New Medicare Supplement Insurance · 2019. 10. 24. · BENEFIT PLANS AVAILABLE: A, B, F, HF, G & N...

Outline of coverageMedicare Supplement Insurance

Benefit plans: A, B, F, H, G, N

Deleware

Underwritten by

Aetna Health and Life Insurance Company

aetnaseniorproducts.comAHLMS05035DE ©2019 Aetna Inc. Rates effective: 02/2019 B

http://aetnaseniorproducts.com

AETNA HEALTH AND LIFE INSURANCE COMPANYOUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE:

BENEFIT PLANS AVAILABLE: A, B, F, HF, G & N

This chart shows the benefits included in each of the standard Medicare supplement plans. Every companymust make Plan "A" available. Some plans may not be available. Only applicants first eligible for Medicarebefore 2020 may purchase Plans C, F, and high deductible F.Note: A ✓ means 100% of the benefit is paid.

Benefits Plans Available to All Applicants

A B D G1 K L M N

Medicare first eligible before 2020 only C F1

Medicare Part A coinsurance and hospital coverage (up to an additional 365 days after Medicare benefits are used up)

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Medicare Part B coinsurance or copayment ✓ ✓ ✓ ✓ 50% 75% ✓

✓

copays apply3

✓ ✓

Blood (first three pints) ✓ ✓ ✓ ✓ 50% 75% ✓ ✓ ✓ ✓Part A hospice care coinsurance or copayment ✓ ✓ ✓ ✓ 50% 75% ✓ ✓ ✓ ✓

Skilled nursing facility coinsurance ✓ ✓ 50% 75% ✓ ✓ ✓ ✓Medicare Part A deductible ✓ ✓ ✓ 50% 75% 50% ✓ ✓ ✓Medicare Part B deductible ✓ ✓Medicare Part B excess charges ✓ ✓Foreign travel emergency (up to plan limits) ✓ ✓ ✓ ✓ ✓ ✓

Out-of-pocket limit in 20192 $5,5602 $2,7802

1 Plans F and G also have a high deductible option, which require first paying a plan deductible of $2,300 before the plan begins to pay. Once the plan deductible is met, the plan pays 100% of covered services for the rest of the calendar year. High deductible plan G does not cover the Medicare Part B deductible. However, high deductible plans F and G count your payment of the Medicare Part B deductible toward meeting the plan deductible. 2 Plans K and L pay 100% of covered services for the rest of the calendar year once you meet the out-of-pocket yearly limit. 3 Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that do not result in an inpatient admission.

