|
Retiree Plans | Benefit
Summary
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AREA 1:
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IA, NE, NC, SC, SD
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Effective July 1, 2003
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Plan I
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Basic
|
With Generic Drug
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Plan II
|
Basic
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With Drug Card
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(A)
|
MALE
|
FEMALE
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MALE
|
FEMALE
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(C )
|
MALE
|
FEMALE
|
MALE
|
FEMALE
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|
65-69
|
$
77.23
|
$
68.65
|
$
113.63
|
$
105.05
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65-69
|
$
119.57
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$
106.82
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$
246.57
|
$
233.82
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70-74
|
$
90.10
|
$
77.23
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$
126.50
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$
113.63
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70-74
|
$
139.49
|
$
120.38
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$
266.49
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$
247.38
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75-79
|
$
102.97
|
$
88.39
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$
139.37
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$
124.79
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75-79
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$
159.41
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$
137.76
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$
286.41
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$
264.76
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80-84
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$
109.83
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$
96.10
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$
146.23
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$
132.50
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80-84
|
$
170.04
|
$
149.66
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$
297.04
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$
276.66
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85+
|
$
120.13
|
$
102.97
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$
156.53
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$
139.37
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85+
|
$
185.98
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$
160.52
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$
312.98
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$
287.52
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Plan III
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Basic
|
With Drug Card
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Plan IV
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Basic
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With Drug Card
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(D)
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MALE
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FEMALE
|
MALE
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FEMALE
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(F)
|
MALE
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FEMALE
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MALE
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FEMALE
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65-69
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$
113.62
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$
101.00
|
$
240.62
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$
228.00
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65-69
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$
127.72
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$
113.52
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$
254.72
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$
240.52
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70-74
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$
132.55
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$
113.62
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$
259.55
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$
240.62
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70-74
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$
149.00
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$
127.72
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$
276.00
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$
254.72
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75-79
|
$
151.49
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$
130.03
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$
278.49
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$
257.03
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75-79
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$
170.33
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$
146.16
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$
297.33
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$
273.16
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80-84
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$
161.58
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$
141.38
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$
288.58
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$
268.38
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80-84
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$
181.63
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$
158.94
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$
308.63
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$
285.94
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85+
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$
176.72
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$
151.49
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$
303.72
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$
278.49
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85+
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$
198.68
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$
177.26
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$
325.68
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$
304.26
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AREA 2:
|
AL, AR, CO, CT, HI, ID, IN, KS, KY, MS, MO, MT, NH,
ND, OK, OR, RI, TN, UT, VA, WY
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Plan I
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Basic
|
With Generic Drug
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Plan II
|
Basic
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With Drug Card
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(A)
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MALE
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FEMALE
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MALE
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FEMALE
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(C )
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MALE
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FEMALE
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MALE
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FEMALE
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65-69
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$
81.52
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$
72.46
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$
117.92
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$
108.86
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65-69
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$
126.19
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$
112.76
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$
253.19
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$
239.76
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70-74
