Medicare. Supplemental Coverage Outline. n Supplement-65 District of Columbia

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Medicare. Supplemental Coverage Outline. n Supplement-65 District of Columbia"

Transcription

1 Medicare Supplemental Coverage Outline n Supplement-65 District of Columbia SUDDCOB (1/09) Offered by Group Hospitalization and Medical Services, Inc.* d/b/a CareFirst BlueCross BlueShield 840 First Street, NE Washington, DC A not-for-profit health service plan *An independent licensee of the Blue Cross and Blue Shield Association

2 n n n n These charts show the benefits included in each of the standard Medicare supplement plans. Every company must make available plan A. Some plans may not be available in your state. See Outlines of Coverage sections for details about ALL plans. CareFirst BlueCross BlueShield* Outline of Medicare Supplement Coverage Benefit Plans A,C,F** 1 for Plans A J: Hospitalizations: coinsurance plus coverage for 365 additional days after Medicare benefits end. Medical Expenses: coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services. Blood: First three pints of blood each year. Supp-65 PLAN A PLAN B Supp-65 PLAN C PLAN D PLAN E Supp-65 PLAN F** 1 PLAN G PLAN H PLAN I PLAN J** Excess (100%) Excess (80%) Excess (100%) Excess (100%) At-Home Recovery Preventive Care NOT covered by Medicare At-Home Recovery At-Home Recovery At-Home Recovery Preventive Care NOT covered by Medicare * CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Association. ** Plans F and J also have an option called a High Plan F and a High Plan J. These high deductible plans pay the same benefits as Plans F and J after one has paid a calendar year $2,000 deductible. from High Plans F and J will not begin until out-of-pocket expenses exceed $2,000. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for and, but do not include the plan s separate foreign travel emergency deductible. 1 CareFirst BlueCross BlueShield does not sell the High Plan F in the District of Columbia. 1

3 CareFirst BlueCross BlueShield Outline of Medicare Supplement Coverage for K and L include similar services as plans A J, but cost-sharing for the basic benefits is at different levels. PLAN J** PLAN K*** PLAN L*** 100% of Hospitalization plus coverage for 365 days after Medicare benefits end 50% Hospice cost-sharing 50% of Medicare-eligible expenses for the first three pints of blood 50%, except 100% for Preventive Services 100% of Hospitalization plus coverage for 365 days after Medicare benefits end 75% Hospice cost-sharing 75% of Medicare-eligible expenses for the first three pints of blood 75%, except 100% for Preventive Services 50% 75% 50% 75% Excess (100%) At-Home Recovery Preventive care Not covered by Medicare $4,620 Out-of-Pocket Annual Limit**** $2,310 Out-of-Pocket Annual Limit**** *** Plans K and L provide for different cost-sharing for items and services than Plans A-J. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called Excess Charges. You will be responsible for paying excess charges. **** The out-of-pocket annual limit will increase each year for inflation. See Outlines of Coverage for details and exceptions. 2

4 Take Advantage Of CareFirst BlueCross BlueShield s Competitive Rates Notice About Attained Age Rated Medicare Supplement Policies Under Medicare supplement policies or certificates that use attained age rating, premiums automatically increase as you get older. You can expect your premiums to increase each year (or other frequency as established under the policy or certificate) due to changes in age. The premiums for other Medicare Supplement policies that are issue age or community rated do not increase due to changes in your age. While the cost for a Medicare Supplement policy that is based on attained age may be lower than the cost of a Medicare Supplement policy that is issue age or community rated at your present age, it is important to compare the potential cost of these policies over the life of the policy. Currently, the premiums for all ages under this policy (or certificate) are as follows: Medically Underwritten Monthly Rates Effective January 1, 2009* (Billed Monthly) Age Plan A Plan C - Male Plan C - Female Plan F - Male Plan F - Female 65 N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ N/A $ $ $ $ and over N/A $ $ $ $ *Rates available for subscribers who either meet the eligibility criteria specified by the Federal Government or pass medical underwriting. Rates not available if you are under age 65 and have Medicare. Plan A is only available at the higher nonmedically underwritten rate (see rate chart to the right). Rates available for subscribers who either do not meet the eligibility criteria specified by the Federal Government or do not pass medical underwriting. If you are under age 65 and have Medicare, you may apply for Plan A or Plan C only. Non-Medically Underwritten Monthly Rates Effective January 1, 2009 (Billed Monthly) Age Plan A Plan C Plan F Under 65 $ $ N/A 65 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ AND OVER $ $ $

5 Premium Information CareFirst BlueCross BlueShield (CareFirst) can only raise your premium if we raise the premium of all policies like yours, in this State. Medically Underwritten Rates You will receive a premium increase on your January 1st renewal. You will also receive an additional premium increase on renewal as you change from one age band to another, as shown on the monthly rate tables on page 3. Non-Medically Underwritten Rates You will receive a premium increase on your January 1st renewal. You also will receive an additional premium increase on renewal as you change from one age band to another, as shown on the monthly rate tables on page 3. The premiums for other Medicare Supplement policies that are issue age or community rated do not increase due to changes in your age. While the cost for a Medicare Supplement policy that is based on attained age may be lower than the cost of a Medicare Supplement policy that is issue age or community rated at your present age, it is important to compare the potential cost of these policies over the life of the policy. Disclosures Use this outline to compare benefits and premiums among policies. Read Your Policy Very Carefully This document is only a summary of your insurance policy s most important features. Your insurance policy provides all of the details concerning the rights and responsibilities of both you and your insurance company. You should read the policy carefully to ensure that you understand your obligations under your contract. Right to Return Policy If you find that you are not satisfied with your policy, you may return it to: Group Hospitalization and Medical Services, Inc. d/b/a CareFirst BlueCross BlueShield 840 First Street, NE Dept. AF23 Washington, DC If you send the policy back to us within 30 days after you receive it, we will treat the policy as if it had never been issued and return all of your payments. Policy Replacement If you are replacing another health insurance policy, do NOT cancel it until you have actually received your new policy and are sure you want to keep it. Notice This policy may not fully cover all of your medical costs. A more detailed list of exclusions is available upon request. Neither CareFirst BlueCross BlueShield nor its agents are connected with Medicare. This outline of coverage does not give all the details of Medicare coverage. Contact your local Social Security Office or consult Medicare and You for more details. Complete Answers Are Very Important When you fill out the application for your new policy, be sure to answer all questions about your medical and health history truthfully and completely. CareFirst may cancel your policy and refuse to pay any claims if you leave out or falsify important medical information. Review the application carefully before you sign it. Be certain that all information has been properly recorded. Guaranteed Annual Renewal of Policy If you have paid your subscription charges on time, the policy automatically will renew at the end of the term for another 12 consecutive calendar months, unless you notify CareFirst in writing at least 30 days in advance that you do not want to renew the policy. Subscription charges may be adjusted based on your age at the time of renewal. 4