AHLMS05035DE 1 02/2019 B

Aetna Health and Life Insurance CompanyAnnual Attained A ge Premiums

For Use in ZIP Codes: Entire State

Female Rates

Rates Effective 2/1/2019

Attained

Age

Preferred

Plan A Plan B Plan F Plan HF Plan G Plan N

Under 65 (ESRD) 25,290 29,114 37,616 25,732 26,164 19,852

Under 65 (non-ESRD) 5,248 6,023 7,777 2,380 5,408 4,100

65 1,552 1,748 2,245 688 1,556 1,176

66 1,596 1,806 2,323 711 1,611 1,217

67 1,638 1,862 2,395 733 1,663 1,258

68 1,680 1,916 2,470 756 1,716 1,299

69 1,723 1,971 2,544 778 1,766 1,339

70 1,766 2,025 2,615 800 1,818 1,379

71 1,806 2,080 2,688 822 1,869 1,418

72 1,846 2,131 2,759 844 1,920 1,457

73 1,880 2,187 2,833 867 1,975 1,499

74 1,916 2,239 2,905 889 2,026 1,541

75 1,950 2,291 2,979 911 2,080 1,583

76 1,984 2,341 3,050 933 2,130 1,624

77 2,018 2,394 3,123 956 2,183 1,665

78 2,040 2,442 3,193 978 2,236 1,708

79 2,061 2,490 3,263 999 2,290 1,751

80 2,082 2,536 3,335 1,021 2,342 1,794

81 2,103 2,584 3,405 1,042 2,395 1,836

82 2,124 2,630 3,474 1,064 2,446 1,878

83 2,152 2,672 3,541 1,084 2,501 1,923

84 2,178 2,715 3,611 1,105 2,553 1,968

85 2,200 2,748 3,670 1,124 2,600 2,007

86 2,220 2,784 3,730 1,141 2,648 2,048

87 2,242 2,818 3,790 1,160 2,696 2,090

88 2,265 2,853 3,852 1,179 2,746 2,132

89 2,286 2,890 3,915 1,198 2,793 2,174

90 2,309 2,922 3,974 1,216 2,843 2,216

91 2,329 2,957 4,034 1,235 2,890 2,257

92 2,352 2,991 4,092 1,253 2,938 2,298

93 2,375 3,024 4,150 1,271 2,984 2,337

94 2,398 3,057 4,207 1,287 3,031 2,377

95 2,421 3,088 4,263 1,305 3,076 2,416

96 2,444 3,118 4,320 1,322 3,120 2,454

97 2,468 3,150 4,374 1,339 3,166 2,492

98 2,492 3,180 4,428 1,356 3,207 2,530

99+ 2,517 3,210 4,481 1,371 3,251 2,566

Attained

Age

Standard


Under 65 (ESRD) 28,099 32,350 41,796 28,592 29,072 22,058

Under 65 (non-ESRD) 5,832 6,694 8,643

2,645 6,009 4,556

65 1,724 1,943 2,495 764 1,729 1,307

66 1,772 2,007 2,579 790 1,789 1,352

67 1,820 2,069 2,663 815 1,847 1,398

68 1,867 2,129 2,745 840 1,907 1,443

69 1,914 2,191 2,825 864 1,964 1,488

70 1,962 2,250 2,906 889 2,020 1,532

71 2,007 2,311 2,987 914 2,076 1,576

72 2,050 2,369 3,065 938 2,133 1,619

73 2,091 2,429 3,147 964 2,193 1,666

74 2,129 2,486 3,229 988 2,252 1,712

75 2,167 2,545 3,309 1,012 2,310 1,759

76 2,204 2,602 3,390 1,037 2,368 1,804

77 2,242 2,661 3,468 1,062 2,426 1,850

78 2,267 2,712 3,549 1,086 2,485 1,898

79 2,291 2,766 3,625 1,110 2,544 1,946

80 2,313 2,818 3,706 1,134 2,603 1,993

81 2,337 2,870 3,784 1,157 2,659 2,040

82 2,361 2,922 3,859 1,182 2,718 2,087

83 2,391 2,969 3,935 1,204 2,778 2,137

84 2,420 3,017 4,011 1,227 2,836 2,187

85 2,444 3,053 4,078 1,248 2,888 2,230

86 2,468 3,092 4,144 1,268 2,941 2,276

87 2,492 3,132 4,211 1,289 2,995 2,322

88 2,517 3,170 4,280 1,310 3,050 2,369

89 2,540 3,210 4,348 1,331 3,104 2,416

90 2,565 3,247 4,417 1,351 3,158 2,462

91 2,590 3,285 4,481

1,372 3,212 2,508

92 2,615 3,322 4,546 1,392 3,264 2,553

93 2,640 3,360 4,611 1,411 3,317 2,597

94 2,665 3,395 4,675 1,430 3,367 2,641

95 2,691 3,431 4,738 1,450 3,418 2,684

96 2,716 3,466 4,800 1,469 3,467 2,727

97 2,742 3,500 4,860 1,488 3,516 2,769

98 2,769 3,534 4,921 1,506 3,564 2,811

99+ 2,796 3,566 4,979 1,524 3,612 2,851

Modal Factors: Semi-Annual: 0.5200 Quarterly: 0.2650 Monthly: 0.0833

The above rates do not include the $20 application fee.

To calculate a Household discount:

Annual premium x modal factor = modal premium (round to nearest whole cent)

Modal premium x .93 = discounted premium

If applying during Open Enrollment or Guaranteed Issue Period, use Preferred rates.

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Aetna Health and Life Insurance CompanyAnnual Attained A ge Premiums

