Page 60 - Cover Letter & Evaluation for Michael Novotny

6/9/2018 Your Plan Results
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $2,900 Enroll
Annual: $0.00 Deductible: $0 Choice: Plan Formulary :N/A
Drug: $0.00 Doctors for 4.5 out of 5
Mail Order Health: Health Plan Most Services Drug Restrictions: stars
Annual: N/A $0.00 Deductible: $0 Out of Pocket N/A
Drug Copay/
Part B Coinsurance: Spending MTM Program :
Premium $4 - $100, 33% Limit: $4,900 Yes
Reduction In-network
:No

Alignment Health Plan smartHMO (HMO) (H3815-013-0)
Organization: Alignment Health Plan
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $1,900 Enroll
Annual: $0.00 Deductible: $0 Choice: Plan Formulary :N/A
Drug: $0.00 Doctors for 4.5 out of 5
Mail Order Health: Health Plan Most Services Drug Restrictions: stars
Annual: N/A $0.00 Deductible: $0 Out of Pocket N/A
Drug Copay/
Part B Coinsurance: Spending MTM Program :
Premium $5 - $75, 33% Limit: $3,400 Yes
Reduction In-network
:Yes

Anthem StartSmart Plus (HMO) (H0544-007-0)
Organization: Anthem Blue Cross
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $1,610 Enroll
Annual: $0.00 Deductible: $0 Choice: Plan Formulary :N/A
Drug: $0.00 Doctors for 4.5 out of 5
Mail Order Health: Health Plan Most Services Drug Restrictions: stars
Annual: N/A $0.00 Deductible: $0 Out of Pocket N/A
Drug Copay/
Part B Coinsurance: Spending MTM Program :
Premium $5 - $95, 33% Limit: $3,000 Yes
Reduction In-network
:Yes

Alignment Health Plan Platinum (HMO) (H3815-008-0)
Organization: Alignment Health Plan
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $1,880 Enroll
Annual: $0.00 Deductible: $0 Choice: Plan Formulary :N/A
Drug: $0.00 Doctors for 4.5 out of 5
Mail Order Health: Health Plan Most Services Drug Restrictions: stars
Annual: N/A $0.00 Deductible: $0 Out of Pocket N/A
Drug Copay/
Part B Coinsurance: Spending MTM Program :
Premium $0 - $75, 33% Limit: $1,499 Yes
Reduction In-network
:No

SCAN Classic (HMO) (H5425-007-0)
Organization: SCAN Health Plan

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