6 Supplement-65 PLAN A Medicare Hospital Services Per Benefit Period * A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. ** Notice: When your Medicare hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core. During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. SERVICES MEDICARE PAYS PLAN A PAYS YOU PAY n Hospitalization* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1,068 $0 $1,068 ( ) 61st thru 90th day All but $267 a day $267 a day $0 91st day and after: While using 60 lifetime reserve All but $534 a day $534 a day $0 days Once lifetime reserve days are used: Additional 365 days $0 100% of Medicare $0** Eligible Expenses Beyond the additional 365 days $0 $0 All costs n Care* You must meet Medicare s requirements, including having been in a hospital for at least 3 days and entered a Medicare- Approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 $0 21st thru 100th day All but $ a day $0 Up to $ a day 101st day and after $0 $0 All costs n Blood First 3 pints $0 3 pints $0 Additional amounts 100% $0 $0 n Hospice Care Available as long as your doctor certifies you are terminally ill and you elect to receive these services All but very limited coinsurance for outpatient drugs and inpatient respite care $0 Balance 5

7 Supplement-65 PLAN A Medicare Medical Services Per Calendar Year *Once you have been billed $135 of Medicare Approved Amounts for covered services (which are noted with an asterisk), will have been met for the calendar year. SERVICES MEDICARE PAYS PLAN A PAYS YOU PAY n Medical Expenses-In Or Out Of Hospital And Outpatient Hospital Treatment Such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment: First $135 of Medicare-Approved Amounts* Remainder of Medicare-Approved Amounts n Excess Charges (Above Medicare-Approved Amounts) n Blood $0 $0 $135 ( ) Generally 80% Generally 20% $0 $0 $0 All costs First 3 pints $0 All costs $0 Next $135 of Medicare-Approved Amounts* Remainder of Medicare-Approved Amounts n Clinical Laboratory Services $0 $0 $135 ( ) 80% 20% $0 Tests for diagnostic services 100% $0 $0 Medicare Parts A and B n Home Health Care Medicare-Approved Services Medically necessary skilled care 100% $0 $0 services and medical supplies Durable medical equipment First $135 of Medicare- Approved Amounts* Remainder of Medicare- Approved Amounts $0 $0 $135 ( ) 80% 20% $0 6

8 Supplement-65 PLAN C Medicare Hospital Services Per Benefit Period * A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. ** Notice: When your Medicare hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core. During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. SERVICES MEDICARE PAYS PLAN C PAYS YOU PAY n Hospitalization* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1,068 $1,068 ( ) $0 61st thru 90th day All but $267 a day $267 a day $0 91st day and after: While using 60 lifetime reserve All but $534 a day $534 a day $0 days Once lifetime reserve days are used: Additional 365 days $0 100% of Medicare $0** Eligible Expenses Beyond the additional 365 days $0 $0 All costs n Care* You must meet Medicare s requirements, including having been in a hospital for at least 3 days and entered a Medicare-Approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 $0 21st thru 100th day All but $ a day Up to $ a day $0 101st day and after $0 $0 All costs n Blood First 3 pints $0 3 pints $0 Additional amounts 100% $0 $0 n Hospice Care Available as long as your doctor certifies you are terminally ill and you elect to receive these services All but very limited coinsurance for outpatient drugs and inpatient respite care $0 Balance 7

9 Supplement-65 PLAN C Medicare Medical Services Per Calendar Year *Once you have been billed $135 of Medicare Approved Amounts for covered services (which are noted with an asterisk), your will have been met for the calendar year. SERVICES MEDICARE PAYS PLAN C PAYS YOU PAY n Medical Expenses-In Or Out Of Hospital And Outpatient Hospital Treatment - Such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment: First $135 of Medicare-Approved $0 $135 ( $0 Amounts* ) Remainder of Medicare-Approved Generally 80% Generally 20% $0 Amounts n Excess Charges - (Above Medicare-Approved Amounts) $0 $0 All costs n Blood First 3 pints $0 All costs $0 Next $135 of Medicare-Approved $0 $135 ( $0 Amounts* ) Remainder of Medicare-Approved 80% 20% $0 Amounts n Clinical Laboratory Services Tests for diagnostic services 100% $0 $0 Medicare Parts A and B n Home Health Care Medicare-Approved Services Medically necessary skilled care 100% $0 $0 services and medical supplies Durable medical equipment First $135 of Medicare- $0 $135 ( $0 Approved Amounts* ) Remainder of Medicare- 80% 20% $0 Approved Amounts Other Not Covered by Medicare n -Not Covered by Medicare - Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of charges $0 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum 8

