Page 109 - Cover Letter and Evaluation for John

10/9/2018 Your Plan Results
SCAN Prime (HMO) (H5425-067-0)
Organization: SCAN Health Plan
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star Rating:
Costs: [?] [?] Copay [?] / Restrictions [?] Health and [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $23.00 Annual Drug Doctor All Your Drugs on $11,990 Coming Soon Enrollment begins
Deductible: $0 Choice: Plan Formulary :No October 15, 2018
Pharmacy Drug: $0.00 Doctors for
Status: Health: Health Plan Most Services Drug Restrictions:
Preferred Cost- $23.00 Deductible: $0 No
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: Spending Costs
Annual: $9,839 Premium $0 - $95, 33% Limit: $2,400
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $9,545
SCAN Classic II (HMO) (H5425-061-0)
Organization: SCAN Health Plan
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star Rating:
Costs: [?] [?] Copay [?] / Restrictions [?] Health and [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $12,720 Coming Soon Enrollment begins
Deductible: $0 Choice: Plan Formulary :No October 15, 2018
Pharmacy Drug: $0.00 Doctors for
Status: Health: Health Plan Most Services Drug Restrictions:
Preferred Cost- $0.00 Deductible: $0 No
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: Spending Costs
Annual: $9,911 Premium $2 - $95, 33% Limit: $5,000
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $9,545
SCAN Plus (HMO) (H5425-045-0)
Organization: SCAN Health Plan
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star Rating:
Costs: [?] [?] Copay [?] / Restrictions [?] Health and [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $34.80 Annual Drug Doctor All Your Drugs on $13,040 Coming Soon Enrollment begins
Deductible: Choice: Plan Formulary :No October 15, 2018
Pharmacy Drug: $415 Doctors for
Status: $34.80 Most Services Drug Restrictions:
Preferred Cost- Health: Health Plan No
Sharing $0.00 Deductible: Out of Pocket Lower Your Drug
Coming soon Spending Costs
Annual: Part B Drug Copay/ Limit: $6,700
$10,233 Premium Coinsurance: In-network MTM Program :
Reduction $0, 25% Yes
Mail Order :No
Annual:
$10,269
Golden State (HMO) (H2241-007-1)
Organization: Golden State
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star Rating:
Costs: [?] [?] Copay [?] / Restrictions [?] Health and [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]

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