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HomeMy WebLinkAbout1992-05-27 92-279 ORDERDate WV5'27'92V Item No. 92 27 ameE, ueaignatfng b p losvlth mauran^e C� for Item/Subject: Retirees O Age 65 in tlas City of Barg Arxatnt Responsible Department: Hwcaati Commentary: Chmxies in ysderal lca ruga s[aMardiaattm of agplmental IAeditaxe it vearce plane fo� xetircpa over age 65. gbe Bx acxa includity sty, lbpeUal Atrttarity and Llbr retirees o£fece Ca¢union Plan I with Blue Alliaext Major Medical. effective . y 1, 1992, This cvvsre9s-will not ba available ad a selst3en must be vele aimng ] options that veet tatexeguixa- ma¢s. 1ha eptiwls and the essociatal henefit level asd cost ivpa ate detailed in the ati lad seen label May 19, 1992. A principal issue in this decision is Mtetlmr retirees we 65 (cuav2ly 131) sfrnald be retaueerl as pvxt of the BaeaJe¢ accwn[, xesultinnI in mod ately hfghct: pxmdtss fox evmry xne, ox ae}x2'atsl fxva tde amrnmt, rosulting in to a pxa mums for the sewae I greuP participants. 9ts Riranre C tree diacuseei this issue at lemg at ttel. neetimi on May 18th arcl m ucetei fur discussion at a budge; w Iurlop echetluled for Svesdey, May 26th. Barbara Rice of the Library atd Elsie Coffey of the Horsing AutFnrity axe eNwxe of this issue and have been invitei to attxexd aM participate. y 1 - `�, �Depmnrnrxead�ryl� Manager's Comments: pb tm-U. [LWUAxOf1 B -R ituuAAA.(fi. ✓hUa�'6v i 11aD9Pew�JoA �^& City.Nvmgn Associated IMonnadon: - lNler, with Aeeociated Inf®atian Walter: Approval: Fdunee Diree,d Legal Approval blk dm COY SW ckw Inst--tm{{{duced For Passage `First Reading No—of — ❑Referral 5sslr,e1 to Councuor Bragg May 27,1992 92-279 s _ CITY OF BANGOR (TITLE.) (JOnNV£-_.__..._...........Y cjnati ..Group. stealth.insucaace. Covemge _. for Pefiieea Pier Age 65 sn the City of Bangor PcmuR By W City fbum l of aty Of Ba :' ORDER®. TEAT in acmrdarce With Federal leglsletion ralufr++5 the atmaia Zation of suppl� medicare t th inaurame covecagez the Bangor City Cwuvtl hereby salxts the £ollwheg zy health izrei¢m plan to corer thoee employees over age 65 in the City of Bangor account: 92-279 ORDER p: ` :.:Title. egna. IN CITY COUNCIL May 27, 1992 D ik tin& Group Health Insurance 11� . \ p Coverage forRetirees Over Ag 65 in the ..aU" .Afey �o _¢ �E IM, CITE COUNCIL [v Assgued Sud¢ 3, 1992 Inserting I in apace provided pass an11ed Co p by the yes ..... ... orsfollowing and no Cohen. Councilors voting yes: wlc ilaav voting Bragg, Cohen. Soucy and Shona. Councilors Coding no: BaldacciCouncilor Blanchette, Frankel. and Sail. Councilor absent: Sawyer. Motion to carve felled to page by the following yea and n votes. Coutou colons yes: keland and Blanchette, FraSoucy orscouncilors Seal. Saul. g no: Bra Saucy end Stone. no: voting n absent: Sawyer. consid rateq CouAmended Reconsideration of insertion of Group I Passedvotes.. I Amended by intention :f Croup I Passed by the by yes and voter. Councilors voting yes: Blanchette, Bragg, Cohen, a oh n, Franke Soucy and Stone. Councilor voting v Baldache and Sail. Councilor for Abse Councilors Order Passed As Amended by the yea and no votes. Councilors kel¢fl. Blanchette. Bragg, Cohen, Frankel. Saucy and Stone. e, Bragg, yrs: Baldting Cozen i^^tv��Cing no: B xl. councilor absent: Sawyer. Couingncilor no: y i L 92 279 3,I 5b: Finance C ttae Members -Fri: Fnbart W. Farrar, Dir Yon of ern,:..:mention Re: Health Insurance Benefit levels arca B3te.5 - Bangor Atv-rmt Fetireea O ar sge 65 Date: May 14, 1992 intn2duction Vara has b0ea zecent Federal legislation c=emtng the stamdaxdfzation of health irauraoe coverage (�are Msdigap) that is goixy to have an imuedisre aaddreaeUC iapact m the benafdt levels and � costs for retirees over age 65 under the City of Bangor G; Health Plan. Inchon in this yrngi are City, Public Librery, ead abusing Autharity retfraes. 'Brae xetireee in tla M Cpion are excluded fxm: this issue. Bangor was ratified of this pending change recently vrhen we r Leaved our proposed health inmueaca rates for PY 1992-93. (:ran rte a Wdficmice of this issue aW the i Iicatios for the aty, ire earreat aplaFa g a,d retirees, I will attempt to ratline the major points ttat read w be considered w the parties immlvad rove toward a necIsla5. Please be advised that musx this i gislatlmz, health ineurems plans vast erre i cmpli July 1, 1992 or when t gimp health insurance plan C,eas dua for renewal, whichever comes first. in Bmgor's case, this le July 1, 1992. Background As a benefit upon ratfrerent, forret eia,Fees may slat to xe"a;" in the aty's grmp health insurance plan. pergreas under the Bangor account are PrxsamtlY mvered.urmtler a g Blue Cross-Blua 9 ld plan loam as coqvLLrn Plan I wiu Blue Alliance Major Medical. nmay are resp risible for paying the full praairy enumt, either through a de uctlon in t Sr M State Fe.