$0-$250
Humana pays zero$250-$2,250
Humana pays rest
Helen Pays
$45 x 10
Sub-Total
Cost of Drugs for $2,250 limit
Over $3,600
Humana pays 95%
Helen Pays
Insurance
Premium
Total Helen
Pays
Total Humana
Pays
Total Paid
1
$250
$0
$250
$250
$22
$272
$0
$272
1
$750
$500
$250
$750
$250
$500
$750
2
$1,000
$550
$450
$1,000
$22
$472
$550
$1,022
3
$500
$50
$450
$500
$22
$472
$50
$522
3
$500
$500
`
$500
$0
$500
4
$1,000
$1,000
$22
$1,022
$0
$1,022
5
$1,000
$1,000
$22
$1,022
$0
$1,022
6
$1,000
$950
$50
$22
$22
$950
$972
$4,035
7
$1,000
$950
$50
$22
$22
$950
$972
8
$400
$380
$20
$22
$22
$380
$402
8
$600
$570
$30
$30
$570
$600
9
$1,000
$950
$50
$22
$72
$950
$1,022
10
$1,000
$950
$50
$22
$72
$950
$1,022
11
$1,000
$950
$50
$22
$72
$950
$1,022
12
$1,000
$950
$50
$22
$72
$950
$1,022
Total
$12,000
$1,100
$3,900
$2,250
$6,650
$350
$270
$4,400
$7,750
$12,150
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