Prescription Drug Plans
Medicare Part D
Benefit Summary for 2007 Benefits

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(972) 355-8132

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Walmart $4 drug list

Humana - Guidance when you need it most.
Plan Name Monthly Premium Rx Coverage

(Retail pharmacy amounts up to 30-day supply)
Save with Mail-Order
Humana PDP Standard S5884-080 $12.70
Rx Costs
Stage 1
$0-$265
Stage 2
$266-$2400
Stage 3
Over $2400
Stage 4
Over $3850
Rx Type You Pay You Pay You Pay You Pay *
Generic 100% 25% 100% 5%
Preferred Brand 100% 25% 100% 5%
Non-preferred Brand 100% 25% 100% 5%
Specialty 100% 25% 100% 5%
Humana PDP Enhanced S5884-020 $19.80
Rx Costs
Stage 1
$0-$265
Stage 2
$266-$2400
Stage 3
Over $2400
Stage 4
Over $3850
Rx Type You Pay You Pay You Pay You Pay *
Generic $5 $5 100% 5%
Preferred Brand $30 $30 100% 5%
Non-preferred Brand $60 $60 100% 5%
Specialty 25% 25% 100% 5%
Humana PDP Complete S5884-050 $76.60
Rx Costs
Stage 1
$0-$265
Stage 2
$266-$2400
Stage 3
Over $2400
Stage 4
Over $3850
Rx Type You Pay You Pay You Pay You Pay *
Generic $5 $5 $5 5%
Preferred Brand $30 $30 100% 5%
Non-preferred Brand $60 $60 100% 5%
Specialty 25% 25% 100% 5%

Humana Formulary

*For this threshold, there is a variable payment. This payment is as follows: For Generic drugs, the payment is $2 or 5%, whichever is greater. For Preferred Brand, Non-Preferred Brand and Specialty Rx drugs, the payment is $5 or 5%, whichever is greater. This information is to be used as a brief summary, refer to policy for complete information on benefits, exclusions and limitations.

Plan Name Monthly Premium Rx Coverage

(Retail pharmacy amounts up to 30-day supply)
Save with Mail-Order
UniCare Rewards Value $27.80
Rx Costs
Stage 1
$0-$265
Stage 2
$266-$2400
Stage 3
Over $2400
Stage 4
Over $3850
Rx Type You Pay You Pay You Pay You Pay **
Generic 100% $5 100% $2.15 to 5%
Preferred Brand 100% $29 100% $2.15 to 5%
Non-Specialty Injectible 100% 25% 100% $2.15 to 5%
Specialty Injectable 100% 25% 100% $2.15 to 5%
UniCare Rewards Plus $30.50
Rx Costs
Stage 1
$0-$250
Stage 2
$266-$2400
Stage 3
Over $2400
Stage 4
Over $3850
Rx Type You Pay You Pay You Pay You Pay **
Generic $10 $10 100% $2.15 to 5%
Preferred Brand $30 $30 100% $2.15 to 5%
Non-Specialty Injectible 30% 30% 100% $2.15 to 5%
Injectable drugs 30% 30% 100% $2.15 to 5%
UniCare Rewards Premier $44.50
Rx Costs
Stage 1
$0-$250
Stage 2
$266-$2400
Stage 3
Over $2400
Stage 4
Over $3850
Rx Type You Pay You Pay You Pay You Pay **
Generic $10 $10 $10 $2.15 to 5%
Preferred Brand $30 $30 100% $2.15 to 5%
Non-Preferred Brand $60 $60 100% $2.15 to 5%
Injectable drugs 30% 30% 100% $2.15 to 5%

** Greater of $2.15 for Generic (including brand drugs with and available generic) and $5.35 for all other drugs, or 5%
Call or request plan Summary of Benefits to see full description of benefits as well as Mail-Order drugs.

This information is to be used as a brief summary, refer to policy for complete information on benefits, exclusions and limitations.

UniCare Formulary

Example if you choose to wait 5 years to enroll in Part D:

At 1 percent per month penalty for 5 years (60 months = 60% penalty). If the Part D average premium is $27.00, add the $16.20 penalty. If you choose a plan which costs $20 add the $16.20 and your plan choice, but your plan now costs $36.20 (81% higher, due to the penalty). This penalty stays with you forever - so there is an incentive to enroll once eligible.