N/A WHAT YOU PAY ON THIS HUMANA PLAN 
AMBULANCE 
Ambulance $0 copay 
TRANSPORTATION 
N/A $0 copay for plan approved location up to 24 one-way trip(s) per year. 
This benefit is not to exceed 50 miles per trip. 
The member  must  contact transportation vendor to arrange 
transportation and should contact Customer Care to be directed to 
their plan's specific transportation provider. 
MEDICARE PART BDRUGS 
Chemotherapy drugs $0 copay 
Other Part Bdrugs $0 copay 
Prescription Drug Benefits 
PRESCRIPTION DRUGS