| Rates effective January 1, 2012 |
Plan A |
Plan F |
High Ded
Plan F |
Plan N |
| Monthly AFT Rate |
$132 |
$166 |
$68 |
$130 |
| Monthly Paper Bill Rate |
$137 |
$171 |
$73 |
$135 |
| Benefits |
Plan A |
Plan F |
High Ded
Plan F |
Plan N |
| Medicare Part A Coinsurance and Hospital Benefits |
 |
|
|
|
| Medicare Part A Deductible |
|
|
|
|
| Medicare Part B Coinsurance or Co-payment |
|
|
|
3 |
| Medicare Part B Deductible |
|
|
|
|
| Medicare Part B Excess Charges |
|
|
|
|
| Blood (First Three Pints) |
|
|
|
|
| Hospice Care Coinsurance or Co-payment |
|
|
|
|
| Skilled Nursing Coinsurance |
|
|
|
|
| Foreign Travel Emergency (Up to Plan Limits)3 |
|
|
|
|
| Medicare Preventive Care Part B Coinsurance |
|
|
|
|
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