For Use in ZIP Codes: Entire State

Male Rates

Rates Effective 2/1/2019

Attained

Age

Preferred


Under 65 (ESRD) 29,083 33,482 43,259 29,592 30,089 22,830

Under 65 (non-ESRD) 6,035 6,928 8,945 2,737 6,219 4,715

65 1,785 2,011 2,582 791 1,789 1,352

66 1,836 2,076 2,669 818 1,851 1,400

67 1,885 2,141 2,756 843 1,912 1,447

68 1,931 2,203 2,841 869 1,973 1,494

69 1,981 2,267 2,926 895 2,032 1,540

70 2,030 2,329 3,008 920 2,090 1,586

71 2,076 2,391 3,091 945 2,151 1,631

72 2,123 2,451 3,173 971 2,207 1,676

73 2,164 2,514 3,258 998 2,270 1,724

74 2,203 2,573 3,342

1,023 2,330 1,772

75 2,242 2,635 3,425 1,048 2,392 1,820

76 2,281 2,693 3,508 1,073 2,450 1,868

77 2,321 2,753 3,590 1,099 2,510 1,915

78 2,346 2,809 3,672 1,125 2,573 1,964

79 2,371 2,862 3,753 1,149 2,633 2,014

80 2,394 2,917 3,837 1,174 2,693 2,063

81 2,419 2,971 3,916 1,198 2,753 2,111

82 2,443 3,025 3,996 1,223 2,814 2,160

83 2,474 3,073 4,073 1,246 2,875 2,211

84 2,505 3,121 4,153 1,271 2,937 2,263

85 2,529 3,160 4,220 1,293 2,990 2,308

86 2,553 3,200 4,289 1,313 3,044 2,355

87 2,578 3,242 4,359 1,335 3,100 2,404

88 2,603 3,282 4,430 1,356 3,157 2,452

89 2,628 3,322 4,501 1,378 3,214 2,500

90 2,654 3,362 4,570 1,399 3,268 2,548

91 2,679 3,401 4,638 1,420 3,324 2,596

92 2,705 3,440 4,704 1,441 3,378 2,643

93 2,733 3,477 4,773 1,462 3,432 2,688

94 2,758 3,515 4,837 1,481 3,486 2,734

95 2,785 3,550 4,903 1,500 3,537 2,778

96 2,811 3,587 4,967 1,520 3,589 2,822

97 2,838 3,622 5,030 1,539 3,640 2,866

98 2,866 3,657 5,094 1,559 3,687 2,910

99+ 2,894 3,692 5,154 1,577 3,739 2,951

Attained

Age

Standard


Under 65 (ESRD) 32,314 37,202 48,066 32,881 33,432 25,367

Under 65 (non-ESRD) 6,706 7,699 9,940 3,042 6,909 5,239

65 1,982 2,236 2,870 879 1,988 1,503

66 2,038 2,309 2,967 908 2,057 1,555

67 2,094 2,378 3,062 937 2,124 1,608

68 2,148 2,448 3,157 966 2,192 1,659

69 2,201 2,519 3,249 993 2,259 1,711

70 2,255 2,589 3,343 1,023 2,325 1,762

71 2,309 2,657 3,434

1,051 2,389 1,812

72 2,360 2,724 3,524 1,078 2,452 1,862

73 2,403 2,794 3,619 1,109 2,522 1,916

74 2,448 2,860 3,711 1,136 2,588 1,969

75 2,493 2,927 3,805 1,164 2,657 2,023

76 2,535 2,993 3,898 1,193 2,723 2,075

77 2,578 3,060 3,988 1,221 2,789 2,128

78 2,608 3,118 4,081 1,248 2,858 2,183

79 2,635 3,182 4,169 1,277 2,926 2,238

80 2,661 3,242 4,261 1,304 2,993 2,292

81 2,688 3,301 4,352 1,330 3,060 2,346

82 2,715 3,362 4,438 1,360 3,124 2,400

83 2,750 3,415 4,526 1,385 3,194 2,458

84 2,784 3,469 4,612 1,411 3,262 2,515

85 2,811 3,512 4,689 1,435 3,321 2,565

86 2,838 3,557 4,767 1,458 3,384 2,617

87 2,866 3,601 4,843 1,483 3,444 2,670

88 2,894 3,645 4,922 1,507 3,507 2,724

89 2,920 3,692 5,001 1,531 3,571 2,778

90 2,948 3,734 5,079 1,554 3,632 2,831

91 2,978 3,777 5,154 1,578 3,694 2,884

92 3,007 3,819 5,229 1,601 3,754 2,936

93 3,036 3,864 5,303 1,623 3,814 2,987

94 3,064 3,905 5,376 1,644 3,873 3,037

95 3,095 3,946 5,449 1,667 3,930 3,087

96 3,124 3,986 5,520 1,689 3,987 3,136

97 3,153 4,025 5,590 1,712 4,044 3,184

98 3,184 4,064 5,659 1,731 4,098 3,233

99+ 3,216 4,102 5,727 1,752 4,154 3,279

Modal Factors: Semi-Annual: 0.5200 Quarterly: 0.2650 Monthly: 0.0833

The above rates do not include the $20 application fee.

