Advocate Benefits

HumanaHMO provides you with more coverage than traditional medical insurance, including many preventive care benefits to maintain your good health. Most services are covered 100% (in some cases, after a small copayment$20 for office visits with your primary care physician and $30 for office visits with a specialist). There are no deductible amounts to pay or claim forms to file.

The HMO contracts with group practice physicians, hospitals and other health care professionals in your community, including many Advocate providers. To receive benefits under the HMO, you must choose a primary care physician (PCP) from the plan's provider directory. Your PCP will provide or arrange for your health care services. Whenever you need medical services, you must receive care arranged by your PCP.

Not sure if participating in an HMO is right for you? Here are a few questions you may want to ask yourself:

	Do you prefer to pay a set amount when you see your doctor? In the HMO you pay a set copayment for most services, and in either PPO/DRP coverage option you pay a coinsurance fee, which is a percentage of the total cost of the service.
	Do you mind paying a deductible before benefits are paid? In the HMO you do not need to meet a deductible before benefits are paid, but you must meet an annual deductible in either PPO/DRP coverage option before benefits are paid (for services other than preventive care).
	Do you need flexibility in terms of which physicians you can see? In the HMO, you must select a primary care physician (PCP), who then coordinates your care with specialist. Benefits are only payable if you see your primary care physician and other HMO physicians to which your PCP provides a referral. In either PPO/DRP coverage option, you can see any doctor you choose (although benefits are payable at different levels depending on whether the doctor you see participates in your PPO/DRP's network or not). Note: The copayment for a doctor's office visit is $20 when you see your primary care physician and $30 when you see a specialist.

Important! Starting January 1, 2010, eligible associates and spouses (or domestic partners) who are enrolled in the HMO medical option can complete a Succeed questionnaire and then be eligible to earn valuable financial incentives including:

$200 each that will be placed in a tax-free Health Reimbursement Account which they can then use to pay eligible health care expenses, and
Other Healthe Rewards for participating in healthy activities

This is a brief plan description, not the plan document. It doesn't include all of the benefits, limitations and exclusions of the plan. More complete terms of the plan are contained in the certificate of coverage, certificate of insurance or Plan Summary.

For another source of information about HMO coverage, see the HMO highlights. For answers to questions about general plan features or claims, contact the plan administrator, Humanaby phone at (866) 636-2371 (8 a.m. to 6 p.m. ct, Monday - Friday), or online at www.humana.com. See the Benefits Directory for the phone number to call if you are hearing impaired or for Behavioral Health precertification, and for an address for written correspondence.

Services	How Humana HMO Works (effective January 1, 2010)
Hospital and surgery centers
Inpatient care	$100 copayment per day at Advocate Facility $200 copayment per day at Non-Advocate Facility

Outpatient surgery	$100 copayment each visit at Advocate Facility $200 copayment each visit at Non-Advocate Facility

Outpatient non-surgical care	$30 copayment each visit ($40 copayment each visit if seen by a specialist)

Emergency room	$200 copayment each visit—copayment is waived if patient is admitted

Physician
Routine physical exams	$30 copayment each visit ($40 copayment each visit if seen by a specialist)

Well-child care	$30 copayment each visit ($40 copayment each visit if seen by a specialist)

Office visits for treatment of illness or injury	$30 copayment each visit ($40 copayment each visit if seen by a specialist)

Pediatric care	$30 copayment each visit ($40 copayment each visit if seen by a specialist)

Immunizations	$30 copayment each visit ($40 copayment each visit if seen by a specialist)

Diagnostic lab tests and x-rays	$30 copayment each visit ($40 copayment each visit if seen by a specialist)

In-office allergy treatments and materials	$30 copayment each visit ($40 copayment each visit if seen by a specialist)

Casts, splints, crutches, braces and prosthetic devices	$30 copayment each visit ($40 copayment each visit if seen by a specialist)

Hearing and vision screening exams including eye refractions	$30 copayment each visit ($40 copayment each visit if seen by a specialist)

Hearing and vision exams due to illness or injury	$30 copayment each visit ($40 copayment each visit if seen by a specialist)

Outpatient surgery	$100 copayment per procedure (when performance in doctor's office)

Infertility	$30 copayment each visit

Inpatient care	No charge

Other medical services
Chiropractic care	$30 copayment each visit, spinal manipulations as determined to be medically necessary by PCP

Home health care	No charge

Skilled nursing facility	No charge

Durable medical equipment	No charge

Physical, occupational and speech therapy	No charge

Behavioral health care
Care must be PRECERTIFIED	Care must be PRECERTIFIED. Please call 800.454.6455.

Mental and nervous disorders
Inpatient	No charge.

Outpatient	$30 copayment each visit

Alcoholism & chemical dependency
Inpatient	No charge

Outpatient	$20 copayment each visit—up to 20 visits each calendar year

Prescription drugs	Provided through the Advocate Prescription Benefits Program (see Prescription Benefits)

Important! When you have the opportunity to use an Advocate facility, Advocate will waive one-half ofthe inpatient or outpatient surgical copayment you would otherwise pay. This waiver will NOT apply to emergency room copayments, nor will it apply to the charges of non-Advocate facilitieseven if Advocate does not provide the service you need or if an Advocate facility is busy (on by-pass) at the time the service is provided.