10 Supplement-65 PLAN F Medicare Hospital Services Per Benefit Period * A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. ** Notice: When your Medicare hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy s Core. During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. SERVICES MEDICARE PAYS PLAN F PAYS YOU PAY n Hospitalization* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1,068 $1,068 ( ) $0 61st thru 90th day All but $267 a day $267 a day $0 91st day and after: While using 60 lifetime reserve All but $534 a day $534 a day $0 days Once lifetime reserve days are used: Additional 365 days $0 100% of Medicare $0** Eligible Expenses Beyond the additional 365 days $0 $0 All costs n Care* You must meet Medicare s requirements, including having been in a hospital for at least 3 days and entered a Medicare-Approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 $0 21st thru 100th day All but $ a day Up to $ a day $0 101st day and after $0 $0 All costs n Blood First 3 pints $0 3 pints $0 Additional amounts 100% $0 $0 n Hospice Care Available as long as your doctor certifies you are terminally ill and you elect to receive these services All but very limited coinsurance for outpatient drugs and inpatient respite care $0 Balance 9

11 Supplement-65 PLAN F Medicare Medical Services Per Calendar Year *Once you have been billed $135 of Medicare Approved Amounts for covered services (which are noted with an asterisk), your will have been met for the calendar year. SERVICES MEDICARE PAYS PLAN F PAYS YOU PAY n Medical Expenses-In Or Out Of Hospital And Outpatient Hospital Treatment - Such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment: First $135 of Medicare-Approved $0 $135 ( $0 Amounts* ) Remainder of Medicare-Approved Generally 80% Generally 20% $0 Amounts n Excess Charges - (Above Medicare-Approved Amounts) $0 100% $0 n Blood First 3 pints $0 All costs $0 Next $135 of Medicare-Approved $0 $135 ( $0 Amounts* ) Remainder of Medicare-Approved 80% 20% $0 Amounts n Clinical Laboratory Services Tests for diagnostic services 100% $0 $0 Medicare Parts A and B n Home Health Care Medicare-Approved Services Medically necessary skilled care 100% $0 $0 services and medical supplies Durable medical equipment First $135 of Medicare- $0 $135 ( $0 Approved Amounts* ) Remainder of Medicare- 80% 20% $0 Approved Amounts Other Not Covered by Medicare n -Not Covered by Medicare - Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of charges $0 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum 10

12 The benefits described are issued under policies: MEDIGAP PLAN F (5/99) DC MEDIGAP PLAN C (5/99) DC MEDIGAP PLAN A (5/99) DC MEDIGAP UW PLAN F (1/01) DC MEDIGAP UW PLAN C (1/01) DC as amended Neither CareFirst BlueCross BlueShield nor its agents represent, work for or receive compensation from any federal, state or local government agency. BOK5017-1S (1/09) CareFirst BlueCross BlueShield Individual Market Division 840 First Street, NE, Washington, DC CareFirst BlueCross BlueShield is the business name of Group Hospitalization and Medical Services, Inc. and is an independent licensee of the Blue Cross and Blue Shield Association. Registered trademark of the Blue Cross and Blue Shield Association. Registered trademark of CareFirst of Maryland, Inc.

Medicare. Supplemental Coverage Outline. n MediGap-65 Maryland

Medicare. Supplemental Coverage Outline. n MediGap-65 Maryland Medicare Supplemental Coverage Outline n MediGap-65 Maryland MGMDOB (1/09) Offered by CareFirst of Maryland, Inc.* d/b/a CareFirst BlueCross BlueShield 10455 Mill Run Circle Owings Mills, Maryland 21117-5559

More information

Medicare Supplemental Coverage Outline

Medicare Supplemental Coverage Outline More to feel good about. Medicare Supplemental Coverage Outline MediGap-65 Maryland Plans A, B, F, High-Deductible F and N Offered by CareFirst of Maryland, Inc.*, d/b/a CareFirst BlueCross BlueShield,

More information

Medicare Supplement Outline of Coverage

Medicare Supplement Outline of Coverage Blue Cross and Blue Shield of Nebraska Medicare Supplement Outline of Coverage Benefit Plans: A, B, C, F, G and L Rates Valid: April 1, 2016 through March 31, 2017 For Plans Effective: January 1, 2016

More information

[COMPANY NAME] Outline of Medicare Supplement Coverage-Cover Page: 1 of 2 Benefit Plans [insert letters of plans being offered

[COMPANY NAME] Outline of Medicare Supplement Coverage-Cover Page: 1 of 2 Benefit Plans [insert letters of plans being offered Incorporated Document (6) [COMPANY NAME] Outline of Medicare Supplement Coverage-Cover Page: 1 of 2 Benefit Plans [insert letters of plans being offered These charts show the benefits included in each

More information

Outline of Medicare Supplement Coverage

Outline of Medicare Supplement Coverage Outline of Medicare Supplement Coverage Cover Page 1 of 2 ATTAINED AGE BENEFIT PLANS A, C, F, J These charts show the benefits included in each of the 1990 standardized Medicare Supplement plans. Every

More information

A B C D F G Basic, including 100% Part B coinsurance. Basic, including 100% Part B coinsurance Skilled Nursing Facility Coinsurance

A B C D F G Basic, including 100% Part B coinsurance. Basic, including 100% Part B coinsurance Skilled Nursing Facility Coinsurance SOUTH CAROLINA HEALTH INSURANCE POOL (SCHIP) OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE 1 OF 2: STANDARDIZED MEDICARE SUPPLEMENT COVERAGE BENEFIT PLANS A and C AVAILABLE These charts show the benefits

More information

Plan F & Plan F* Skilled Nursing Facility Coinsurance Part A Deductible Part B. Deductible. Part B Excess (100%) Foreign Travel Emergency

Plan F & Plan F* Skilled Nursing Facility Coinsurance Part A Deductible Part B. Deductible. Part B Excess (100%) Foreign Travel Emergency Outline of Medicare Supplement Coverage By Reason of Age Cover Page: Benefit Plans A, F, High F and N See Outlines of Coverage sections for detail about all plans. This chart shows the benefits included

More information

Basic, including 100% Part B coinsurance. Foreign Travel Emergency

Basic, including 100% Part B coinsurance. Foreign Travel Emergency BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS A, B, D and F

More information

Basic, including 100% Part B coinsurance. Foreign Travel Emergency

Basic, including 100% Part B coinsurance. Foreign Travel Emergency BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS A, B, D and F

