Page 108 - Cover Letter & Evaluation for Carol Evans

Medicare Select and
Medicare Supplement
Insurance Plans
Guide to Health
Insurance for People with
Medicare
Plan Overview
Rules and Disclosures

Plan A monthly
premium Resume Saved
Application

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application or see the
status of your submitted
View plan details
application.
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Additional Services ††

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additional services
available.
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$90.56 Benefits Benefit Table

100%
Basic Benefits:
Lowest Estimated Monthly Rate*
Part A Deductible: --
The rate is for a non-tobacco user and is
based on the information you entered. Your Part B Deductible: --
actual monthly rate will be determined when
you apply. Part B Excess Charges: --
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Skilled Nursing Facility Coinsurance: --
Foreign Travel Emergency Care
(up to plan limits)** : --

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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.

Plan B (4 of 10 Plans)

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B fi T bl