health services $0 copay Not Covered H5216107000SB23 Summary of Benefits 17 H5216107000 
More benefits with  your plan 
Enjoy some of these extra benefits included in your plan . 
This is asummary of what we cover. It doesn't list every service that we cover or list 
every limitation or exclusion. The Evidence of Coverage (EOC) provides acomplete list of 
coverage and services. Visit  Humana.com/medicare to view acopy of the EOC or call  
1-800-833-2364 .
Travel Coverage