More information

A B C D F F* G K L M N Basic,

A B C D F F* G K L M N Basic, 1515 South 75th Street Omaha, Nebraska 68124 Outline of Medicare Supplement Coverage Benefit Plans A, D, and F www.gomedico.com Toll-Free 1-800-228-6080 This chart shows the benefits included in each of

More information

OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT STANDARD PLANS A, B, C, D, F, J AND HIGH DEDUCTIBLE PLAN F

OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT STANDARD PLANS A, B, C, D, F, J AND HIGH DEDUCTIBLE PLAN F Anthem Blue Cross Blue Shield Connecticut Administrative Office: PO Box 1014 North Haven, CT 06473 Toll Free Telephone Number: 1-800-238-1143 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT

More information

A B C D F F* G K L M N Basic,

A B C D F F* G K L M N Basic, Outline of Medicare Supplement Coverage Benefit Plans A, D, and F Corporate Office Omaha, NE Administrative Services PO Box 10386 Des Moines, IA 50306 www.gomedico.com Toll-Free 1-800-228-6080 This chart

More information

UNITED AMERICAN INSURANCE COMPANY

UNITED AMERICAN INSURANCE COMPANY UNITED AMERICAN INSURANCE COMPANY A Nebraska Stock Company Administrative Offices: McKinney, Texas Outline of Medicare Supplement Coverage - Cover Page: 1 of 2 Benefit Plans B, HDF These charts show the

More information

Coinsurance Part A. Deductible. Nursing. Benefits. Skilled. Part B. Coinsurance Part A. Deductible. Nursing. Benefits. Skilled. Coinsurance Part A

Coinsurance Part A. Deductible. Nursing. Benefits. Skilled. Part B. Coinsurance Part A. Deductible. Nursing. Benefits. Skilled. Coinsurance Part A Guarantee Trust Life Insurance Company Outline of Medicare Supplement Coverage Cover Page: 1 of 2 Benefit Plan(s) A, D, G These charts show the benefits included in each of the standard Medicare supplement

More information

Outline of Medicare Supplement Coverage

Outline of Medicare Supplement Coverage Outline of Medicare Supplement Coverage Cover page 1 of 2 Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010 Plans A, B, C, D, F, high deductible F, G, L, M This

More information

Basic, Including 100% Part B Coinsurance. Part B Coinsurance. Coinsurance* 50% Skilled Nursing Facility Coinsurance. Skilled Nursing Facility

Basic, Including 100% Part B Coinsurance. Part B Coinsurance. Coinsurance* 50% Skilled Nursing Facility Coinsurance. Skilled Nursing Facility AMERICAN RETIREMENT LIFE INSURANCE COMPANY P. O. BOX 26580 AUSTIN, TX 78755-0580 866-459-4272 Outline of Medicare Supplement Coverage - Benefit Plans A, F, G and N This chart shows the benefits included

More information

Regence Bridge. Medicare Supplement (Medigap) Plans

Regence Bridge. Medicare Supplement (Medigap) Plans OUTLINE OF COVERAGE Regence Bridge Medicare Supplement (Medigap) Plans Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association 07355rep06630-or OR

More information

Basic, including 100% Part B coinsurance. Foreign Travel Emergency

Basic, including 100% Part B coinsurance. Foreign Travel Emergency BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS A, C, L and N

More information

A B C D F F* G K L M N Basic, including. Basic, including. coinsurance. 75% Skilled Nursing. Facility Coinsurance. 50% Part A. Deductible.

A B C D F F* G K L M N Basic, including. Basic, including. coinsurance. 75% Skilled Nursing. Facility Coinsurance. 50% Part A. Deductible. This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Some plans may not be available in your state. AmeriHealth Insurance

More information

2015 Benefit Chart of Medicare Supplement Plans Outline of Coverage 1-888-708-0123 mhinsurance.com

2015 Benefit Chart of Medicare Supplement Plans Outline of Coverage 1-888-708-0123 mhinsurance.com 2015 Benefit Chart of Medicare Supplement Plans Outline of Coverage 1-888-708-0123 mhinsurance.com MEMBERS HEALTH INSURANCE COMPANY Home Office: P.O. Box 1424, Columbia, TN 38402-1424 1-888-708-0123;

More information

K L M N Basic, including Basic,

K L M N Basic, including Basic, Companion Life Insurance Company Administrative Office PO Box 14158 Clearwater, Florida 33766-4158 (888) 220-0466 Outline of Medicare Supplement Coverage Cover Page Benefit Plans A, F and G - See Outlines

More information

Benefit Chart of Medicare Supplement Plans Sold on or After January 1, 2014

Benefit Chart of Medicare Supplement Plans Sold on or After January 1, 2014 Benefit Chart of Medicare Supplement Plans Sold on or After January 1, 2014 This chart shows the benefits included in each of the standard Medicare Supplement plans. Every company must make available Plans

More information

MediGap Plans A, C, F, & N 2016 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE

MediGap Plans A, C, F, & N 2016 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE MediGap Plans A, C, F, & N 2016 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE This page was intentionally left blank. BENEFIT CHART OF MEDICARE SUPPLEMENT PLANS SOLD FOR EFFECTIVE DATES ON OR AFTER JUNE 1, 2010

More information

Outline of Medicare Supplement Coverage Cover Page: 1 of 2 Benefit Plan A, Plan D, Plan F, Plan K and Plan L

Outline of Medicare Supplement Coverage Cover Page: 1 of 2 Benefit Plan A, Plan D, Plan F, Plan K and Plan L Outline of Medicare Supplement Coverage Cover Page: 1 of 2 Benefit Plan A, Plan D, Plan F, Plan K and Plan L Medicare Supplement insurance can be sold in only 12 standard plans plus two high-deductible

More information

MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE BENEFIT PLANS A, C AND F

MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE BENEFIT PLANS A, C AND F MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE BENEFIT PLANS A, C AND F Medicare supplement insurance can be sold in only 10 standard plans plus two high deductible

More information

Offered by. Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010

Offered by. Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010 SecureBlue This chart shows the benefits included in each of the standard Medicare Supplement plans. Every company must make available Plans A, B and C or F. Some plans may not be available in your state.