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$
95.10
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$
81.52
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$
131.50
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$
117.92
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70-74
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$
147.23
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$
127.07
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$
274.23
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$
254.07
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75-79
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$
108.69
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$
93.29
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$
145.09
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$
129.69
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75-79
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$
168.27
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$
145.41
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$
295.27
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$
272.41
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80-84
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$
115.93
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$
101.44
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$
152.33
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$
137.84
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80-84
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$
179.48
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$
157.97
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$
306.48
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$
284.97
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85+
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$
126.79
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$
108.69
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$
163.19
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$
145.09
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85+
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$
196.31
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$
169.43
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$
323.31
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$
296.43
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Plan III
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Basic
|
With Drug Card
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Plan IV
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Basic
|
With Drug Card
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(D)
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MALE
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FEMALE
|
MALE
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FEMALE
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(F)
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MALE
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FEMALE
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MALE
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FEMALE
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65-69
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$
119.93
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$
106.59
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$
246.93
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$
233.59
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65-69
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$
134.81
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$
119.82
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$
261.81
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$
246.82
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70-74
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$
139.91
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$
119.93
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$
266.91
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$
246.93
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70-74
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$
157.27
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$
134.81
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$
284.27
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$
261.81
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75-79
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$
159.91
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$
137.24
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$
286.91
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$
264.24
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75-79
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$
179.75
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$
154.29
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$
306.75
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$
281.29
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80-84
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$
170.56
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$
149.24
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$
297.56
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$
276.24
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80-84
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$
191.74
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$
167.76
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$
318.74
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$
294.76
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85+
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$
186.55
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$
159.91
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$
313.55
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$
286.91
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85+
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$
209.71
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$
179.75
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$
336.71
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$
306.75
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AREA 3:
|
DE, GA, IL, LA, MD, MA, NJ, OH, TX, WV
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Plan I
|
Basic
|
With Generic Drug
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|
Plan II
|
Basic
|
|
With Drug Card
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(A)
|
MALE
|
FEMALE
|
MALE
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FEMALE
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(C )
|
MALE
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FEMALE
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MALE
|
FEMALE
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65-69
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$
85.81
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$
76.26
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$
122.21
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$
112.66
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65-69
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$
132.84
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$
118.69
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$
259.84
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$
245.69
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70-74
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$
100.11
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$
85.81
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$
136.51
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$
122.21
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70-74
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$
154.99
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$
133.76
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$
281.99
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$
260.76
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75-79
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$
114.41
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$
98.19
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$
150.81
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$
134.59