To calculate a Household discount:

Annual premium x modal factor = modal premium (round to nearest whole cent)

Modal premium x .93 = discounted premium

If applying during Open Enrollment or Guaranteed Issue Period, use Preferred rates.

AHLMS05035DE 3 02/2019 B

PREMIUM INFORMATION

Aetna Health and Life Insurance Company can only raise your premium if we raise the premium for all policies like yours in this state. Premiums for this policy will increase due to the increase in your age. Upon attainment of an age requiring a rate increase, the renewal premium for the policy will be the renewal premium then in effect for your attained age. Other policies may be provided with Issue Age rating and do not increase with age. You should compare Issue Age with Attained Age policies.

Premiums payable other than annually will be determined according to the following factors:

Semi-annual: 0.5200 Quarterly: 0.2650 Monthly EFT: 0.0833.

HOUSEHOLD DISCOUNT

In order to be eligible for the Household discount under an Aetna Health and Life Insurance Company Medicare supplement plan, you must apply for a Medicare supplement plan at the same time as another Medicare eligible adult or the other Medicare eligible adult must currently be covered by a Aetna Health and Life Insurance Company Medicare supplement policy. The Medicare eligible adult must be either (a) your spouse; (b) be someone with whom you are in a civil union partnership; or (c) be a permanent resident in your home. The household discount will only be applicable if a policy for each applicant is issued. The discounted rate will be 7 percent lower than the individual rates and will apply as long as both policies remain in force.

DISCLOSURES

Use this outline to compare benefits and premium among policies.

READ YOUR POLICY VERY CAREFULLY

This is only an outline describing your policy’s most important features. The policy is your insurance contract. You must read the policy itself to understand all of the rights and duties of both you and your insurance company.

RIGHT TO RETURN POLICY

If you find that you are not satisfied with your policy, you may return it to Aetna Health and Life Insurance Company, P.O. Box 14770, Lexington, KY 40512-4770. If you send the policy back to us within 30 days after you receive it, we will treat the policy as if it had never been issued and return all your payments.

POLICY REPLACEMENTIf you are replacing another health insurance policy, do NOT cancel it until you have actually received your new policy and are sure you want to keep it.

NOTICEThe policy may not cover all OF your medical costs.

Neither Aetna Health and Life Insurance Company nor its agents are connected with Medicare.

This outline of coverage does not give all the details of Medicare coverage. Contact your local Social Security Office or consult Medicare & You for more details.

COMPLETE ANSWERS ARE VERYIMPORTANT

When you fill out the application for the new policy, be sure to answer truthfully and completely any questions about your medical and health history. The company may cancel your policy and refuse to pay any claims if you leave out or falsify important medical information.

Review the application carefully before you sign it. Be certain that all information has been properly recorded.

THE FOLLOWING CHARTS DESCRIBE PLANS A, B, F, HIGH DEDUCTIBLE F, G and N OFFERED BY AETNA HEALTH AND LIFE INSURANCE COMPANY.

AHLMS05035DE 4 02/2019 B

PLAN AMEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD

*A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

SERVICES MEDICARE PAYS PLAN PAYS

YOU PAY

HOSPITALIZATION* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1364 $0 $1364

(Part A Deductible)

61st thru 90th day All but $341 a day $341 a day $0 91st day and after •While using 60 lifetime reserve days All but $682 a day $682 a day $0 •Once lifetime reserve days are used: •Additional 365 days $0 100% of Medicare

Eligible Expenses $0**

•Beyond the Additional 365 days $0 $0 All costs SKILLED NURSING FACILITY CARE* You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-Approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 $0 21st thru 100th day All but $170.50 a day $0 Up to $170.50 a

day 101st day and after $0 $0 All costs BLOOD First 3 pints $0 3 pints $0 Additional amounts 100% $0 $0 HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness.

All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care

Medicare copayment/ coinsurance

$0

**NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

AHLMS05035DE 5 02/2019 B

PLAN AMEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR

*Once you have been billed $185 of Medicare-Approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.


