STANDARDIZED MEDICARE SUPPLEMENT PLANS

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Plan A	Plan B	Plan C	Plan D	Plan E	Plan F*	Plan G	Plan H	Plan I	Plan J*
Basic Benefits	Basic Benefits	Basic Benefits	Basic Benefits	Basic Benefits	Basic Benefits	Basic Benefits	Basic Benefits	Basic Benefits	Basic Benefits
	Part A Deductible	Part A Deductible	Part A Deductible	Part A Deductible	Part A Deductible	Part A Deductible	Part A Deductible	Part A Deductible	Part A Deductible
		Part B Deductible			Part B Deductible				Part B Deductible
					Part B Excess 100%	Part B Excess 80%		Part B Excess 100%	Part B Excess 100%
		Skilled Nursing Facility Co-Insurance	Skilled Nursing Facility Co-Insurance	Skilled Nursing Facility Co-Insurance	Skilled Nursing Facility Co-Insurance	Skilled Nursing Facility Co-Insurance	Skilled Nursing Facility Co-Insurance	Skilled Nursing Facility Co-Insurance	Skilled Nursing Facility Co-Insurance
		Foreign Travel Emergency	Foreign Travel Emergency	Foreign Travel Emergency	Foreign Travel Emergency	Foreign Travel Emergency	Foreign Travel Emergency	Foreign Travel Emergency	Foreign Travel Emergency
			At Home Recovery			At Home Recovery		At Home Recovery	At Home Recovery
				Preventive Care					Preventive Care
							Basic Drugs ($1,250.00) limit $250 deductible. 50% copay	Basic Drugs ($1,250.00) limit $250 deductible. 50% copay	Basic Drugs ($3,000.00) limit $250 deductible. 50% copay
Blood First 3 pints	Blood First 3 pints	Blood First 3 pints	Blood First 3 pints	Blood First 3 pints	Blood First 3 pints	Blood First 3 pints	Blood First 3 pints	Blood First 3 pints	Blood First 3 pints
Plan A	Plan B	Plan C	Plan D	Plan E	Plan F/F*	Plan G	Plan H	Plan I	Plan J/J*

* Plan F and J have a high deductible option called High Deductible Plan F and High Deductible Plan J. These plans have the same benefits as plans F and J after a $1,730 deductible has been met during the calendar year. Benefits do not begin until out of pocket expenses paid are $1,730. Out of pocket expenses are those that the policy would ordinarily pay. Part A and B deductibles count towards the $1,730 deductible but do not apply to the separate Plan J prescription deductible. These deductibles increase.