| Rates effective 11/1/2011 |
Plan A |
Plan B |
Plan C |
Plan F |
High Ded
Plan F |
Plan K |
Plan L |
Plan N |
Monthly Premiums
Community Rates |
$158.12 |
$171.91 |
$197.90 |
$201.90 |
$76.96 |
$93.56 |
$132.13 |
$123.68 |
| Benefits |
Plan A |
Plan B |
Plan C |
Plan F |
High Ded
Plan F |
Plan K |
Plan L |
Plan N |
| Medicare Part A Coinsurance and Hospital Benefits |
 |
|
|
|
|
|
|
|
| Medicare Part A Deductible |
|
|
|
|
|
50% |
75% |
|
| Medicare Part B Coinsurance or Co-payment |
|
|
|
|
|
50% |
75% |
3 |
| Medicare Part B Deductible |
|
|
|
|
|
|
|
|
| Medicare Part B Excess Charges |
|
|
|
|
|
|
|
|
| Blood (First Three Pints) |
|
|
|
|
|
50% |
75% |
|
| Hospice Care Coinsurance or Co-payment |
|
|
|
|
|
50% |
75% |
|
| Skilled Nursing Coinsurance |
|
|
|
|
|
50% |
75% |
|
| Foreign Travel Emergency (Up to Plan Limits)3 |
|
|
|
|
|
|
|
|
| Medicare Preventive Care Part B Coinsurance |
|
|
|
|
|
|
|
|
Monthly premiums presented include $2 for coupon book billing method. If a policyholder elects either automatic bank withdrawal or recurring credit card transaction as a payment method, the premium is $2 less.
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