may need advance approval from your plan. This is called a"prior authorization" or "preauthorization." Please 
contact your PCP or refer to the Evidence of Coverage (EOC) for services that require aprior authorization from the 
plan .
c
8 Summary of Benefits H5619075000SB23 H5619075000 
Covered Medical and Hospital Benefits  (cont.) 
N/A WHAT YOU PAY ON THIS HUMANA PLAN 
•Medical nutrition therapy services 
•Obesity screening and counseling 
•Prostate cancer screenings (PSA)