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Standardized Plan Description

12 Standard Medicare Supplement Benefit Plans

CORE BENEFITS PLAN A PLAN B PLAN C PLAN D PLAN E PLAN F PLAN G PLAN H PLAN I PLAN J PLAN K PLAN L
Part A Hospital
Days 61-90
X X X X X X X X X X X X
Lifetime Reserve
Days 91-150
X X X X X X X X X X X X
365 Life Hospital
Days 100%
X X X X X X X X X X X X
Parts A and B
Blood
X X X X X X X X X X 50% 75%
Part B Coinsurance
20%
X X X X X X X X X X 50% 75%
ADDED BENEFITS PLAN A PLAN B PLAN C PLAN D PLAN E PLAN F PLAN G PLAN H PLAN I PLAN J PLAN K PLAN L
Skilled Nursing Facility Coinsurance
Days 21-100
    X X X X X X X X 50% 75%
Deductibles
Part A
  X X X X X X X X X 50% 75%
Deductibles
Part B
    X     X       X    
Excess Charges
Part B
          100% 80%   100% 100%    
Foreign Travel
Emergency
    X X X X X X X X    
Recovery
At Home
      X     X   X X    
Preventative Medical
Care
        X         X X X

Hospice Cost-sharing Part A

                    50% 75%
Out-of-pocket Annual Limit                     $4000 $2000
** Plans K and L provide for different cost-sharing for items and services than Plans A - J.
Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year.  The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called "Excess Charges".  You will be responsible for paying excess charges.

The out-of-pocket annual limit will increase each year for inflation.

August 29, 2008
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