• Retiree Health Plan
    Comparisons

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.

Benefits - Plans A B C D F F(1) with
Deductible
G K L M N(2)
Preventative Care 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Hospitalization 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Medical Expenses 100% 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Blood 100% 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Part B Coinsurance 100% 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Skilled Nursing
Facility Coinsurance
- - 50% 75%
Part A Deductible - 50% 75% 50%
Part B Deductible - - - - - - - -
Part B Excess (100%) - - - - - - - -
Foreign Travel
Emergency
- - - -
Out-of-Pocket limit - - - - - - - Limit
$5,120;
Paid at
100%
after limit
is reached
Limit
$2,560;
Paid at
100%
after limit
is reached
- -

(1) Each calendar year you must pay the first $500 or $1,000 of Part B coinsurance and Medicare Part B deductible expenses before Part B coinsurance claims are covered under this plan. Expenses you pay for Medicare Part B deductible and Medicare Part B coinsurance amounts will apply to your deductible only if they are incurred after your coverage effective date while your coverage is in force. These expenses do not include the plan’s separate foreign travel emergency deductible.

(2) Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit and up to $50 copayment for ER.