Page 107 - Cover Letter & Evaluation for Carol Evans
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Plan F (1 of 10 Plans)
1-888-378-0849
Most Popular^ (TTY 711)
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7AM-11PM ET, Monday-
Friday
$145.12 Benefits Benefit Table 9AM-5PM ET, Saturday
100%
Basic Benefits:
Lowest Estimated Monthly Rate*
Part A Deductible: 100% Meet with a
The rate is for a non-tobacco user and is licensed
based on the information you entered. Your Part B Deductible: 100% insurance agent
actual monthly rate will be determined when
you apply. Part B Excess Charges: 100% Make an appointment with
Edit your information a licensed insurance
Skilled Nursing Facility Coinsurance: 100% agent.
Foreign Travel Emergency Care
(up to plan limits)** : 80%
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*Rates shown are based on the information entered and are for the current month. All rates are subject to change. Any rate
change will apply to all members of the same class insured under your plan who reside in your state/area.
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Plan G (2 of 10 Plans)
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