, it is imperative the University continues to explore strategic initiatives to provide MSU retirees with high-quality benefits at an affordable cost. After careful analysis with our health care consultants, MSU has decided to make this change from providing plans through Blue Cross Blue Shield of Michigan to Humana, a company with over 30 years of experience in health care, prescription and Medicare coverage.

Who is eligible

There will be Humana plans available to the following populations:

  • MSU retirees eligible for Medicare (age 65+)
  • MSU retirees not yet eligible for Medicare (age 64 and under)
  • MSU retiree dependents eligible for Medicare
  • MSU retiree dependents not yet eligible for Medicare
  • MSU employees not actively working due to workers compensation, long-term disability, or other reasons that are eligible for Medicare, and their associated dependents
  • MSU active employees with End Stage Renal Disease (ESRD) who have been enrolled in Medicare for longer than 30 months

The Humana Medicare Employer PPO Plan

The Humana Medicare Employer PPO Plan contains medical and prescription drug coverage. This plan will replace MSU’s Blue Cross Blue Shield of Michigan supplemental Medicare plans and CVS/Caremark prescription plan currently in place.

The plan covers all preventive services at 100 percent. Selected services are covered at 96%-100% after the required annual deductible of $192 per member; however, not all services are subject to the deductible. Participants should refer to the type of service for benefit details. The annual out-of-pocket maximum is $1,200 per member per calendar year (excludes Part D Pharmacy, Extra Services and the Plan Premium).

Prescription drug coverage is included in this plan. The table below shows co-pay rates for various types of prescription drugs:

Prescription Plan Co-Pays for Humana Medicare Employer PPO Plan
# Drug Tier 30-Day Supply Co-Pays at Retail 90-Day Supply Co-Pays at Retail 90-Day Supply at Mail Order or MSU Pharmacy
1. Generic Medications $10 $20 $20*
2. Preferred Brand Name Medications $30 $60 $60
3. Non-Preferred Brand Name Medications $60 $120 $120
4. Specialty Drugs $75 N/A N/A**
Annual Out-of-Pocket Co-Pay Maximum
Individual: $1000    


*Some generics may be on higher tiers.

**Specialty medications limited to 30-day supply.

  • If you or your dependents are eligible for Medicare and currently enrolled in an MSU plan, you will be automatically enrolled in the Humana Medicare Employer PPO Plan and will have the option to opt-out during Open Enrollment.
  • If you or your dependents are eligible for Medicare but not currently enrolled in an MSU Medicare supplemental plan, you will have the option to enroll in the new Humana Medicare Employer PPO Plan during Open Enrollment.
  • If enrolled, you can choose any provider who accepts Medicare and agrees to bill the plan, but you may save money by using providers from Humana’s large provider network.
  • You are not required to have a referral to see any provider.
  • You have access to wellness tools and resources to help you reach your personal health goals.

The Humana Non-Medicare Employer PPO Plan

The Humana Non-Medicare Employer PPO Plan contains medical and prescription drug coverage that is comparable to MSU’s Blue Cross Blue Shield of Michigan Non-Medicare plans and CVS/Caremark prescription plan currently in place.

The plan covers in-network preventive services at 100 percent. The majority of the in-network diagnostic services are covered at 100% of the approved amount after either the required copayment or annual deductible of $100 for single and $200 for family. Selected in-network services are covered at 50%-90% of the approved amount after the required in-network annual deductible of $100 for single and $200 for family; however, not all services are subject to the deductible. Participants should refer to the type of service for benefit details. The annual out-of-pocket maximum, which consists of applicable deductible and coinsurance, is $3000 for single and $6000 for family per calendar year.

The plan also covers out-of-network services. The majority of out-of-network preventive and diagnostic services are covered at 80% of the approved amount after the required out-of-network annual deductible of $500 for single and $1000 for family. Selected out-of-network services are covered at 50% of the approved amount after the required out-of-network annual deductible. Participants should refer to the type of service for benefit details. Participants may be responsible for the amount that exceeds the approved amount in addition to their deductible or coinsurance. The annual out-of-network out-of-pocket maximum, which consists of applicable coinsurance only, is $3000 for single and $6000 for family per calendar year.

  • If you or your dependents are not eligible for Medicare and are currently enrolled in an MSU plan, you will be automatically enrolled in the Humana Non-Medicare Employer PPO Plan and will have the option to opt out.
  • If you or your dependents are not eligible for Medicare and are not currently enrolled in an MSU plan, you will have the option to enroll in the new Humana Non-Medicare Employer PPO Plan. You will have access to Humana’s large network of physicians.
  • You are not required to have a referral to see any provider.

Prescription drug coverage is included in this plan. The table below shows co-pay rates for various types of prescription drugs:

Prescription Plan Co-Pays for Humana Non-Medicare Employer PPO Plan
# Drug Tier 30-Day Supply Co-Pays at Retail 90-Day Supply Co-Pays at Retail 90-Day Supply at Mail Order or MSU Pharmacy
1. Generic Medications $10 $30 $20
2. Preferred Brand Name Medications $30 $90 $60
3. Non-Preferred Brand Name Medications $60 $180 $120
4. Specialty Drugs $75 N/A* N/A*
Annual Out-of-Pocket Co-Pay Maximum
Individual: $1000 Family: $2000  


*Specialty medications limited to 30-day supply.

Additional Information and Resources

Enrollment Materials

MSU HR will be sending further details about these plans in September as part of our October Open Enrollment materials. In addition, eligible participants will receive an Enrollment Kit from Humana with further details and instructions.

Frequently Asked Questions

View a list of frequently asked questions here.

Informational Seminars

MSU and Humana will be hosting informational seminars early in the fall to provide more information about benefits of the plans and to answer questions. MSU is working closely with Humana on various seminar options, keeping in mind both state and organization social distancing guidelines due to COVID-19. Watch for seminar dates and options very soon.

Contact

Direct contact information for Humana will be available in September. In the meantime, contact the HR Solutions Center with general questions at 517-353-4434 or SolutionsCenter@hr.msu.edu.

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