RETIREE HEALTH PLAN

SUMMARY OF BENEFITS

The chart below shows the benefits provided under all standardized Medicare supplement plans and the unique Plan F with deductible options available through this program. Every company must make available Plan “A”. Some plans may not be available in your state.

BASIC BENEFITS:

Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.

Medical Expenses: Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services. Plans K, L and N require insurers to pay a portion of the Part B coinsurance or copayments.

Blood: First three pints of blood each year.

The plans offered as part of your Retiree Health Plan are highlighted below.