Humana Unveils New PPO Plans for Small Business


    Humana Inc. has announced a new line of PPO health insurance plans created especially for small businesses in Michigan.

    Michigan businesses with as few as two and as many as 99 employees qualify for the new plans, which are available in most areas of the state. Humana’s Small Group Division markets and administers the HumanaPPO 2001 plans under the name Employers Health Insurance Company.

    Humana says it has designed the plans, collectively called HumanaPPO 2001, to be cost-effective and easy for small employers to use.

    The firm says the plans allow employees to make their own health care decisions, and to seek care from doctors they prefer.

    Plan features include a four-tier pharmacy benefit and preventative care coverage. Copayment and coinsurance levels reward members for selecting care within a network of preferred providers, but recipients may visit any provider they choose.

    Humana says its PPO is a network offering of doctors, hospitals and other providers through which customers can obtain negotiated network discounts. Fewer plan variations further reduce administrative costs.

    “We’ve listened to the small business community,” said John Crusse, sales director for Humana in Michigan. “Business owners have told us the rising cost of health insurance is a major concern. With these plans, we’ve designed a solution that’s affordably priced and yet preserves choice for plan members.”

    Humana says that its pharmacy benefit is simple and predictable, with four tiers or categories allowing consumers to choose between generic or brand name drugs. The consumer’s financial responsibility varies by tier.

    With Rx-4, 99 percent of all prescriptions written for Humana members are covered without prior authorization. Consumers pay only a copayment for drugs in the first three tiers and a percentage of the cost for drugs in the fourth tier, which includes gene therapy drugs and some self-injected drugs that require careful monitoring by a physician.

    For example, consumers might pay a $5 copayment for drugs in the first tier, $15 for second tier drugs and $35 for third tier drugs. For fourth-tier drugs, consumers pay 25 percent of the cost up to an annual maximum of $2,500 out-of-pocket. Rx-4 also offers several other options with varying co-payment levels.

    Humana says the plans also enable consumers to check claims, review benefits and locate doctors online at

    Humana says it offers access to a number of programs that promote healthy living or help members cope with chronic disease. Two such plans are HumanaBeginnings for expectant mothers and the HumanaHealth Ready to Quit smoking cessation program.

    HumanaPPO 2001 plans include coverage of a wide range of preventative procedures such as immunizations, mammographies and pap smears. They also offer access to Humana’s National Transplant Network.

    Humana Inc., headquartered in Louisville, Ky., is one of the nation’s largest publicly traded health services companies, with approximately 5.3 million medical members located primarily in 15 states and Puerto Rico.

    Humana offers coordinated health benefits coverage through a variety of plans — health maintenance organizations, preferred provider organizations and administrative service products — to employer groups and government-sponsored plans.

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