� rmnthly check or df insufficient funds e r rtumgh a direct palaent t gh the City Tri pt.m Shield. a gently, sroe 212 retiraes partic4Ate, 81 t= age 65, 3 age 65. 93a change that must occur m or abort July 1 is frOe t e t o0av ,ar Plan I and. Major y4dical for retirees war age 65 to one of sever optioe. As our provider, Blue Cross -Blue Shield has radia wallable these seven optica which Imbat the new Federal staciardizel .a.,.�...= for health imvnnce mveraga careening those o x age 65. here aro air raw CMPm Plan gltiorm Al B, C, E, F, I and One C¢� id� as CaVe-Qat cvxrage. Me Chart below illustrates arse options and The associated costs. gff-�, Cwpaniw Plea I wtth Blue Alliarsa Major Ma ical Btlivithml 2 -Parson 7/91 - 6/92 $ 70.53 $156.35 7/92 - 6/93* $ 83.28 $185.43 *Estimated o y - c0a a r Plan I with Major Dktlir.r no linger available A $ 39.23 $ 78.46 B $ 53.69 $ 87.30 C $ 64.35 $128.70 E $65.58 $131.16 F $ 78.94 $157.88 I - $115.92 $231.84 $ 97.05 $212.97 92 279 O the six new C®ianion Plane, pptiq g A, B, C, B, F, I, Q> m I most closely maeffilea the t,gent hKiget Setel enjoyed by mtdrepa. tvaever, this oarerage 3s not irisntical ZUNI theme is Sae dcczasse in benefits, if arty of these six optima axe sedated, the expsrieoe (utilization rate) of the +65 group wind not be factoxel Lrco the Bangor amxnmt. PmsetlY, their s:,+/i a 1A Lrluded in our xcoimt. As will ba discassel later, this is a part of the overall decinlam making prxees. when consia'er all wren optinw, the Caxve-put option'tast olcsay mat the existing level of benefits. Hoerer, I the Carve- ut option, the experiece (utflizetion rata) of the +65 gxoup is factored into the overall City gxoup rating. Tia result is that the wM account, in fact, a,beidiaea the +65 GXtW. slue Omss-O ua Shield has ralm,late3 tbet tda =c , wind same some $73,000 in peeenia cost for F792-93 ff the +65 group xexe aepsrate,, frena the meet of the account. 1 ,.� mases, the dart belw swnarfres the 1992-93 Proposed rata for laeseot eeployee with eni without the +65 9rm+P. IbMhly Health mesa.ee Pmapfuets 1991-92 lPcesaRl whitl1 Lwithout �5 Croup) hxiividnal C� $147 $144 Fa y Couarage $364 $375 $356 The chart illustrates that inst ad of a 38 ircmase in rates (with L*e +65 group it 'l ) the tenger eCCGmt wind ac y en]oy a 2% dsxaeee in mtes without the age 65 gawp, ar on Ore diffexerce of 58 ($73,000 est;.,we,v savings).. pl.$aus As we begin to analyse the jwpeot of tee cptioee, the axe other variables that nest la cweitlzretl es is a swsaxy of variables and issues that need to be revtc ti regarding tte cpcxws. 1. Ceve-0ut Cat¢age Optima. As stated pxeviousiy. the Carve-0ut cm's a optima Pmovirles the highest ard met level of •bnoeffts w Copemed to the existing cot¢ags. ibavar, it is significantly wm axp naive for tla retiree than Ua current Pdan, ar if selected, ths 3 92 279 retixea utilization rate .raid continue be negatively inpsct the in a of tho gzOup. Btnuld the City select this option, it may at a later date, switch to one of the follawin2 Cakn Plan options; AB C, E, F. Cr, the egAcypa may select Cmpntinn Plan option A, B, C, , , E, P or I at a later date, but mould then ba in a non -group plan ani would be subject to Pnoentieiiy higher' rates. Further, the "I" option could only be selectai by an rookies during the next ysar. 2. CMDOniPlan . Ibe City ney select any of the new Crngmdon Plan optfone identified es A, B, C, E, F, I. The °I- option ie only available now as a City iFnop plan. If "I" is not selected by the City nO as the group plan, it cannot be selected at any time in the future as a group pian. An indtvidml rails¢, buena., say elect at a latex date W upgrade hen a lout plan (A, B, Cr a or F) to tyle •I" covetage, but only ! a nun -group setting, eM only for the next year. There is an Opportunity none Per year fox. the City to elect to upgrade or dmveRteda coverage by One step within the A, B, C, Er F range. Idditionally, the ® IOYse may elect to upgefe or dvwngnade WVarage ly one step W Ut the A, Br C, E, F, I ange. Again, if the totixeee, eelection does not coxxespnd with the city's group selection, then the mr:.,n cold be pieced in a no nyscvp category. IYe benefit to salecting any of the Coopanon Plan options, A, Br C, E, Fr I is that the negative expos due to pour expxiesce by the retirees, is eliminft d. mor becaase the +65 getup would be ental aepsrat 1yy Eton the Bangor account. For illustrative pyrEoses, with the +65 group included in the Bangor account, the lajor Maitcel partion of our health insurance pre iuume rose 23.58 fxmn 1991-92 to 1992-93. Backing not this 9r , which would lapnun under ell of the six oec Corp kon plan optione, the Malo. M el pxtime decreased 5.16 