More information

OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, F AND G

OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, F AND G UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, F AND G These charts show the benefits included in each of the standard

More information

Hospitalization and preventive care paid at 100%; other basic benefits paid at 50% Basic, including 100% Part B coinsurance. 100% Part B coinsurance

Hospitalization and preventive care paid at 100%; other basic benefits paid at 50% Basic, including 100% Part B coinsurance. 100% Part B coinsurance Health First Insurance, Inc. OUTLINE OF COVERAGE 2014 Benefit Plans A, F, N Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010 This chart shows the benefits included in each of the

More information

OUTLINE OF COVERAGE. Regence Bridge. Medicare Supplement (Medigap) Plans

OUTLINE OF COVERAGE. Regence Bridge. Medicare Supplement (Medigap) Plans OUTLINE OF COVERAGE Regence Bridge Medicare Supplement (Medigap) Plans Regence BlueCross BlueShield of Utah is an Independent Licensee of the Blue Cross and Blue Shield Association 09713rep07355-ut UT

More information

A B C D F F* G K L M N. Basic Benefits. Basic Benefits* Skilled Nursing Facility Coinsurance Part A Deductible Part B. 50% Skilled Nursing Facility

A B C D F F* G K L M N. Basic Benefits. Basic Benefits* Skilled Nursing Facility Coinsurance Part A Deductible Part B. 50% Skilled Nursing Facility Outline of Medicare Supplement Coverage Standard Benefit for Plan A, Plan F, High Plan F*, Plan N, and Blue Plan65 Select Benefit for Plan F and Plan N This chart shows the benefits included in each of

More information

MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, C, D, F AND G

MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, C, D, F AND G OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, C, D, F AND G These charts show the benefits included in each of the standard Medicare supplement plans. Every company must make

More information

OREGON Basic, including 100% Part B coinsurance. Skilled Nursing Facility Coinsurance Part A Deductible Part B. Deductible

OREGON Basic, including 100% Part B coinsurance. Skilled Nursing Facility Coinsurance Part A Deductible Part B. Deductible Oxford Life Benefit Chart of Medicare Supplement Plans sold on or after June 15, 2015 Insurance Company This chart shows the benefits included in each of the standard Medicare supplement plans. Every company

More information

Skilled Nursing Facility Coinsurance. Skilled Nursing Facility Coinsurance Part A Deductible Part B. Part A Deductible Part B.

Skilled Nursing Facility Coinsurance. Skilled Nursing Facility Coinsurance Part A Deductible Part B. Part A Deductible Part B. Aetna Life Insurance Company Outline of Medicare Supplement Coverage Benefit Plans A, B, F, G and N are Offered Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010

More information

APPLICATION FOR MEDICARE SUPPLEMENT INSURANCE ILLINOIS

APPLICATION FOR MEDICARE SUPPLEMENT INSURANCE ILLINOIS HEARTLAND NATIONAL LIFE INSURANCE COMPANY Medicare Supplement Administrative Office: PO Box 2878, Salt Lake City, UT 84110-2878 APPLICATION FOR MEDICARE SUPPLEMENT INSURANCE ILLINOIS HNAPP2013IL (2014)

More information

Basic, including 100% Part B coinsurance Skilled Nursing Facility Coinsurance

Basic, including 100% Part B coinsurance Skilled Nursing Facility Coinsurance Group Health Options, Inc. Outline of Medicare Supplement Coverage - Cover Page Benefit Plans A, F, K and N See Outlines of Coverage sections for details about ALL plans These charts show the benefits

More information

A B C D F F* G K L M N Basic,

A B C D F F* G K L M N Basic, Outline of Medicare Supplement Coverage Benefit Plans A, D, and F Corporate Office Omaha, NE Administrative Services PO Box 10386 Des Moines, IA 50306 www.gomedico.com Toll-Free 1-800-228-6080 This chart

More information

Basic, Including 100% Part B Coinsurance. Part B Coinsurance. Coinsurance* 50% Skilled Nursing Facility Coinsurance. Skilled Nursing Facility

Basic, Including 100% Part B Coinsurance. Part B Coinsurance. Coinsurance* 50% Skilled Nursing Facility Coinsurance. Skilled Nursing Facility AMERICAN RETIREMENT LIFE INSURANCE COMPANY P. O. BOX 26580 AUSTIN, TX 78755-0580 866-459-4272 Outline of Medicare Supplement Coverage - Benefit Plans A, F, G and N This chart shows the benefits included

More information

Benefit Chart of Medicare Supplement Plans Sold On or After June 1, 2015

Benefit Chart of Medicare Supplement Plans Sold On or After June 1, 2015 Outline of Medicare Supplement Coverage Benefit Chart of Medicare Supplement Plans Sold On or After June 1, 2015 This chart shows the benefits included in each of the standard Medicare Supplement plans.

More information

Outline of Medicare Supplement Coverage - Standard Benefits for Plans A, B, C, F, High Deductible Plan F*, G, K, L and N

Outline of Medicare Supplement Coverage - Standard Benefits for Plans A, B, C, F, High Deductible Plan F*, G, K, L and N Outline of Medicare Supplement Coverage - Standard Benefits for Plans A, B, C, F, High Deductible Plan F*, G, K, L and N This chart shows the benefits included in each of the standard Medicare supplement

More information

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

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. OMAHA INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, D, F, AND G This chart shows the benefits included in each of the standard Medicare

More information

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

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. OMAHA INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, D, F, AND G This chart shows the benefits included in each of the standard Medicare

More information

Outline of Medicare Supplement Coverage

Outline of Medicare Supplement Coverage Outline of Medicare Supplement Coverage Benefit Plans A, C, F, L, N for 2016 Outline of Medicare Supplement Coverage Benefit Plans A, C, F, L, N for 2016 These charts show the benefits included in each

More information

Benefit Chart of Medicare Supplement Plans Sold On or After January 1, 2015

Benefit Chart of Medicare Supplement Plans Sold On or After January 1, 2015 19 North Main Street, Wilkes-Barre, Pennsylvania, 18711 Blue Cross of Northeastern Pennsylvania Benefit Chart of Medicare Supplement Plans Sold On or After January 1, 2015 BlueCare Security Benefit Plans

More information

Part B. Coinsurance. Skilled Nursing Facility. 50% Skilled Nursing Facility. Coinsurance. Coinsurance 75% Part A Deductible.

