Compare your plan options. Use the charts below for an overview of Today’s Options PPO benefits and copays.

• Today’s Options Advantage 1 powered by CCRx (PPO)
• Today’s Options Advantage 2 powered by CCRx (PPO)
• Today’s Options Advantage 3 powered by CCRx (PPO)

	Today’s Options Advantage 1 powered by CCRx (PPO)
	In-Network	Out-of-Network
Monthly Premium*	*$0 - $99	*$0 - $99
2010 MEDICARE-COVERED MEDICAL BENEFITS
Annual Out-of-Pocket Limit	$3,250	N / A
Inpatient Hospital Care:
Initial coverage, you pay:	Days 1-5: $175 per day	$1,000 each hospital stay
Additional days, you pay:	$0 per day	$1,000 each
Primary Care Physician (PCP) Copay:	$10-$35 per visit	20% coinsurance
Specialist Copay:	$35 per visit	20% coinsurance
Outpatient Surgery – Ambulatory / Hospital:
Ambulatory surgical center:	$75 per visit	20% coinsurance
Outpatient hospital facility:	$150 per visit	20% coinsurance
Skilled Nursing Facility:
Initial coverage Days 1-20, you pay:	$0	$0
Additional days (21 - 100) each day, you pay:	$100	$130
Emergency Care:	$50, worldwide coverage	$50, worldwide coverage
Annual Preventive Services:	Bone Mass Measurement, Colorectal Screening Exam, Pneumonia & Flu Vaccine, Screening Mammogram, Pap Smear & Pelvic Exam, Prostate Screening
Each visit, you pay:	$0	20% coinsurance
2010 MEDICARE PART D PRESCRIPTION DRUG COVERAGE
Phase 1: DEDUCTIBLE	$0	$0
Phase 2: INITIAL COVERAGE	Amount paid for prescriptions by both you and the plan until the combined total (co-pay & coinsurance) reaches $2,830
You pay:	30-day / 90-day supply
Generic Drugs	$5 / $15	$5
Preferred Brands	$35  /  $105	$35
Non-Preferred Brands	$65  /  $195	$65
Specialty Drugs	33% coinsurance	33% coinsurance
Phase 3: GAP COVERAGE	Amount you pay for prescriptions between the Initial Coverage and until you reach $4,550 in out-of-pocket covered prescription drug costs
You pay:	30-day / 90-day supply
Generic Drugs	100% of cost	100% of cost
Preferred Brands	100% of cost	100% of cost
Non-Preferred Brands	100% of cost	100% of cost
Specialty Drugs	100% of cost	100% of cost
Phase 4: CATASTROPHIC COVERAGE	Amount you pay for prescriptions after you reach $4,550 in out-of-pocket covered prescription drug costs
You pay:	30-day / 90-day supply
Generic Drugs	The greater of 5% coinsurance or $2.50
Brand Drugs	The greater of 5% coinsurance or $6.30
Return to top

	Today’s Options Advantage 2 powered by CCRx (PPO)
	In-Network	Out-of-Network
Monthly Premium*	*$9 - $76	*$9 - $76
2010 MEDICARE-COVERED MEDICAL BENEFITS
Annual Out-of-Pocket Limit	$3,400	$3,400
Inpatient Hospital Care:
Initial coverage, you pay:	Days 1-5: $300 per day	Days 1-5: $300 per day
Additional days, you pay:	$0 per day	$0 per day
Primary Care Physician (PCP) Copay:	$10-$35 per visit	$20-$35 per visit
Specialist Copay:	$45 per visit	$45 per visit
Outpatient Surgery – Ambulatory / Hospital:
Ambulatory surgical center:	$145 per visit	$145 per visit
Outpatient hospital facility:	$245 per visit	$245 per visit
Skilled Nursing Facility:
Initial coverage Days 1-20, you pay:	$0	$0
Additional days (21 - 100) each day, you pay:	$100	$100
Emergency Care:	$50, worldwide coverage	$50, worldwide coverage
Annual Preventive Services:	Bone Mass Measurement, Colorectal Screening Exam, Pneumonia & Flu Vaccine, Screening Mammogram, Pap Smear & Pelvic Exam, Prostate Screening
Each visit, you pay:	$0	$0
2010 MEDICARE PART D PRESCRIPTION DRUG COVERAGE
Phase 1: DEDUCTIBLE	$0	$0
Phase 2: INITIAL COVERAGE	Amount paid for prescriptions by both you and the plan until the combined total (co-pay & coinsurance) reaches $2,830
You pay:	30-day / 90-day supply
Generic Drugs	$5 / $15	$5
Preferred Brands	$35  /  $105	$35
Non-Preferred Brands	$65  /  $195	$65
Specialty Drugs	33% coinsurance	33% coinsurance
Phase 3: GAP COVERAGE	Amount you pay for prescriptions between the Initial Coverage and until you reach $4,550 in out-of-pocket covered prescription drug costs
You pay:	30-day / 90-day supply
Generic Drugs	100% of cost	100% of cost
Preferred Brands	100% of cost	100% of cost
Non-Preferred Brands	100% of cost	100% of cost
Specialty Drugs	100% of cost	100% of cost
Phase 4: CATASTROPHIC COVERAGE	Amount you pay for prescriptions after you reach $4,550 in out-of-pocket covered prescription drug costs
You pay:	30-day / 90-day supply
Generic Drugs	The greater of 5% coinsurance or $2.50
Brand Drugs	The greater of 5% coinsurance or $6.30
Return to top

