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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
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With Generic Drug
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Plan II
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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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$
77.23
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$
68.65
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$
113.63
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$
105.05
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65-69
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$
119.57
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$
106.82
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$
246.57
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$
233.82
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70-74
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$
90.10
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$
77.23
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$
126.50
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$
113.63
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70-74
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$
139.49
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$
120.38
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$
266.49
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$
247.38
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75-79
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$
102.97
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$
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
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$
170.04
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$
149.66
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$
297.04
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$
276.66
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85+
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$
120.13
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$
102.97
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$
156.53
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$
139.37
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85+
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$
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
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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
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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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$
113.62
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$
101.00
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$
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
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$
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:
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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
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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
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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
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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:
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DE, GA, IL, LA, MD, MA, NJ, OH, TX, WV
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Plan I
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Basic
|
With Generic Drug
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|
Plan II
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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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$
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
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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
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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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$
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
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$
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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