Page 90 - APPENDICES for Fred Falten

Selected drugs Package Quantity Frequency Brand/Generic

Tamsulosin hydrochloride 0.4mg Every
60 Generic
capsule month

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PART B DRUGS

Chemotherapy drugs
In-network: 20% coinsurance

Out-of-network: 30% coinsurance

Limits apply

Other Part B drugs
In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Limits apply

Star ratings

OVERALL STAR RATING

HEALTH PLAN STAR RATINGS

DRUG PLAN (PART D) STAR RATING

Contact information