Part B. Coinsurance. Skilled Nursing Facility. 50% Skilled Nursing Facility. Coinsurance. Coinsurance 75% Part A Deductible. AMERICAN RETIREMENT LIFE INSURANCE COMPANY P. O. BOX 26580 AUSTIN, TX 78755-0580 866-459-4272 Outline of Medicare Supplement Coverage - Benefit Plans A, F, G and N This chart shows the benefits included

More information

MedicareBlue Supplement

MedicareBlue Supplement SM MedicareBlue Supplement Plans A, D, F, High Deductible F, and N 2015 Outlines of Coverage Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or after January 1, 2015 This chart shows

More information

UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company

UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE S UPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F AND G These charts show the benefits included in each of the standard

More information

Texas Department of Insurance

Texas Department of Insurance Texas Department of Insurance Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010 This chart shows the benefits included in each of the standard Medicare supplement

More information

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

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. GERBER LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans. Every

More information

Aetna Individual Medicare Supplement PlanSM

Aetna Individual Medicare Supplement PlanSM Aetna Individual Medicare Supplement PlanSM Aetna Life Insurance Company Outline of Medicare Supplement Coverage Benefit Plans A, B and F OOC-MD 18.02.312.1 MD (8/04) Outline of Medicare Supplement Coverage

More information

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, B, C, D, F AND G These charts show the benefits included in each of the standard Medicare supplement

More information

Plan F* Plan G. Basic, including 100% Basic, including 100% Basic, including 100% Part B coinsurance. Skilled nursing facility coinsurance

Plan F* Plan G. Basic, including 100% Basic, including 100% Basic, including 100% Part B coinsurance. Skilled nursing facility coinsurance Outline of Coverage UnitedHealthcare Insurance Company Overview of Available s Benefit Chart of Medicare Supplement s Sold on or After June 1, 2010 This chart shows the benefits included in each of the

More information

MedicareBlue Supplement SM

MedicareBlue Supplement SM MedicareBlue Supplement SM Important Information about the enclosed premiums and Medicare deductibles and cost-sharing amounts The MedicareBlue Supplement information enclosed in this Outline of Coverage

More information

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. UNITED WORLD LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, B, C, D, F, G, AND M These charts show the benefits included in each of

More information

A B C D F F* G K L M N Basic, Co-insurance. Skilled Nursing Facility Co-insurance 50% Part A. Skilled Nursing Facility. Part A Deductible Part B

A B C D F F* G K L M N Basic, Co-insurance. Skilled Nursing Facility Co-insurance 50% Part A. Skilled Nursing Facility. Part A Deductible Part B TRANSAMERICA PREMIER LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, G AND N SEE OUTLINES OF COVERAGE SECTIONS FOR DETAILS ABOUT ALL PLANS These charts show

More information

2015 Outline of Coverage Security 65 Medicare Supplement Plans. Plan A Plan B Plan C Plan H Plan H with Drug

2015 Outline of Coverage Security 65 Medicare Supplement Plans. Plan A Plan B Plan C Plan H Plan H with Drug 2015 Outline of Coverage Security 65 Medicare Supplement Plans Plan A Plan B Plan C Plan H Plan H with Drug Independence Blue Cross and Highmark Blue Shield Outline of Medicare Supplement Coverage Security

More information

MEDICARE SUPPLEMENT OUTLINE OF BENEFIT COVERAGE

MEDICARE SUPPLEMENT OUTLINE OF BENEFIT COVERAGE Shaded Sections show Benefit Plans A, B, C, F, High Deductible F*, M and N which are available These charts show the benefits included in each of the standard Medicare Supplement plans. Every company must

More information

2014 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F, High Deductible Plan F, G & N

2014 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F, High Deductible Plan F, G & N Anthem Blue Cross and Blue Shield Colorado Administrative Office: PO Box 9063, Oxnard, CA 93031-9063 Toll Free Telephone Number: 1-877-831-3000 Benefit Chart of Medicare Supplement Plans Sold for Effective

More information

Outline of Medicare Supplement Coverage

Outline of Medicare Supplement Coverage Outline of Medicare Supplement Coverage Effective January 1, 2015 301 S. Vine St., Urbana, IL 61801-3347 1-800-965-4022 TTY 711 HealthAllianceMedicare.org med-msoutcov-11 med-2105msoutcov-1114 November

More information

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

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans.

More information

Omaha Insurance Company Application Packet

Omaha Insurance Company Application Packet Omaha Insurance Company Application Packet Thank you for your interest in the Omaha Insurance Company Medicare Supplement plan! This application packet provides you with a link to the Online Application

More information

Skilled Nursing Facility Coinsurance Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible

Skilled Nursing Facility Coinsurance Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA An Independent Licensee of the Blue Cross and Blue Shield Association OUTLINE OF BLUE SELECT COVERAGE COVER PAGE 1 of 2: BENEFIT PLANS TRADITIONAL A and BLUE

More information

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

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans.

More information

Skilled Nursing Facility. Coinsurance. Skilled Nursing Facility. Coinsurance

Skilled Nursing Facility. Coinsurance. Skilled Nursing Facility. Coinsurance Equitable Life & Casualty Insurance Company Outline Of Medicare Supplement Plans Sold for Effective Date on or After June 1, 2010 These charts show the benefits included in each of the standard Medicare

More information

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

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans.