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75-79
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$
177.12
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$
153.07
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$
304.12
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$
280.07
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80-84
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$
122.04
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$
106.78
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$
158.44
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$
143.18
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80-84
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$
188.94
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$
166.30
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$
315.94
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$
293.30
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85+
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$
133.46
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$
114.41
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$
169.86
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$
150.81
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85+
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$
206.65
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$
178.35
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$
333.65
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$
305.35
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Plan III
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Basic
|
With Drug Card
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|
Plan IV
|
Basic
|
With Drug Card
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|
(D)
|
MALE
|
FEMALE
|
MALE
|
FEMALE
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|
(F)
|
MALE
|
FEMALE
|
MALE
|
FEMALE
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65-69
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$
126.24
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$
112.21
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$
253.24
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$
239.21
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65-69
|
$
141.91
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$
126.14
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$
268.91
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$
253.14
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70-74
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$
147.28
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$
126.24
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$
274.28
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$
253.24
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70-74
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$
165.55
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$
141.91
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$
292.55
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$
268.91
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75-79
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$
168.31
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$
144.47
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$
295.31
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$
271.47
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75-79
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$
189.21
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$
162.41
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$
316.21
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$
289.41
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80-84
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$
179.53
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$
157.10
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$
306.53
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$
284.10
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80-84
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$
201.82
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$
176.58
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$
328.82
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$
303.58
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85+
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$
196.38
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$
168.31
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$
323.38
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$
295.31
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85+
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$
220.75
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$
189.21
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$
347.75
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$
316.21
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AREA 4:
|
AK, AZ, MI
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Plan I
|
Basic
|
With Generic Drug
|
|
Plan II
|
Basic
|
|
With Drug Card
|
|
|
(A)
|
MALE
|
FEMALE
|
MALE
|
FEMALE
|
|
(C )
|
MALE
|
FEMALE
|
MALE
|
FEMALE
|
|
65-69
|
$
94.39
|
$
83.90
|
$
130.79
|
$
120.30
|
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65-69
|
$
146.14
|
$
130.55
|
$
273.14
|
$
257.55
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70-74
|
$
110.13
|
$
94.39
|
$
146.53
|
$
130.79
|
|
70-74
|
$
170.48
|
$
147.14
|
$
297.48
|
$
274.14
|
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75-79
|
$
125.85
|
$
108.01
|
$
162.25
|
$
144.41
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75-79
|
$
194.84
|
$
168.37
|
$
321.84
|
$
295.37
|
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80-84
|
$
134.24
|
$
117.46
|
$
170.64
|
$
153.86
|
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80-84
|
$
207.83
|
$
182.93
|
$
334.83
|
$
309.93
|
|
85+
|
$
146.81
|
$
125.85
|
$
183.21
|
$
162.25
|
|
85+
|
$
227.32
|
$
196.17
|
$
354.32
|
$
323.17
|
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|
Plan III
|
Basic
|
With Drug Card
|
|
Plan IV
|
Basic
|
With Drug Card
|
|
(D)
|
MALE
|
FEMALE
|
MALE
|
FEMALE
|
|
(F)
|
MALE
|
FEMALE
|
MALE
|
FEMALE
|
|
65-69
|
$
138.87
|
$
123.42
|
$
265.87
|
$
250.42
|
|
65-69
|
$
156.09
|
$
138.75
|
$
283.09
|
$
265.75
|
|
70-74
|
$
162.00
|
$
138.87
|
$
289.00
|
$
265.87
|
|
70-74
|
$
182.11
|
$
156.09
|
$
309.11
|
$
283.09
|
|
75-79
|
$
185.14
|
$
158.91
|
$
312.14
|
$
285.91
|
|
75-79
|
$
208.14
|
$
178.64
|
$
335.14
|
$
305.64
|
|
80-84
|
$
197.48
|
$
172.80
|
$
324.48
|
$
299.80
|
|
80-84
|
$
222.00
|
$
194.25
|
$
349.00
|
$
321.25
|
|
85+
|
$
216.00
|
$
185.14
|
$
343.00
|
$
312.14
|
|
85+
|
$
242.81
|
$
208.14
|
$
369.81
|
$
335.14
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AREA 5:
|
DC, CA
|
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|
Plan I
|
Basic
|
With Generic Drug
|
|
Plan II
|
Basic
|
|
With Drug Card
|
|
|
(A)
|
MALE
|
FEMALE
|
MALE
|
FEMALE
|
|
(C )
|
MALE
|
FEMALE
|
MALE
|
FEMALE
|
|
65-69
|
$
102.97
|
$
91.51
|
$
139.37
|
$
127.91
|
|
65-69
|
$
159.41
|
$
142.43
|
$
286.41
|
$
269.43
|
|
70-74
|
$
120.13
|
$
102.97
|
$
156.53
|
$
139.37
|
|
70-74
|
$
185.98
|
$
160.52
|
$
312.98
|
$
287.52
|
|
75-79
|
$
137.29
|
$
117.84
|
$
173.69
|
$
154.24
|
|
75-79
|
$
212.55
|
$
183.68
|
$
339.55
|
$
310.68
|
|
80-84
|
$
146.44
|
$
128.14
|
$
182.84
|
$
164.54
|
|
80-84
|
$
226.72
|
$
199.56
|
$
353.72
|
$
326.56
|
|
85+
|
$
160.16
|
$
137.29
|
$
196.56
|
$
173.69
|
|
85+
|
$
247.98
|
$
214.01
|
$
374.98
|
$
341.01
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Plan III
|
Basic
|
With Drug Card
|
|
Plan IV
|
Basic
|
With Drug Card
|
|
(D)
|
MALE
|
FEMALE
|
MALE
|
FEMALE
|
|
(F)
|
MALE
|
FEMALE
|
MALE
|
FEMALE
|
|
65-69
|
$
151.49
|
$
134.66
|
$
278.49
|
$
261.66
|
|
65-69
|
$
170.29
|
$
151.36
|
$
297.29
|
$
278.36
|
|
70-74
|
$
176.72
|
$
151.49
|
$
303.72
|
$
278.49
|
|
70-74
|
$
198.68
|
$
170.29
|
$
325.68
|
$
297.29
|
|
75-79
|
$
201.97
|
$
173.36
|
$
328.97
|
$
300.36
|
|
75-79
|
$
227.05
|
$
194.89
|
$
354.05
|
$
321.89
|
|
80-84
|
$
215.45
|
$
188.52
|
$
342.45
|
$
315.52
|
|
80-84
|
$
242.18
|
$
211.91
|
$
369.18
|
$
338.91
|
|
85+
|
$
235.63
|
$
201.97
|
$
362.63
|
$
328.97
|
|
85+
|
$
264.90
|
$
227.05
|
$
391.90
|
$
354.05
|
|
|
|
|
|
|
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