or a total awing of 28.66. Ibe dxadacl¢ to this appx is that, in all nilaal .w, the pxeoiwrs wlll be higher for the matinees and the benefit levels offenal in all option A -I axe lo,.ar than what is being cusantyy prrnid . Ca%mala these. issues is the fact that a &cisio n met be ride in a y short timefmmma. Although July 1 is the effective coon ion date, B W met hove a decision by aiproxientely Tore 1 es the mmrUdy deductions Eon health insurance pre em must be proressed by w:.,e Stat �^^ during the smovtl v�k in Ture Eon the vmrth of July. Further, _ samoeenx gh ea have a master i t of tine 131 xecixeover 65, vs love id ei e to oa�edcata with ttm he ei.e group, otherr than through im3i+dAna1 letters. Cur intent is to provide this infomation to yon in order that F.inante Fmmi eenoers etl the City Cmacil can begin to sigh the benefits and limitetias of the available optima wtlin ed above. ore of the key VAicy Is involved is wdethm or not the city aril anent employees stmuid, in fact, subsidize retired MVnYe6S wen age 65 who now utilize b alth ins 000ne benefits at a higter rate seri MMe create a greater cost to the entire ace nt. -4 92 ,'. 179 If the ansos:r to that question is ys, thm oansi ation shwltl be gtven to the IE the to that question is than' consideration stnihi W sei should be given to seedas^; eigocu CPl{iniow Pian "£" or •I°" nn agha xcnallixrg that if "I•• is mt selected as the g plan it cannot to Plan ata later date. xaarrendatinn an t by W//B is that the City lon --I-.ai tY give sttorg ooruidnvation to Crnganion Plan "I". City staff a . p�tives f an, Cmss/Blve Shield mill he available to fully tlfsc s this issue on today night. Also, I Lave invited M. Partes nice, Bangor nuhiic Librarian, ani Ma. Elsie Coffey, Bangor Noosing Authority oitsmr, to att l tMd P�ipate as they a in Uu _++ct City of Bogor eccmmt. M t msantme, Please feel fcee to m tact ma 1E l have arty gamtl=- W/jar cc: City ManarAr Finance Director EGYNIt FesOiuce9 Manager [4s. Edam Bice Ms. Elsie Coffey 1. v i ULBIueShx: Y)ATED GROUPS ONLY (EXCLUDES RETENTION) .r % 92 279 Your Aaitner Ftir Life li ,ENDING; BLUE CROSS/BLUE SHIELD Ito e,ee s:rcei.Yumana:mund YEAR - INCOME INCURRED CLAIMS LOSS RATIO 7/31/90 - '$-..862,035 $693,797 80.55 7/31/91.t {,IL GROUP NAME: CITY OF BANGOR ACCOUNT NUMBER: 9472-00 • RENEWAL DATE: JULY 10 1992 p'BLUE PREPARED BY: MIKE GILES ,. _____,------------- -___------- --------- -------------_-_-_----- ------ ' CURRENT PROPOSED COMPARISON YEAR 1991 YEAR 1993 7/31/91 - OF MONTHLY TOTALS BC/BS ` ' MM TOTAL Be/B$ MM TOTAL EXP 3991 1992 IND 121.34 :25.30 146.64 119.63 31.25 150.88 166 24,342.24 25,046.08 FAM 297.78 .65.89 363.67 293.55 81.37 374.92 234 85,098.98 870731.29 -:P-9 202.17 44.80 246.97 'P-8 199.33 5543 254.66 37 9,137.89 9,422.42 4 84.9 17.72 102.66 21.88 105.63 1 102.66 105.63 ---83_75 -------------------- ..____ ________---__-_____-- TOTALB 338 118,681.57 122,305.41 TOTAL MONTHLY INC(D£C 3,623.84 k OF CHANCE ypg ----------- _------------- _-------------------- _---------- ______________________ ANNUAL COST $Se424e179 $1,467,665 TOTAL ANNUAL INC/DEC 0431486 k OF CHANGE 3.05 LavvcSvaCHANGEasss_Tss=vse-= _s��__-_ __v_=essvaevsssss_syssssss CHANGE IN RATES MM $ AND k OF CHANGE PER CATEGOR $ +EC/85 k $ + k IND -1.71 -1.45 5.95 23.55 I IND $4.24 2.9 FAM -4.2] 1.4E 15.48 23.5$ PAM $11.25 I 3.1 P-9 -1,84 1.4$ 10.53 23.51 P-9 $7.69 '" 3.1 P-8 i -1.19 1.45 4.16 23.51 P-8 $2.97 2.9 tAFER1ENCE Y)ATED GROUPS ONLY (EXCLUDES RETENTION) li ,ENDING; BLUE CROSS/BLUE SHIELD YEAR - INCOME INCURRED CLAIMS LOSS RATIO 7/31/90 - '$-..862,035 $693,797 80.55 7/31/91.t {,IL ,$Xe0731819 ...$688,403 64.15 p'BLUE - ,. ALLIANCE 7/31/90 `. $ 300,053 $116,336 58.11 7/31/91 - '. $' 292,537 $160,679 54.95 4 li 9z 279 GROUP NAMEt CITY OR BANGOR i ACCOUNT NUMBER: 9472-00 RENEWAL DATE: JULY 1, 1992 - PREPARED BY: MIRE GILES YEAR 1991 BC/BS- 194 TOTAL IND 121..34 ¢5.30 146.64 FAM 297.78 65.89 363.67 P-9 202.17 44.80 246.92 P-8 84.94 17.72 102.66 PROPOSED YEAR 1992 BC/BS IRS TOTAL 119.63 24.01 143.64 293.55 62.53 356,08 199.33 42.52 243.85 83.25 16.82 100.57 ---------------- TOTALS COMPARISON -3.36 OF MONTHLY TOTALS EXP 1991 1952 166 24,042.24 23,844.24 234 85,098.28 83,322.72 37 9,132.89 81946.45 1 ------------------------- 102.66 ----------------- 100.52 TOTALS 438 118,681.52 116,215.90 TOTAL MONTHLY INC/DEC (2,465.59) % OF CHANGE -2.093 ANNUAL COST $1,424,179 $1,394,592 TOTAL ANNUAL INC/DEC ($294587) 2 OF CHANGE -2.08% CHANGE IN RATES ---------------------------------------------------------------•---------------- 8C/BS MN S AND $ OF CHANGE PER CATEGORY S +71. IND rl.]Y -1.43 -1.29 -$.IS IND ($3 00) -2 08 FAM P-9 P-8 EXPERIENCE -4.23 -1.4% -3.36 -S.1$ $ 862,035 $693,797 80.5% FAM ($7.59) -2.1% -2.84 -1.4% -2.28 -S.Ii P-9 ($5.12) -2.1% -1.19 -1.4% -0.90 -5.1i RATES MRPLECT REMOVAL OF MAJOR MEDICAL COVERAGE P-8 ($2.09) -2.0% -------------- --- -------------------------------------------- ------ GROUPS ONLY (EXCLUDES RETENTION) BLUE CROSS/BLUE SHIELD YEAR ENDING- INCOME INCURRED CLAIMS LOSS RATIO -_7/31/90 $ 862,035 $693,797 80.5% 7/31/91 $1,023,819 $688,403 64.1% - -BLUE ALLIANCE 7/31/90 ': $ 200,353 $116,336 58.1$ e 7/31/91 $ 292,537 $160,679 54.9% RATES MRPLECT REMOVAL OF MAJOR MEDICAL COVERAGE POM X65 RETIREES 3� 92 279 0BT The Carve -Out product supplements Medicare and provides the group -enrolled member With the same level of coverage held by payor, andrthe nregular (Under 65)ugroupecoverage dicare sh is secondary. vi. Member Enrollment A. Eiimibility. To be eligible for enrollment in Carve -out: 1. An applicant must be enrolled in both Part A and Part B of Medicare at all times; . 2. An through asnt group of 2rorlCarve-Out more; and, 3. An applicant must meet the applicable criteria for groups not-TEFPA qualified, TEFPA qualified, not -OBRA qualified, or OBRA qualified as . previously described under section III. B, Termination. When a Carve -Out member fails to maintain Medicare Part B coverage: 1. we will terminate his/her Carve -Out coverage on the first of the month after subscriber _ notification. 2. Ali coverage will stop unless, within 30 days of the ueonthe group's regular la ber elects to continue r coverage. Procedure Letter Underwriting RegUlations/Ccmvanion and Carve -Out ageNine ofEleven woon MeSheld Blue Crass and Blue Shield of Maine 1992 Outline of Medicare Supplemental Coverage Companion Plan A. Plan B. Plan C. Plan E. Plan F, and Plan I* Medicare supplemeral insurance can be sold in only An standard plans. This chant shows the benefits included in each plan. Every company most make available Plan "A" Some plans may not be available in your enure. Basic Benefits: Included in all Plans. Hospitalization: Pan A coinsurance plus coverage for 365 adt itiond days after Medicare benefits end. Medical Fipentes: Pmt B reassurance (20% of Medicare-appamol expenses).❑ Plans D, G, H, and I are not offered by Blood: Fire[ tinea piens of blood each year. Blue Cross and Blue Shield of Maine A B C D E F G H I*FPDeducfible Basic Benefits Basic HeneSts Basic Benefas Heaic Benefits Basic Benefits Basic Benefits Basic Benefits Basic Benefits Basic Benefitsenefits Skilled Skilled Skilled Skilled Sk0led Skilled Sued Nursing Nursing Nursing Nursing Nursing Nursing Nursing Coirvsurance Coinsurance Coinsumvce Coinsurance Cainsumnce Coinsurance Coinmmnce Coinsurance NAA Pat PartA PdnA FenA Pat Part PenA Deductible Deducible Deductible Deductible Deductible Deductible Deductible Deductible iblePan B Tart B Deducible Deductible ibleNAB NAB Partes Excess 00% Excess 80% Excess 100% 100%Foreign Foreign Foreign Foreign Foreign Foreign Fomign Travel Travel Travel Travel Travel Travel Travel Travel Eme emenev Ememenev I haterseraw I Ememencv, I Ememencv Emementv At -Honor At Home At -Home At -Home Recovery Recovery Recomery Basic Basic Extended Drugs Drags Drug $1,250Eimit 9,250Umit)($3,0001,mai Preventive Preventive Care Care I *BnroUmeM in Cmtpa ims Man lisreshieted. PkaemauaN aafarmore information. N $$39.23 $53.69 $64.35 $65.58 $78.94 $115.92 N � 1 m Premium Information Companion Plan A: $36.47* Companion Plan B: $50.57* Companion Plan C: $60.75* Companion Plan E: $62.22* Companion Plan F. $76.24* Companion Plan I: $110.16* • Discoume: 1) Your premium will be discounted $0.50 per month if you participate in our CmssCheck payment Panama; 2) your premium will be discounted R33% (Nath) each month for the first twelve months of your enrollment if you submit your application to us during the seven month period which includes the three months before, the month of, and three months after your 65th biMday; and/or 3) your premium will be discounted 8.33% ('/,2dd each month for the fust twelve months of your enrollment if you transfer coverage from a TEFRA group within the three month period following your termination of group coverage. Surchmges: For applications submitted on or after October 1, 1992 the following applies: if your application is submitted later than the 91h month following the mouth of your 65th birthday or later than the 9th month following the month of your transfer of coverage from a TEFRA group, your premium will be pemuneutly surcharged 5% for each year 41 am enrollment up to a maximum of 50%. This does not apply to applications submitted within 90 days of print Companion Plan or other Blue Cross and Blue Shield coverage. We Blue Cass and Blue Shield of Maine) can only rain your premium if we raise the premium for all policies like yours in this state Disclo6nre5 Use this outline to compare heralds and premiums among