Common use of Plan Types Clause in Contracts

Plan Types.  Basic Plan (Pre-Medicare)  Supplemental Medicare Plan (Retiree and dependent(s) are Medicare eligible)  Combination Plan (when at least one covered party – retiree or dependent are Medicare eligible but at least one of the other covered individuals is not Medicare eligible) Single Party Only $671.82 Two-Party $1,343.65 Family $1,746.74 Plan Type – Supplemental Medicare Plan Type (Retiree and dependent(s) are all Medicare eligible) Medicare Retiree Only $287.52 Medicare Retiree+1 Medicare Dependent $575.04 Medicare Retiree+2 or more Medicare Dependents $862.56

Plan Types.  Basic Plan (Pre-Medicare)  • Supplemental Medicare Plan (Retiree and dependent(s) are Medicare eligible)  • Combination Plan (when at least one covered party – retiree or dependent are Medicare eligible but at least one of the other covered individuals is not Medicare eligible) Single Party Only $671.82 Two-Party $1,343.65 Family $1,746.74 Plan Type – Supplemental Medicare Plan Type (Retiree and dependent(s) are all Medicare eligible) Medicare Retiree Only $287.52 Medicare Retiree+1 Medicare Dependent $575.04 Medicare Retiree+2 or more Medicare Dependents $862.56