YOU PAY

MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic test, durable medical equipment First $185 of Medicare-Approved amounts*

$0 $0 $185 (Part B Deductible)

Remainder of Medicare-Approved amounts Generally 80% Generally 20% $0 Part B Excess Charges (Above Medicare-Approved amounts) $0 $0 All costs BLOOD First 3 pints $0 All costs $0 Next $185 of Medicare-Approved amounts*


Remainder of Medicare-Approved amounts 80% 20% $0 CLINICAL LABORATORY SERVICES – TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0

PARTS A & B


YOU PAY

HOME HEALTH CARE – MEDICARE APPROVED SERVICES •Medically necessary skilled care services and medical supplies

100% $0 $0

•Durable medical equipment •First $185 of Medicare Approved amounts*


•Remainder of Medicare Approved amounts 80% 20% $0

AHLMS05035DE 6 02/2019 B

PLAN BMEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD

* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.


YOU PAY

HOSPITALIZATION* Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1364 $1364

(Part A Deductible) $0



•Beyond the Additional 365 days $0 $0 All costs SKILLED NURSING FACILITY CARE* You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-Approved facility within 30 days after leaving the hospital First 20 days All approved

amounts $0 $0

21st thru 100th day All but $170.50 a day

$0 Up to $170.50 a day

101st day and after $0 $0 All costs BLOOD First 3 pints $0 3 pints $0 Additional amounts 100% $0 $0 HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness.



$0

**NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

AHLMS05035DE 7 02/2019 B

PLAN BMEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR

* Once you have been billed $185 of Medicare-Approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.


YOU PAY

MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician'sservices, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic test, durable medical equipment First $185 of Medicare-Approved amounts*


Remainder of Medicare-Approved amounts Generally 80% Generally 20%

$0 Part B Excess Charges (Above Medicare-Approved amounts) $0 $0 All costs BLOOD First 3 pints $0 All costs $0 Next $185 of Medicare-Approved amounts*



PARTS A & B


YOU PAY

HOME HEALTH CARE – MEDICARE APPROVED SERVICES •Medically necessary skilled careservices and medical supplies

100% $0 $0



•Remainder of Medicare Approved amounts

80% 20% $0

AHLMS05035DE 8 02/2019 B

PLAN FMEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD



YOU PAY






amounts $0 $0


Up to $170.50 a day

$0

101st day and after $0 $0 All costs BLOOD First 3 pints $0 3 pints $0 Additional amounts 100% $0 $0 HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness.



$0


AHLMS05035DE 9 02/2019 B

PLAN FMEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR



YOU PAY


$0 $185 (Part B Deductible)

$0

Remainder of Medicare-Approved amounts Generally 80% Generally 20% $0 Part B Excess Charges (Above Medicare-Approved amounts) $0 100% $0 BLOOD First 3 pints $0 All costs $0 Next $185 of Medicare-Approved amounts*


$0


PARTS A & B


YOU PAY


100% $0 $0



$0


AHLMS05035DE 10 02/2019 B

PLAN FOTHER BENEFITS – NOT COVERED BY MEDICARE


YOU PAY

FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of charges $0 80% to a lifetime

maximum benefit of $50,000

20% and amounts over the $50,000 lifetime maximum

AHLMS05035DE 11 02/2019 B

HIGH DEDUCTIBLE PLAN FMEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD

*A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. ***This high deductible plan pays the same benefits as Plan F after one has paid a calendar year $2300 deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses are $2300. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy.These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan’s separate foreign travel emergency deductible.

SERVICES MEDICARE PAYS

AFTER YOU PAY $2300

DEDUCTIBLE*** PLAN PAYS

IN ADDITION TO $2300

DEDUCTIBLE*** YOU PAY






amounts $0 $0


Up to $170.50 a day

$0

101st day and after $0 $0 All costs BLOOD First 3 pints $0 3 pints $0 Additional amounts 100% $0 $0

AHLMS05035DE 12 02/2019 B

HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness.



$0


AHLMS05035DE 13 02/2019 B

HIGH DEDUCTIBLE PLAN FMEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR

*Once you have been billed $185 of Medicare-Approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year. ***This high deductible plan pays the same benefits as Plan F after one has paid a calendar year $2300 deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses are $2300. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy.These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan’sseparate foreign travel emergency deductible.


