Understanding Benefits & Costs

Virgin Life Care HealthMiles PlusVirgin Life Care HealthMiles Plus

Get a quote

The HEALTHMILES PLUS program is currently available to Arizona, Florida, and Texas residents only. The program is coming soon to California.

Read your state’s Benefit Summary for details on your health care package.

Helpful Links
Physician Finder
Prescription Finder
Pharmacy Finder

Understanding Benefits and Costs

Your health care costs are influenced by a variety of factors. The better you understand the following factors, the more you can balance benefits and costs within your chosen package:

How the Elements Work Together

Factors to Consider

Use the following information to help you decide which HEALTHMILES PLUS health care package is right for you:

Factor

Did you know?

Costs/savings

Humana's Provider Network

You can check online to see which doctors, hospitals, and specialists are in the Humana network.

Staying in-network and using generic drugs means lower out-of-pocket(OOP) costs for you.

Deductible

Deductibles are available in three different individual packages : low, medium and high, and vary if you seek services out of network.

The package and deductible you choose will not only affect your monthly premiums but how much you will ultimately pay in OOP costs as well.

Health Savings Account (HSA)

If you choose the HEALTHMILES PLUS High Deductible Package, you can save money by opening an HSA at a qualifying bank.

With the High Deductible Package and an HSA you could save 20-25 percent on your monthly premiums, and you'll be able to set aside money tax-free to cover future medical expenses.

Co-insurance

Think about how much you want to pay in OOP costs once you've satisfied your deductible.

An 80/60 package (one that covers 80 percent of covered expenses in-network and 60 percent out-of-network) may have a lower monthly premium than a 100/70 package, but your OOP costs could end up being higher.

Copayment

The copayment option (applicable only to the Low and Medium deductible packages) enables you to see a doctor in your network for a flat rate.

There are limitations to this option. To begin with, doctor visits per family member per year may be limited*, and they apply only to treatment for illness or injury, not preventive care. Furthermore, co-payments don't apply to your deductible or out-of-pocket maximum.

Prescription Benefits

With all HEALTHMILES PLUS packages, you can save money by choosing lower-cost drugs when they're available and appropriate for you. If your doctor prescribes an expensive brand-name medication, ask about generic equivalents, therapeutic alternatives, and even over-the-counter options.

For HEALTHMILES PLUS Low and Medium Packages, you get an allowance of either $30/20/10/0 toward your prescription with a maximum of $100 per prescription; and a $2,500 annual OOP to member.

For the HEALTHMILES PLUS High Deductible Health Package, the prescription benefit** deductible and OOP maximum are integrated with the medical benefits. The insurance plan pays 100 percent of prescription cost if purchased from an in-network pharmacy.

*See your state-specific Summary of Benefits for additional information on copayment benefit.
**Limitations and exclusions apply. See your state-specific Summary of Benefits for details.

How the Elements Work Together

If a service requires a co-payment and a deductible, the copayment applies first, then your deductible, then coinsurance. For example, suppose you have $3,200 worth of doctor's office and outpatient surgery visits during the package year. You have a $1,000 deductible and then your package pays 80 percent. Here's how it breaks down:

Network provider charges $3,200
PPO discount (-$800)
Balance $2,400
You pay your annual deductible (-$1,000)
Balance $1,400
HEALTHMILES PLUS pays 80 percent (-$1,120)
Your coinsurance balance $280
Your total cost $1,280

In this example, your estimated cost is the $1,000 annual deductible plus your $280 coinsurance, for a total of $1,280.

back to top