policies. Read Your Policy Very Carefully This is My an outline describing your policy's mast important features. The policy is your insurance contract. You mug read the policy itself to understand all of the rights and duties of both you and your insurance company. Right To Return Policy If you fired that you are not satisfied with your policy, you may return it to 2 Gannett Drive, South Portland, Maine 04106-6911. If you send the policy back m us within 30 days after you receive it, we will treat the policy as if it had never been issued and mtum a0 of your payments. Policy Replacement If you are replacing number health insurance policy, do NOT cancel it until you have actually received your new policy and are sure you want to keep it. Notice This policy, may not fully cover all of your medical casts. Neither Blue Cross and Blue Shield of Maine nor its agents am connected with Medicare. This outline 9 coverage does nor give all the details of Medicare coverage. Contact your local Social Security Office or consult "The Medicare Handbook" for more details. - iv Complete Answers Are Very important IND Review, the application carefully before you sign it. Be certain that all information has been property retarded. Plan A Medicare (Part A) — Hospital Services — Per Benefit Period * A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY lWaVlfa's $nmiprnawivaM mom and board, general nursing, and miscellaneous services andsupplies First AO but M52 $0 $652 (Pon AdMuctible) 61st throughhrough son day All but $10 163eday $163aChia, so 91st day and after: •while using 0 All but $326aday $326 allay so reserve • Once lifetime reserve days are used: used —Additional 363 days $0 $100%oftaedicam $0 eligible expeuses —Beymd the additional 365 days EO $0 All mats .Skilled Nursing Adhfy Care* Y must meat Medicarc'a requirements, including having been in a hospital for at least 3 days and entered a MMirareapproved facility within 30 days after leaving the hospital Fiat 20 days All approved amounts $0 $0 21st through tooth due All but $81.50 a day $0 Up to $81.50 a day 101st day and atter $0 All costs Blood First 3 Fina 3 Pints $0 Additiondamauna 100% $0 $o Hosake Care Available as long as your doctor certifies you am terminally ill and you elect All but very limited so Balance to receive these servicesce for outpatient usna drugainpabrnt rtapite care Plan A Medicare (Part B) — Medical Services — Per Calendar Year * Once you have been billed $Iq) of Medicare -approved amounts for covered services (which are noted with an asterisk), your part Bdeductible will have been met for the calendar year. $FdtVICaS MEDICARE PAYS PLAN R$YS NDC PAY McA'ml fiepmvw - In or enl of the hospital atm outpatieat hospital treatment, such as pbysl- 100% $0 $0 chim's services, Inpatient and Outpatient medical and surgical services and supplies, physical and ;peach therapy, diannomic tare, durable medical _ $0 $100 (Pan B deductible) m. eqP r $I00 of Medicare-appvm'ed] amounn* $0 $0 - $100 (Pan B dedugible) Remainder of Medicareapproved amounts 80% 20% $0 Part B Excess Charges (above Medinnreappmsysd amounts) $0 $0 - All casts Blood First 3 pass $0 All emits SIP Nmt$I00 of Medicare-approred amwna* $0 $0 she (hit B deductible) Remainder ofMedicnre-approved amoums 80% 20% $0 Ctinudtn$mmoo' Sorsa—Blood Tats For diagnatic services 100% $0 $0 Parts A & B Home Health Car¢ Medicare-apprmed services - - Medically necessary skilled cure services and medical supplies 100% $0 $0 Durable medical equipment • Firat $100 of Medicare -approved amounts* $0 $0 $100 (Pan B deductible) • Remainder ofMedicam-approved amount; 80% 20% $0 Plan B Medicare (Part A) — Hospital Services — Per Benefit Period ' A benefit period begins on the first day, you receive service as an inpatient in a hospital and ends after you here been out of the hospital and have not received skilled care in any other facility for 60 days in a row. SMVICFS h1EOICAItE PAYS MANPAYS YOU PAY SpvWim' Semiprrivate room and bnaN, general nursing, and miscellaneous services emi and supplies - Pirst60days All but $652 $652 50 - PanAdeductible) h day 61st through 90th$ All but $163 achy $163 atlay $0 •tetchy add • usingafter: dyssam All but $326adry $326 edgy $0 • used: lifetime reserve days are used: Onceuerals reserve —Ad —Additional 365 drys $0 1100% of Medicare M eligible expenses —Beyon0 the additional M5 days SD SO All mars Skiifed Nursing NraBiry Card We must nrcd Medicare's rets iremenrs, including baring been in a hospial far at least 3 days and entered a Medicare-appmrei facility within 30 days after leaving the hospital First 20 days All approved amounts $0 - $0 21stthmugh 100th day Allbut$81.50aday $0 Up to $81.50 a day 101st day and after $0 $0 All costs Bland First 3 pints $0 Spines $0 