More information

A B C D F F* G K L M N. Basic Benefits. Basic Benefits* Skilled Nursing Facility Coinsurance Part A Deductible. 50% Skilled Nursing Facility

A B C D F F* G K L M N. Basic Benefits. Basic Benefits* Skilled Nursing Facility Coinsurance Part A Deductible. 50% Skilled Nursing Facility Outline of Medicare Supplement Coverage Standard Benefit for Plan A, Plan F, High Plan F*, Plan N, and Blue Plan65 Select SM Benefit for Plan F and Plan N This chart shows the benefits included in each

More information

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

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. OMAHA INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement

More information

Outline of coverage. January 2015 May 2015

Outline of coverage. January 2015 May 2015 January 2015 May 2015 Outline of coverage The federal government has asked us to provide this outline of coverage to help you decide which plan best fits your needs and meets your budget. D98, 10/14, SM

More information

Outline of coverage. June 2014 May 2015

Outline of coverage. June 2014 May 2015 June 2014 May 2015 Outline of coverage The federal government has asked us to provide this outline of coverage to help you decide which plan best fits your needs and meets your budget. D98, 3/14, SM Marks

More information

Outline of coverage. June 2015 - May 2016

Outline of coverage. June 2015 - May 2016 June 2015 - May 2016 Outline of coverage The federal government has asked us to provide this outline of coverage to help you decide which plan best fits your needs and meets your budget. D98, 2/15, SM

More information

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

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. OMAHA INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement

More information

Skilled Nursing Facility. Coinsurance. Skilled Nursing Facility. Coinsurance

Skilled Nursing Facility. Coinsurance. Skilled Nursing Facility. Coinsurance Equitable Life & Casualty Insurance Company Outline Of Medicare Supplement Plans Sold for Effective Date on or After June 1, 2010 These charts show the benefits included in each of the standard Medicare

More information

Basic, including 100% Part B coinsurance* Basic, including 100% Part B coinsurance. Skilled Nursing Facility Coinsurance Part A Deductible

Basic, including 100% Part B coinsurance* Basic, including 100% Part B coinsurance. Skilled Nursing Facility Coinsurance Part A Deductible (Agency Note: Proposed new N.J.A.C. 11:4-23 Appendix Exhibit D reproduced below is not depicted in boldface, as would be the standard format for proposed new text, in order for the permanent boldfacing

More information

Basic, including 100% Part B. Part B co- Skilled Nursing Facility Coinsurance. Skilled Nursing. Skilled Nursing Facility Coinsurance

Basic, including 100% Part B. Part B co- Skilled Nursing Facility Coinsurance. Skilled Nursing. Skilled Nursing Facility Coinsurance UNITED OF OMAHA LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, F, G, and M These charts show the benefits included in each of the

More information

A B C D F F* G K L M N. Basic, including 100% Part B Coinsurance. Part B. 75% Skilled Nursing Facility. Part B. Deductible

A B C D F F* G K L M N. Basic, including 100% Part B Coinsurance. Part B. 75% Skilled Nursing Facility. Part B. Deductible This chart shows the benefits included in each of the standard supplement plans sold for effective dates on or after June 1, 2010. Every company must make Plan A available. Blue Cross and Blue Shield of

More information

AFLAC MEDICARE SUPPLEMENT

AFLAC MEDICARE SUPPLEMENT AFLAC MEDICARE SUPPLEMENT P E N N S Y LVA N I A 2 0 13 IC(1/13) AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS Outline of Medicare Supplement Coverage Benefit Plans A, B, C, D, F, G and N Benefit

More information

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

Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. OMAHA INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement

More information

2014 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F & N

2014 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F & N Anthem Blue Cross and Blue Shield Virginia Administrative Office: P.O. Box 27401, Richmond, VA 23279-7401 Toll Free Telephone Number: 1-800-916-2583 Benefit Chart of Medicare Supplement Plans Sold for

More information

Basic, including 100% Part B coinsurance 2

Basic, including 100% Part B coinsurance 2 Highmark Blue Cross Blue Shield Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010 MEDIGAP BLUE - Benefit Plans A, B, C, F, High F and N This chart shows the benefits included in

More information

Basic, including. Hospitalization and preventive care paid. 50% Skilled Nursing. Part A Deductible. 50% Part A. Deductible

Basic, including. Hospitalization and preventive care paid. 50% Skilled Nursing. Part A Deductible. 50% Part A. Deductible United of Omaha Life Insurance Company A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, C, F, HIGH DEDUCTIBLE F, G, M AND N This chart shows the benefits included

More information

Skilled Nursing Facility Coinsurance. Part A Deductible Part B. Deductible. Part B Excess- 100% Foreign Travel Emergency

Skilled Nursing Facility Coinsurance. Part A Deductible Part B. Deductible. Part B Excess- 100% Foreign Travel Emergency Aetna Life Insurance Company Outline of Medicare Supplement Coverage Benefit Plans A, B, F, G and N are Offered Benefit Chart of Medicare Supplement Plans Sold with an Effective Date for Coverage on or

More information

Basic Benefits Skilled Nursing Facility Coinsurance Part A Deductible

Basic Benefits Skilled Nursing Facility Coinsurance Part A Deductible MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 STANDARDIZED BENEFIT PLAN A AND SELECT BENEFIT PLANS B, C, D, E, F AND G These charts show the benefits included

More information

Medicare Supplement Coverage Options

Medicare Supplement Coverage Options Medicare Supplement Coverage Options Thank you for your interest in our Medicare Supplemental coverage options, also known as HealthNow New York Inc. Medicare Supplement (Medigap) plans. The Medicare Supplement

More information

Outline of Medicare Supplement Coverage

Outline of Medicare Supplement Coverage Outline of Medicare Supplement Coverage for Vermont residents Medicare supplement benefit plans with Dental and Vision: A, F, High Deductible F, K, and N Humana Reader s Digest Healthy Living Medicare

More information

Basic, including 100% Part B coinsurance. Skilled Nursing Facility Coinsuranc e Part A Deductible Part B

Basic, including 100% Part B coinsurance. Skilled Nursing Facility Coinsuranc e Part A Deductible Part B Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010 This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must

