Know every plan in your county before your client asks.¹

CMS field

pbp_b7a_copay_amt_mc_min

Plan / year

H1036-269-000 · 2027

Document

Page 4

Primary Care Provider (PCP) • PCP's office: $0 copay • Telehealth: $0 copay Specialist • Specialist's office: $15 copay • Telehealth: $15 copay Your primary care provider (PCP) will work with you to coordinate the care you need with specialists or certain other providers in the network. This is called a "referral." This plan requires prior authorization for certain items and services. The following link will take you to a list of items and services that may be subject to prior authorization: Humana.com/PAL . 4 Summary of Benefits H1036269000SB27

CMS field

pbp_b7a_copay_amt_mc_max

Plan / year

H1036-269-000 · 2027

Document

Page 4

Primary Care Provider (PCP) • PCP's office: $0 copay • Telehealth: $0 copay Specialist • Specialist's office: $15 copay • Telehealth: $15 copay Your primary care provider (PCP) will work with you to coordinate the care you need with specialists or certain other providers in the network. This is called a "referral." This plan requires prior authorization for certain items and services. The following link will take you to a list of items and services that may be subject to prior authorization: Humana.com/PAL . 4 Summary of Benefits H1036269000SB27