Additional amounts 100% $0 $0 Avableas ong as your doctor certifies you me terminally ill and you elect All but very limited $0 Balance to receive these services minsureece kr outpatient drugs and inpatient respite Plan B Medicare (Part B) — Medical Services — Per Calendar Year * Once you have been billed $100 of Medicaweppmrcd amounts for covered services (which are noted with an aweriels), your Parc B deductible will have been met for the calendar year. sEltvfCES MEDICARE PAYS PLAN PAYS Home Heald Care s physi- oat of thenpatie t and outpatie t meth ailand puri cial se is andinpatient and outpatient nodical and surgcal aemedic endsupplies, 100% $0 7�UPAYUcb�)OtofthIvor pM1ysical and speech [M1erapy, diegwstic testi. durable medicalequipment. • First VW of Medicare -approved emwats* $0 W $100(Part B deductible) Firs[$100r amour• $0 $0 $0 of Maicaroappmove Mance; o-appmvedamaunts g0% 20% For Bexcess Pan Bexcese cM1argu (above MedicareapprwMammmb) $0 $0 Blood First J pints $0 All costs $0 Next $I00 of Medicare-approva�amounta* - $0 $0 $100 (Ran B deductible) Remainderof Medic approelamaans M% 20% - $0 Cb oe6—Blood'RIIS adiagnostic For services 100% $0 $0 Parts A & B Home Heald Care Mediusc-appswedservices Medically necessary skilled cart services aid medical supplies 100% $0 $0 Durable medial equipment • First VW of Medicare -approved emwats* $0 W $100(Part B deductible) Remainder of Medicae-approved amounts $0% 20% $0 Plan C Medicare (Part A) — Hospital Services — Per Benefit Period A benefit period begins on the riot day you receive service Man inpatient in a hospital and ends after you have been out oithe hospilal am have not received skilled care in my other facility for 60 days in a row. SERVICES MEDICARE PAYS TIAhl PAYS YUUPAY Xospiadliate roam and board, general noming, and miscellaneous services no• and supplies and First Pirsl M days W d All bw 5652 $652 $0 A deductible) after day 61sl day All but E163 edgy $Pan $163 qday $0 am 91st dale using • 60 omsdyssam All but E326adry 532fiaday FO used • Once li4time reserve drys are used: Once fiedune moms —Additional 365 days $0 ellbo%af Medicare $D eligible expenses —Beyond the additione1365 days EO $0 All cost Skilled Naming fbcik Care* You most meet Medicare's reauiremms, including having been in a hospital - foraleast 3 days and entered a Medicare approved facility within M days after Icaving the hospital Pirst20days All approved summers $0 $0 21at through High day All but $81.50 a day Up to SBI.50 a day $ft Won day and after EO $0 All cons Elrod first 3 pints $0 Spins $o Additional amounts 100% $0 So Hospice Cam Available as long as your doctor cerifies yon are womanly ill and you elect All but very limited $0 balance to receive these services coinsurance for outpatient - drugs and impudent respite Plan C Medicare (Part B) — Medical Services — Per Calendar Year * Once you have been billed $100 of Medicare -approved amount¢ for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year. SERVICES MEDICARE PAYS PLAN PAYS YOUPAY Mmieal serving In or net of due hospital and outpe teal hospital treatment, such as phyai- 100% $0 n, inpatient and outpatient medical and sugieal services and — supplies, physical and speech in=". diagmatic tuts, durable medical $0 $100 $0 equipment. (Part B deductible) First $100 of Medicare -approved anmumA $0 $100 $0 (Parr B deductible) Remainder of Medicare -approved amounts 80% 20% Part Beeess charges(above Medicarwappri ed amOmts) SO $0 All sous &sad First 3 pints $0 All costs $0 Next $100 of Mediesmappiu ed amounts* SO $100 $0 (Pert B deductible) Remainder of Medirerreppmved amounts 80% 20% $0 animal faAomrory Services —Bbol few Fordiagmslicservices 100% $0 $0 Parts A & B Hone HeaRA Care Medicare -approved service Medically necessary skilled care services and medical supplies 100% $0 Durable medical equipment — • First $100 of Medicare-approeed amouors* $0 $100 $0 (Part B deductible) • Remainder of Medicare-epprmed amounts s0% 20% $0 T Plan C Other Be fits - Not Covered By Medicare SERVICES M I. REPA" PLANPAYS YOU PAY Poreign ]Y me—NN fmremdBy am serve Medically each emergency care services beginning during the lira[ 60 Jaya trip the each trip outside the USA First 2 each year 59 EO of RemeiiMer of chargee mete SA g0%to amura 20%And amounsover 20% beime am neaeR[ Nesfaeme Of $SQOgO maximumimam Plan E Medicare (Part A) — Hospital Services — Per Benefit Period A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have riot received skilled care in any other facility for 60 days in a mw. SERVICES MEDICARE PAVS PLAN PAYS YOU PAY H pna4'wtion• Semiprivate room am bound, general nursing, and miscellaneous services am supplies First 60days All but $652 $652 $0 (Pan A deductible) 61st through 90th day All but $163 a day $163 a day $o 91st day and after: • While using 050 lifetime reserve days All but $326 a day $326 a day $0 • once lifetime reserve days are used: —Additional 365 days ad $100%dismisses $o eligible expenses —Beyond the additional 365 days $0 $0 All mats Cary requirements, including having been in mustedicar red You must men Mand 30 days kr at least 3 days and en¢red a MMicere-eppmvcd facility within 30 days entered a after the hospital 0 d First 2 20 days All approved amounts EO $0 lgkh Mry All $gL50aday Up $81.50lo50 eday lost by allies sday am � EO All msrc Must First 3 pine - $0 Spins $0 Additional amounts 100% $0 $0 Hospice Care Available as long as your doctor certifies you are terminally ill and you elect All but very limited $0 Balance to receive these services coinsurance for outpatient drugs and mpmimt respite - cam Plan E Medicare (Part B) — Medical Services — Per Calendar Year ' Once you have been billed $100 of Medicare -approved amounts for covered services (which are nded with an asterisk), your Part B deductible will have been met for the calendar year. SERVICES MEDICARE PAW PLAN PAYS YOU PAY MdICN Exporter In or out of the hospital and outpatient hosphal treatment, such as pbysi- 100% $0 $0 outpatient Inpatlent and outpatient medical and sugical urvims; and suppear l and speech therapy, diagnostic testa, durable medical $0 $0 $IOD that B deductible) equipment. W% 20% $0 First $100 of Madicsreappareed amounest $0 $0 $100(Pam B deductible) Remainder of MedicarrapprOved amounts - SO% 20% $0 Part B excess chames(above Mdicato-approved amounts) W ED All costs Blood First 3 pints $0 All coma - $0 Next $100 of Medicare-approvdl amOuwA W $0 1100 Wart B deductible) Remainder of Medicareapprovedamounts W% 20% $0 QFordrinbomforyvices r—BbM ]Erb - Pordiagnosticservicer IW% 10 - $0 Home HeaBh Care Mdicare-apprmed services Medically necessary skilled care services sed medical supplies 100% $0 $0 Durable medical equipment • Fo t $100 of Merficam-appraved amount* $0 $0 $IOD that B deductible) • Remainder ofMedicarc-approved amounts W% 20% $0 U Plan E Other Benefits — Not Covered By Medicare SERVICES MEDICARE PAYS PI RAYS YOU PAY rmmtm—Abt Cmeredy cam seine Medicallycare services beginning daring the first Medically necessary unide fio days each trip outside they USA year 2 each year $0 8250 Remainder ares Remainder of chargee $0 maximum fetime 20% add over maximum benefit e$5000mounis turce the$500001iktime 01700,000 Prevendre MedhW Gam Benefit— Not Covesed By Medicare Annual physical and preventive rcss and services such es: kcal occult blood test, chiral rectal exam, mvomognm, hearing screening, dipstick urinalysis, diabetes ideating, thyroid function teat. influenv shot, tetanus and diphtheria - booster, and education, administered or ordered by your doctor when not covered by Medicare First $120 each calendar year so $120 So Additional charges - $0 $o All tests Plan F Medicare (Part A) — Hospital Services — Per Benefit Period A befit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have and received skilled care in any other facility for of days in a row. - SERVICES MEDICARE PAYS PLAN PAYS YOU PAY n+ Semiprivate Semiprivate room and based, general mining, and miscellaneous services - a ant esd W Flrat 60 days First All but $652 $632 EO - (Part Aaedunible) 61st through 90th day All but $163 alley $163 silty SD 91st day and after: • All but $326aday E326adry EO Once lising601ifefimereservedrys reserve Jaya are a. is —Additional —Additiats1365 days EO $lila%of Mes $0 eligible expenses s —Beyond the additional drys $0 EO - All caste Skilled Nursing Facility C lbn must meet Medicare's refinements, including having been in a hospital fur at least 3 days and entered a Medicare -approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 all 2 though 100th day All but$81.50 a day Up to $81.50 a day SO What day and after SO $0 All ones RINKI First 3 pins SO _ 3iies SD Additional amounts 100% $0 SO ykassum Can Available as long as your donor cedifies you are terminally ill and you elan All but very limited $O Balance to receive these services mainsuranceforcumatient drugs and inpatient respite Plan F Medicare (Part B) — Medical Services — Per Calendar Year * Once you have been billed SIM of Medirareappsoved amounts for cweret services (which are rested wide an asterisk), your Part B deductible will have brain and for the calendar year. SERVIC MEDICARE PAYS. PLAN PAYS YOU PAY Med cad Expenses In or out oath¢ hospital and outpatient hi epital treatment, such as physi- 100% 0 50 inpatient and outpatient medical and surgical services and supplies' physical and speech therapy, diagnostic posts, durable medical w SI00 SO equipment. (Pad B deductible) First SIM of Medicam-approva]amounu* $0 SIM $0 yantlidedudlble) Remainder of Medicaro-appaved amounts 80% M% - SO Part a excess chzrges(above Medicare -approved amours) $0 100% - $0 Bland First 3 pines $0 All coats SO Next SIM of Medicate -approver ameune+ $0 SIM (PartBdeduRble) Remainder of Flodicaro approvadi amounts 80% 20% CBnhwiagnomroryvicem a—Bbod TSID Por diagnas�ic services - 100% $0 $0 Home Health Can Mediraro-npProved services Medically mxeasary, skilled care services and medical supplies 100% 0 50 Durable motion] equipment • First SIM of Meticam-approved amounts* w SI00 SO (Pad B deductible) •Remainder of Medicaroapproved amounts 80% N% SO Plan F Other Benefits — Not Covered By Medicare SP.a [M MEDICABEPAYS PLANPAYS YOU PAY I Wgn]favi!