AFTER YOU PAY $2300






$0

Remainder of Medicare-Approved amounts Generally 80% Generally 20% $0 Part B Excess Charges(Above Medicare-Approved amounts) $0 100% $0 BLOOD First 3 pints $0 All costs $0 Next $185 of Medicare-Approved amounts*


$0


AHLMS05035DE 14 02/2019 B

HIGH DEDUCTIBLE PLAN F

PARTS A & B


AFTER YOU PAY $2300





100% $0 $0



$0


OTHER BENEFITS – NOT COVERED BY MEDICARE


AFTER YOU PAY $2300

DEDUCTIBLE** PLAN PAYS


DEDUCTIBLE** YOU PAY

FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of charges $0 80% to a lifetime



AHLMS05035DE 15 02/2019 B

PLAN GMEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD



YOU PAY






amounts $0 $0


Up to $170.50 a day

$0

101st day and after $0 $0 All costs BLOOD First 3 pints $0 3 pints $0 Additional amounts 100% $0 $0 HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness services



$0


AHLMS05035DE 16 02/2019 B

PLAN GMEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR



YOU PAY



Remainder of Medicare-Approved amounts Generally 80% Generally 20% $0 Part B Excess Charges(Above Medicare-Approved amounts) $0 100% $0 BLOOD First 3 pints $0 All costs $0 Next $185 of Medicare-Approved amounts*


Remainder of Medicare-Approvedamounts 80% 20% $0 CLINICAL LABORATORY SERVICES – TESTS FOR DIAGNOSTIC SERVICES 100% $0 $0

PARTS A & B


YOU PAY

HOME HEALTH CARE – MEDICARE APPROVED SERVICES • Medically necessary skilled care services and medical supplies 100% $0 $0 •Durable medical equipment •First $185 of Medicare Approved amounts*



AHLMS05035DE 17 02/2019 B

PLAN G


SERVICES MEDICARE PAYS PLAN PAYS YOU PAY FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of charges $0 80% to a lifetime



AHLMS05035DE 18 02/2019 B

PLAN NMEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD



YOU PAY






amounts $0 $0


Up to $170.50 a day

$0

101st day and after $0 $0 All costs BLOOD First 3 pints $0 3 pints $0 Additional amounts 100% $0 $0 HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness services



$0


AHLMS05035DE 19 02/2019 B

PLAN NMEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR

*Once you have been billed $185 of Medicare-Approved amounts for covered services (which are notedwith an asterisk), your Part B deductible will have been met for the calendar year.


YOU PAY



Remainder of Medicare-Approvedamounts

Generally 80% Balance, other thanup to $20 per office visit and up to $50 per emergency room visit. The co-payment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.

Up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.

Part B Excess Charges(Above Medicare-Approved amounts) $0 0% All costs BLOOD First 3 pints $0 All costs $0Next $185 of Medicare-Approved amounts*



AHLMS05035DE 20 02/2019 B

21

PLAN N

PARTS A & B


YOU PAY

HOME HEALTH CARE – MEDICARE APPROVED SERVICES • Medically necessary skilled careservices and medical supplies 100% $0 $0 •Durable medical equipment •First $185 of Medicare Approved amounts*





YOU PAY

FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during thefirst 60 days of each trip outside the USA

First $250 each calendar year $0 $0 $250

Remainder of charges $0 80% to a lifetime maximum benefit of $50,000


AHLMS05035DE 02/2019 B

Medicare Supplement InsuranceBENEFIT PLANS AVAILABLE: A, B, F, HF, G & NAnnual Attained Age Premiums For Use in ZIP Codes: Entire State Female RatesAnnual Attained Age Premiums For Use in ZIP Codes: Entire State Male RatesPREMIUM INFORMATIONHOUSEHOLD DISCOUNT DISCLOSURESREAD YOUR POLICY VERY CAREFULLY RIGHT TO RETURN POLICYPOLICY REPLACEMENTNOTICECOMPLETE ANSWERS ARE VERY IMPORTANTPLAN A MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIODPLAN A MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEARPARTS A & BPLAN B MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIODPLAN B MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEARPARTS A & BPLAN F MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIODPLAN F MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEARPARTS A & BOTHER BENEFITS – NOT COVERED BY MEDICAREHIGH DEDUCTIBLE PLAN F MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIODHIGH DEDUCTIBLE PLAN F MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEARPARTS A & BOTHER BENEFITS – NOT COVERED BY MEDICAREPLAN G MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIODPLAN G MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEARPARTS A & BOTHER BENEFITS – NOT COVERED BY MEDICARE PLAN N MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIODPLAN N MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEARPARTS A & BOTHER BENEFITS – NOT COVERED BY MEDICARE

New Medicare Supplement Insurance · 2019. 10. 24. · BENEFIT PLANS AVAILABLE: A, B, F, HF, G & N...

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Transcript of New Medicare Supplement Insurance · 2019. 10. 24. · BENEFIT PLANS AVAILABLE: A, B, F, HF, G & N...