Page 54 - APPENDICES for Stephen Spero

Telehealth

Some coverage

Worldwide emergency
Some coverage

Optional packages

This plan includes optional bene ts you can add to your coverage at an additional cost.

Package #1 Includes preventive dental services

Monthly premium: $12.00
Deductible: N/A

Package #2 Includes preventive dental services, comprehensive dental services, and eyewear
Monthly premium: $31.00

Deductible: N/A

Package #3 Includes preventive dental services, comprehensive dental services, and eyewear
Monthly premium: $51.00
Deductible: N/A

Drug coverage & costs

See if there's help to lower costs for drugs you take.

Plans group their drug lists into tiers. The table below shows your portion of the drug cost in certain
tiers based on which coverage phase you're in for this plan

Learn more about drug tiers

TIER DRUG COST FOR