More information

HealthNow New York Inc. Mailing address: PO BOX 15013, Albany, New York 12212-5012 Physical address: 30 Century Hill Drive, Latham, New York 12110

HealthNow New York Inc. Mailing address: PO BOX 15013, Albany, New York 12212-5012 Physical address: 30 Century Hill Drive, Latham, New York 12110 HealthNow New York Inc. Mailing address: PO BOX 15013, Albany, New York 12212-5012 Physical address: 30 Century Hill Drive, Latham, New York 12110 Benefit Chart of Medicare Supplement Plans Sold for Effective

More information

Outline of Medicare Supplement Coverage Benefit Plans A, Select B, Select D and Select E

Outline of Medicare Supplement Coverage Benefit Plans A, Select B, Select D and Select E Outline of Medicare Supplement Coverage Benefit Plans A, Select B, Select D and Select E To review the benefit details, please click your county below: Alachua, Bay, Bradford, Brevard, Charlotte, Citrus,

More information

Medicare Supplement Coverage Options

Medicare Supplement Coverage Options A Division of HealthNow New York Inc. An Independent Licensee of the BlueCross BlueShield Association. Medicare Supplement Coverage Options Thank you for your interest in our Medicare Supplemental coverage

More information

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. UNITED WORLD LIFE INSURANCE COMPANY A Mutual of Omaha Company OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, B, C, D, F, G, M AND N These charts show the benefits included in each

More information

Medicare Supplement Coverage Options

Medicare Supplement Coverage Options Medicare Supplement Coverage Options Thank you for your interest in our Medicare Supplemental coverage options, also known as HealthNow New York Inc. Medicare Supplement (Medigap) plans. The Medicare Supplement

More information

HealthNow New York Inc. Mailing address: PO BOX 13599, Albany, New York 12214-5767 Physical address: 30 Century Hill Drive, Latham, New York 12110

HealthNow New York Inc. Mailing address: PO BOX 13599, Albany, New York 12214-5767 Physical address: 30 Century Hill Drive, Latham, New York 12110 HealthNow New York Inc. Mailing address: PO BOX 13599, Albany, New York 12214-5767 Physical address: 30 Century Hill Drive, Latham, New York 12110 Benefit Chart of Medicare Supplement Plans Sold for Effective

More information

Aetna Life Insurance Company Outline of Medicare Supplement Coverage

Aetna Life Insurance Company Outline of Medicare Supplement Coverage Aetna Life Insurance Company Outline of Medicare Supplement Coverage Benefit Plans A, B, F, G and N are Offered This chart shows the benefits included in each of the standard Medicare supplement plans.

More information

100% of Medicare-eligible expenses Beyond the additional 365 $0 $0 $0 $0

100% of Medicare-eligible expenses Beyond the additional 365 $0 $0 $0 $0 Medicare Supplement Policy Comparison Chart Effective January 1, 2015 Medicare Supplement or BlueCare Plans A, B and C Part A Hospital Insurance Covered Services SERVICE MEDICARE PAYS PLAN A PAYS PLAN

More information

20:06:12:07. Guidelines for examination reports. The insurer's examination report shall be

20:06:12:07. Guidelines for examination reports. The insurer's examination report shall be 20:06:12:07. Guidelines for examination reports. The insurer's examination report shall be prepared in accordance with standards adopted by the National Association of Insurance Commissioners in the Financial

More information

A B C D F F* G K L M N. Basic, including 100% Part B Coinsurance. Part B. Skilled Nursing Facility Coinsurance Part A Deductible Part B

A B C D F F* G K L M N. Basic, including 100% Part B Coinsurance. Part B. Skilled Nursing Facility Coinsurance Part A Deductible Part B This chart shows the benefits included in each of the standard Medicare supplement plans sold for effective dates on or after June 1, 2010. Every company must make Plan A available. Blue Cross and Blue

More information

Simply BLUE MEDICARE SUPPLEMENT PLANS SR BRO 2013.1.A

Simply BLUE MEDICARE SUPPLEMENT PLANS SR BRO 2013.1.A Simply BLUE MEDICARE SUPPLEMENT PLANS 2013 SR BRO 2013.1.A Simply BLUE Table of Contents Standard Benefit Offerings... 2 Disclosures... 3 Important Facts to Consider... 4 Supplement Plan Premiums... 5

More information

2015 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F & N

2015 Outline of Medicare Supplement Coverage Cover Page (1 of 2) Plans A, F & N nthem Blue Cross and Blue Shield Connecticut dministrative Office: 370 Bassett Road, North Haven, CT 06473 Toll Free Telephone Number: 1-800-238-1143 2015 Outline of Medicare Supplement Coverage Cover

More information

Basic, including 100% Part B Coinsurance. Basic, including 100% Part B Coinsurance * Skilled Nursing Facility Coinsurance Part A Deductible Part B

Basic, including 100% Part B Coinsurance. Basic, including 100% Part B Coinsurance * Skilled Nursing Facility Coinsurance Part A Deductible Part B This chart shows the benefits included in each of the standard Medicare supplement plans sold for effective dates on or after June 1, 2010. Every company must make Plan A available. Blue Cross and Blue

More information

Health plans for every body

Health plans for every body Health plans for every body Supplemental coverage for Medicare members Medicare modahealth.com/medicare Available April 1 through Dec. 31, 2015 Hello. Welcome to Moda Health, the place you go when you

More information

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.

Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing. UNITED OF OMAHA LIFE INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, G, AND M These charts show the benefits included in each of the standard Medicare supplement

More information

Simply BLUE MEDICARE SUPPLEMENT PLANS SR BRO 2015

Simply BLUE MEDICARE SUPPLEMENT PLANS SR BRO 2015 Simply BLUE MEDICARE SUPPLEMENT PLANS 2015 SR BRO 2015 Simply BLUE Table of Contents Standard Benefit Offerings...2 Disclosures...3 Important Facts to Consider...4 Supplement Plan Premiums...5 Benefit

More information