Plan Features

							             Brief Summary Of Benefits Comparison
Plan Features                    Medicare Advantage Plan      Traditional Choice Plan
                                   (Plan Pays in-network)             (Plan Pays)
Deductible (per calendar year)              None                         None
Plan / Member Coinsurance                100% / 0%                     90% / 10%
Lifetime Maximum                          Unlimited                    Unlimited

Routine
Physicals/Immunizations                    100%                           90%
Routine Mammograms,
one per calendar year, for
females age 40 and over                    100%                           90%
Routine Digital Rectal Exam /
Prostate Antigen Test (PSA)                100%                           90%
Primary Care Physician Office
Visits, no referral needed                 100%                           90%

Specialist Office Visits                   100%                           90%

Hospital Inpatient Coverage                100%                          100%

Outpatient Facility                        100%                          100%
Emergency Room                             100%                          100%
Ambulance                                  100%                          90%
Outpatient Short-Term
Rehabilitation                             100%                           90%
Hearing Aid Reimbursement         $500 once every 36 months           Not covered


                                                                $50 Individual Deductible
Prescription Drugs                  No Annual Deductible
                                                                 $150 Family Deductible
Retail (up to 30 days)
  Generic                                $10 Copay                     $10 Copay
  Preferred Brand                        $20 Copay                     $30 Copay
  Non-Preferred Brand                    $40 Copay                     $50 Copay

Mail Order (up to 90 days)
  Generic                                $20 Copay                     $25 Copay
  Preferred Brand                        $40 Copay                     $75 Copay
   Non-Preferred Brand                   $80 Copay                    $125 Copay




                                                                  Printed: 9/16/2009