Page 66 - Cover Letter & Evaluation for Michael Novotny

6/9/2018 Your Plan Results
Retail $28.50 Annual Drug Doctor All Your Drugs on $2,470 Enroll
Annual: Deductible: $0 Choice: Plan Formulary :N/A
$342.00 Drug: Doctors for 4.5 out of 5
$28.50 Health Plan Most Services Drug Restrictions: stars
Mail Order Health: Deductible: $0 N/A
Annual: N/A $0.00 Drug Copay/ Out of Pocket
Coinsurance: Spending MTM Program :
Part B $0 - $100, 33% Limit: $1,500 Yes
Premium In-network
Reduction
:No
SCAN Plus (HMO) (H5425-037-0)
Organization: SCAN 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 $32.50 Annual Drug Doctor All Your Drugs on $3,640 Enroll
Annual: Deductible: Choice: Plan Formulary :N/A
$390.00 Drug: $405 Doctors for 4.5 out of 5
$32.50 Most Services Drug Restrictions: stars
Mail Order Health: Health Plan N/A
Annual: N/A $0.00 Deductible: Out of Pocket MTM Program :
$183 per year
Spending
Part B for in-network Limit: $6,700 Yes
Premium services. In-network
Reduction Drug Copay/
:No Coinsurance:
$0, 25%
Anthem Connect Plus (HMO) (H0544-049-0)
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 $33.00 Annual Drug Doctor All Your Drugs on $3,780 Enroll
Annual: Deductible: Choice: Plan Formulary :N/A
$396.00 Drug: $405 Doctors for 4.5 out of 5
$33.00 Most Services Drug Restrictions: stars
Mail Order Health: Health Plan N/A
Annual: N/A $0.00 Deductible: Out of Pocket MTM Program :
$183 per year
Spending
Part B for in-network Limit: $6,700 Yes
Premium services. In-network
Reduction Drug Copay/
:No Coinsurance:
25%
Anthem MediBlue Coordination Plus (HMO) (H0544-072-0)
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 $35.50 Annual Drug Doctor All Your Drugs on $3,700 Enroll
Annual: Deductible: Choice: Plan Formulary :N/A
$426.00 Drug: $405 Doctors for 4.5 out of 5
$35.50 Most Services Drug Restrictions: stars
Mail Order Health: Health Plan N/A
Annual: N/A $0.00 Deductible: $0 Out of Pocket
Drug Copay/ Spending MTM Program :
Part B Coinsurance: Limit: $6,700 Yes
Premium $0 - $95, 25% In-network
Reduction
:No
Alignment Health Plan CalPlus (HMO) (H3815-009-0)
Organization: Alignment Health Plan

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