ALTERNATIVE # 2: ACTIVE OR RETIRED, AGE 65 & OVER,
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Available in NEW YORK Only |
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| FIRST UNITED |
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| MEDI-GAP PLAN F PAYS |
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| |
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| Part A Deductible of Medicare |
| 61st day to 90th day |
198 a day |
| 91st day & after – using 60 lifetime reserve days |
396 a day |
| Once Lifetime Reserve Days are used: |
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| Additional 365 days |
100% of
Medicare
Eligible Expenses |
| |
|
| Skilled Nursing Facility Care |
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| 21st day to 100th day |
Up to $99
per day |
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| Blood |
Up to 3 pints |
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| Part B Doctors and Surgeons |
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| Medicare deductible – approved amounts |
$100 |
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| Part B Deductible |
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| Excess Charges |
20% |
| Above Medicare Approved Amounts |
100% |
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Quarterly Rate: $611.00
Available in New York Only
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Optional Drug Plan through NDHS (National Discount Healthcare Solutions) which can be purchased with the above Medi-Gap Plan. This drug plan cannot be sold without the Medi-Gap plan.
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| Cost of Prescriptions: |
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| Formulary/Generic Drugs |
$10 co pay per RX |
| Formulary/Brand Drugs |
$20 co pay per RX |
| Non Formulary Drugs – AWP (Average Wholesale Price) |
up to 45% |
| |
| Cost of RX Plan (includes vision and dental benefits): |
| Individual |
$ 90.00 per quarter |
| Family |
$120.00 per quarter |
| No Age Restrictions |
| |
Retiree
Medical Coverage
