| Freedom
Blue
Plan
I
|
Freedom
Blue
Plan
II
|
| Total
Premium
$0.00/month |
Total
Premium
$50.00/month
($600.00/year)
|
|
You
pay
$10
for
each
in-network
primary
care
doctor
office
visit
for
Medicare-covered
services.
You
pay
$10
for
each
in-network
specialist
visit
for
Medicare-covered
services.
You
pay
15
%
of
cost
for
services
received
from
an
out-of-network
provider.
View
full
benefits
for
more
details |
You
pay
$10
for
each
in-network
primary
care
doctor
office
visit
for
Medicare-covered
services.
You
pay
$10
for
each
in-network
specialist
visit
for
Medicare-covered
services.
You
pay
15
%
of
cost
for
services
received
from
an
out-of-network
provider
View
full
benefits
for
more
details |
| $
1125
yearly
deductible |
$
600
yearly
deductible |
|
The
drug
benefit
has
been
improved!!!
Freedom
Blue
Plan
I
and
Plan
II
both
include
MedicareRx
Part
D
prescription
drug
coverage,
for
no
additional
cost!
and
cover
the
"donut
hole"
See
the
Summary
of
Benefits
|
|
| Freedom
Blue
Plan
I
and
Plan
I
includes
Medicare
Part
D
Prescription
Drug
Coverage. |
| Total
annual
deductible
$0 |
Total
annual
deductible
$0 |
|
Generic:
$
8
Preferred
Brand:
$30
Non-Preferred
Brand:
$64
Non-Specialty
Injectables:
33%
Specialty
Injectables:
33% |
Generic:
$
8
Preferred
Brand:
$30
Non-Preferred
Brand:
$64
Non-Specialty
Injectables:
33%
Specialty
Injectables:
33% |
|
Submit
application
Express
by
fax:
Fax
:
818-776-9865
|
|
2008
year
Prescription
Rx
Drug
List
