Page 80 - APPENDICES for Bob Woods
P. 80
!"#$%&'()*+,-.+&/%0578:;<
<
=
>>?@/+*A@,/B*C)&DAE'A
12$3456789
FGGHIJ
KL
%&'()*+,MDM'N/EO*DHJJQ<
RQSSV#" ZZ[#W\ZY YUZW]W^Y!Z^ _#HYH`V# a#a#Z[YVZ[Y!Z^W"ZW ZZU V#]W^Y"
FPJJU V#W#XYYWZ^" V#W]W^Y Y Z #WYaY#]Z[V\V\Zb#W#"VY#!Z^XW#UZW V
c#W?ED&M&'(
T##\ZY \#W #WdZW#aZ^ ]W^ #WYN@e/f@&T ]W]W# "VWd\!]W^\ZY UZWPgdZ V
This is the benefit summary of the
lowest-cost stand-alone drug plan.