	Today’s Options Advantage 3 powered by CCRx (PPO)
	In-Network	Out-of-Network
Monthly Premium*	*$34 - $143	*$34 - $143
2010 MEDICARE-COVERED MEDICAL BENEFITS
Annual Out-of-Pocket Limit	$3,250	$3,250
Inpatient Hospital Care:
Initial coverage, you pay:	Days 1-5: $200 per day	Days 1-5: $200 per day
Additional days, you pay:	$0 per day	$0 per day
Primary Care Physician (PCP) Copay:	$0-$35 per visit	$10-$35 per visit
Specialist Copay:	$35 per visit	$35 per visit
Outpatient Surgery – Ambulatory / Hospital:
Ambulatory surgical center:	$75 per visit	$75 per visit
Outpatient hospital facility:	$150 per visit	$150 per visit
Skilled Nursing Facility:
Initial coverage Days 1-20, you pay:	$0	$0
Additional days (21 - 100) each day, you pay:	$100	$100
Emergency Care:	$50, worldwide coverage	$50, worldwide coverage
Annual Preventive Services:	Bone Mass Measurement, Colorectal Screening Exam, Pneumonia & Flu Vaccine, Screening Mammogram, Pap Smear & Pelvic Exam, Prostate Screening
Each visit, you pay:	$0	$0
2010 MEDICARE PART D PRESCRIPTION DRUG COVERAGE
Phase 1: DEDUCTIBLE	$0	$0
Phase 2: INITIAL COVERAGE	Amount paid for prescriptions by both you and the plan until the combined total (co-pay & coinsurance) reaches $2,830
You pay:	30-day / 90-day supply
Generic Drugs	$5 / $15	$5
Preferred Brands	$35  /  $105	$35
Non-Preferred Brands	$65  /  $195	$65
Specialty Drugs	33% coinsurance	33% coinsurance
Phase 3: GAP COVERAGE	Amount you pay for prescriptions between the Initial Coverage and until you reach $4,550 in out-of-pocket covered prescription drug costs
You pay:	30-day / 90-day supply
Generic Drugs	$5 / $15	$5
Preferred Brands	100% of cost	100% of cost
Non-Preferred Brands	100% of cost	100% of cost
Specialty Drugs	100% of cost	100% of cost
Phase 4: CATASTROPHIC COVERAGE	Amount you pay for prescriptions after you reach $4,550 in out-of-pocket covered prescription drug costs
You pay:	30-day / 90-day supply
Generic Drugs	The greater of 5% coinsurance or $2.50
Brand Drugs	The greater of 5% coinsurance or $6.30
Return to top

*You must continue to pay your Medicare Part B premium

The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan.

If you decide to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for it to take effect and you will remain responsible for those premiums.

You may be able to get Extra Help to pay for your prescription drug premiums and costs.  To see if you qualify for getting Extra Help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7days a week);
• The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
• Your State Medicaid Office.

Note: Today’s Options PPO has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. We will not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. The pharmacies in our network can change at any time. You can ask for a Pharmacy Directory or visit our website.

For full information on plan benefits, call our Customer Service Department at 1-866-249-8668 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call: 1-800-777-9083) every day.