—M Covered By Ma&&M Medically hemssmy euumpnty care services Insuring during the firs) W days oreach nip mxmde the USA Fust $250 each calendar year a0 $250 Renminderofchmgea $0 SO%malifafime 20%and amouns over um beneft the$SOp001iftime ofs$501" max Plan I Medicare (Part A) — Hospital Services — Per Benefit Period * A benefit period begins on the first day you receive service as an inpatient in a hospital add ends after you have been out of the hospital and base not received skilled care in any other Willy far 60 days in a row. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY ifn..,privamm�• mom and board, geroral nursing, and miscellaneous services and supplies and First 60 day Fim W days All but 5552 5652 A deducible) 61st 9Oh day All but $163 allay $163aday $163 $o daythrough 91st day and nd using 61) • Whileelifetime All but $326aday $326 edgy d0 • Once lifetime reserve days ea used: reservmeresam used —Additional 30 days SO $103% of Medicare $0 eligible expenses —Beyord the additional 365 days 50 SO All costs Skilled Narsiug Ruairy Gave* You must raw Medeares requirements, including having been in a hospital for at least 3 days and entered a Medicars-approved factify within 30 days after leaving the lroapiml FirstMdays All applrrvN amounts $0 SO 21st through 100th day All but $81.50 a they Up to $81.50 a day $0 1019 day add after $0 All were Blood First 3 pinta $0 3 Pima $0 Additional amounts 100% $0 $0 Abadics Care _ Available as long as your elector certifies. you am terminally ill and you elect All but very limited $0 Balance to receive there services coinsurance for outpatient drugs and inpatient respite cars Plan I Medicare (Part B) — Medical Services — Per Calendar Year Once you have been billed $M() of Mer icam-appowed amounts for reacted services (which are armed with au asterisk), your Part B deductible will have been me[ for the calendar year. SERVICES MEDICARE PAYS PLAN PAYS YOU PAY Me dimlt of thew In or out of hospital and outpatient hospital such as plrysi- 100% 30SO sugic l s inpatientand ohem", medicaland s, services, in :,m) durAbservicesand supplies, physical and speech rM1empy, diagnostic was, durable medical $0 $0 (pan B deductible) equipment. 80% 20% $0 00 d aamountts $0 20 $100 (Pari D deductible) der of Medicre-app Remainder Madicare-mmMedamoono Ron 80% 20% $0 Bmcess Peng escess char3es (above Medicare -approved accounts) $0 - 100% $0 Blood First 3 pints $0 All cars $0 Next A00 of Medicare, approved amonnl5* $0 $0 $100(part B deductible) Remainder ofMWicareopproveE amounts 80% 20% 1$0 awnat lalwvrmy SvriunJ—Bond nm For diagnostic services 100% $0 $0 Paris A & B Home Healm Core Medicare-approvedaervires Medically necessary skilled care services and medical supplies 100% 30SO Durable medical equipment :,m) • Ftrst saw of Malicaroapproved amounts* $0 $0 (pan B deductible) • Remainder of Medicare -approved amounts - 80% 20% $0 Continued on nut page S Plan I Medicare (Parts A & B) — (continued) SERVICES MEBICAREPAVS PI. ftw VOUM Dome Health Care monfd) Abbome recovery service— na covered by Medisre Home cert anified by your doctor, for permnel can during recovery from an $0 $0 Balance injury or sicloams bar which Medicare approved a Home Care Oleatmerd Plan $0 80%m a lifrdme M%and amomts over Bandit for each visit $0 Actual chvges the$50,000 B4dme m UO a visit neadneurn Number of visits covered(mast be received within 8 weeks of las[ w Uptodwnumberof Medicaroappmved visit) EO Medicare -approved $250 Next $2,500 each calerMaz year $0 visits, not to exceed 50% 7 each k Caleadar year maximum $0 $1,fi110 Other Benefits amend 2Yawl— NM Covered By Medicare Medically necessary emetgnry care services beginning during the first E0 days aench trip outside the USA Ficu$250eachcahrmaryear $0 $0 $250 Remainder of charges, $0 80%m a lifrdme M%and amomts over ma imm benWt the$50,000 B4dme of$50000 neadneurn Basic Or"ama AeeerWon Drags — Not G ned By Medieare Firm $250 each calendar year EO $0 $250 Next $2,500 each calerMaz year $0 50%—$1,250 50% canaries year mounnuca benefit Over$2,500 eacb calendar year N All cwts