Enabling Objective: Define basic Humana terms and acronyms such as Rx3,

Rx4, Rx5, DED and MOP

1. Match the following Humana terms to its corresponding definition.

A. MOP

B. Rx4
C. DED

D. Rx3

E. Rx5

1. A plan design that groups

medications into four tiers based
on cost
2. Maximum out of pocket
3. A plan design that groups
medications into three tiers
based on brand/generic status
4. A plan design that groups
medications into five tiers based
on cost and preferred/nonpreferred status
5. Deductible

Answer: A 2, B 1, C 5, D 3, E 4
Correct: Correct! You know your Humana terms!
Incorrect: Incorrect. You can review these terms in the HCR Appendix on our
teams SharePoint site.

2. Chose the definition of the following term:

Deductible
o The dollar amount Humana pays for a covered drug
o The set dollar amount a member pays for covered drugs before Humana
starts paying for them
o The percentage of the total cost of a covered drug a member pays
o The most a member will pay in one year
Answer: The set dollar amount a member pays for covered drugs before
Humana starts paying for them.
Correct: Correct, members must pay their deductible in full each year before
Humana will start paying towards covered drugs.
Incorrect: Incorrect. A deductible is the set dollar amount a member must pay
each year before Humana will start paying towards covered drugs.

3. Chose the best definition for the following term:

High Deductible Health Plan
a. A savings account where a member can set aside tax-free money for
use on covered health expenses
b. A plan where members enjoy a limited network and lower premiums
c. A plan where members enjoy lower premiums, but higher deductible
amounts than a traditional copay plan
d. A plan where members are charged a flat amount for services, allowing
them to plan ahead
Answer: A plan where members enjoy lower premiums, but higher deductible
amounts than a traditional copay plan
Correct: Correct, because members are paying more out of pocket for the
higher deductible, they enjoy lower monthly premiums.
Incorrect: Incorrect. A high deductible health plan is a plan with a higher
deductible amount than a traditional copay plan. Because members are
paying more out of pocket up front for the deductible, they enjoy lower
monthly premiums.

Enabling Objective: Explain the difference between each of the copay

plans (Rx3, Rx4, and Rx5)

4. Which of the following Humana pharmacy plan types are copay plans? (Pick
all that apply.)
o HDHP
o Catastrophic
o Rx3
o Rx4
o Rx5
Answer: Rx3, Rx4, Rx5
Correct: Correct! Rx3s, Rx4s and Rx5s are Humanas copay plans. Members
pay a set amount for covered pharmacy drugs that are grouped into different
tier levels.
Incorrect: Incorrect. Rx3s, Rx4s and Rx5s are Humanas copay plans.
Members pay a set amount for covered pharmacy drugs that are grouped into
different tier levels. For HDHPs and Catastrophic plans, members pay 100% of
covered pharmacy drugs until their deductible is met, then, they pay a fixed
percentage of the total cost of the drugs.

Enabling Objective: Describe clearly how a plan with a pharmacy

deductible functions differently than a plan without a deductible

5. Match the description of a processed pharmacy claim (1 5) with the phase

provided (A E). Assume this is an Rx4 with a pharmacy deductible.
A.
B.
C.
D.
E.

Deductible Phase
Split Claim Deduct
Deductible Met
Split Claim Maximum Out of Pocket
Maximum Out of Pocket Met

1. Member pays 100% of the cost of the covered pharmacy claim

2. Plan pays 100% of the cost of the covered pharmacy claim
3. The member pays the remaining deductible amount, plus their copay for
the covered pharmacy claim (The total cost of the claim is greater than
the remaining deductible amount)
4. The member pays the remaining maximum out of pocket amount for the
covered pharmacy claim (The copay amount is greater than the remaining
maximum out of pocket amount)
5. The member pays their copay only for the covered pharmacy claim
Answer: A 1, B 3, C 5, D 4, E 2
Correct: Correct! Did you know, if a drug is very expensive, the member could
meet their deductible with one claim?
Incorrect: Incorrect. You can review the presentation to help clarify the phases
of a copay plan with a deductible.