Page 67 - 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 $35.50 Annual Drug Doctor All Your Drugs on $3,110 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
Spending
Drug Copay/ MTM Program :
Part B Coinsurance: Limit: $3,400 Yes
Premium $5 - $93, 25% In-network
Reduction
:No
Health Net Seniority Plus Sapphire Premier (HMO) (H3561-002-0)
Organization: HEALTH NET COMMUNITY SOLUTIONS, INC.
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 $3,410 Enroll
Annual: Deductible: $85 Choice: Plan Formulary :N/A
$426.00 Drug: Doctors for 4 out of 5
$35.50 Health Plan Most Services Drug Restrictions: stars
Mail Order Health: Deductible: $0 N/A
Annual: N/A $0.00 Drug Copay/ Out of Pocket
Spending
Coinsurance: MTM Program :
Part B $0 - $100, 31% Limit: $6,700 Yes
Premium In-network
Reduction
:No
Health Net Seniority Plus Sapphire (HMO) (H0562-111-1)
Organization: Health Net of California
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 $3,410 Enroll
Annual: Deductible: Choice: Plan Formulary :N/A
$426.00 Drug: $240 Doctors for 3.5 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
Spending
Drug Copay/ MTM Program :
Part B Coinsurance: Limit: $6,700 Yes
Premium $0 - $100, 28% In-network
Reduction
:No
Central Health Premier Plan (HMO) (H5649-004-0)
Organization: Central Health Medicare 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 $35.50 Annual Drug Doctor All Your Drugs on $3,630 Enroll
Annual: Deductible: Choice: Plan Formulary :N/A
$426.00 Drug: $405 Doctors for 3.5 out of 5
$35.50 Most Services Drug Restrictions: stars
Mail Order Health: Health Plan N/A
Annual: N/A $0.00 Deductible: Out of Pocket MTM Program :
Spending
$183 per year
Part B for in-network Limit: $6,700 Yes
Premium services. In-network
Reduction Drug Copay/
:No Coinsurance:
$0 - $10, 25%

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