Transcription
Continental Life Insurance Companyof Brentwood, TennesseeAn Aetna Company800 Crescent Centre Dr.Suite 200Franklin, TN 37067800 264.4000aetnaseniorproducts.comOutline of CoverageMedicare Supplement InsuranceBENEFIT PLANS A, B, F, High Deductible F, G, NUnderwritten byAn Aetna CompanyContinental Life Insurance Companyof Brentwood, TennesseeCaliforniaCLIMS01100CA 2015 Aetna Inc.09012015
Part ADeductibleBasic,including100% Part BcoinsuranceBasic,including100% Part BcoinsuranceSkilledNursingFacilityCoinsurancePart 0% Part BcoinsuranceSkilledNursingFacilityCoinsurancePart ADeductiblePart ilityCoinsurancePart ADeductiblePart BDeductiblePart 100% Part BcoinsurancePart acilityCoinsurancePart ADeductibleBasic,including100% Part BcoinsuranceOut-of-pocketlimit [4970];paid at 100%after limitreached50% SkilledNursingFacilityCoinsurance50% Part ADeductibleHospitalizationand preventivecare paid at100%; otherbasic benefitspaid at 50%Basic,including100% Part BcoinsuranceBasic, including100% Part Bcoinsurance, exceptup to 20copayment for officevisit, and up to 50copayment for ERSkilled NursingFacility CoinsuranceOut-of-pocketlimit [2470];paid at 100%after limitreachedForeignTravelEmergencyForeign TravelEmergency75% SkilledSkilledNursing Facility NursingCoinsuranceFacilityCoinsurance75% Part A50% Part APart A DeductibleDeductibleDeductibleHospitalizationand preventivecare paid at100%; otherbasic benefitspaid at 75%CLIMS01100CA09012015[ 2180] deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed [ 2180]. Out-of-pocket expenses for this deductibleare expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan’sseparate foreign travel emergency deductible.*Plans F also has an option called a high deductible plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar yearBasic,including100% Part BcoinsuranceBasic Benefits:Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.Medical Expenses: Part B coinsurance (generally 20% of Medicare-Approved expenses) or, co-payments for hospital outpatient services. PlansK, L, and N require insureds to pay a portion of coinsurance or copaymentsBlood: First three pints of blood each year.Hospice-Part A coinsuranceBCDF/F*GKLMNASee Outlines of Coverage Sections for details about ALL PlansCONTINENTAL LIFE INSURANCE COMPANY OF BRENTWOOD, TENNESSEEOUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE: Page 1 of 2BENEFIT PLANS AVAILABLE: A, B, F, HIGH DEDUCTIBLE F, G, NThese charts show the benefits included in each of the standard Medicare supplement plans. Every company must make available Plan “A”Some plans may not be available in your state.
Plan ,1664,2154,2664,3184,3704,4210.5200Plan 73,3523,3953,4403,4833,5263,572AttainedAgeUnder 8990919293949596979899Quarterly:Plan f appyling during Open Enrollment or GI situation use Preferred rates2To calculate household discount:Annual premium x modal factor modal premium (round to nearest whole cent)Modal premium x .95 discounted premiumAttainedPreferredAgePlan APlan BPlan FPlan HFUnder 9501,770993,4064,3075,0091,789Modal Factors:Semi-Annual:The rates do not include the 20 policy fee.Plan 04,5024,5574,6114,6694,7254,780Annual Attained Age PremiumsFor Use in ZIP Codes: 900-912, 914-916, 918, 926-927StandardPlan FPlan 81,985Monthly:Continental Life Insurance Company of Brentwood, TennesseePlan ,6224,6804,7364,7944,8504,9060.0833Plan 33,7213,7683,8203,8653,9153,96609012015
Plan ,7103,7543,7993,8453,8923,9370.5200Plan 52,9853,0233,0633,1013,1403,181AttainedAgeUnder 8990919293949596979899Quarterly:Plan 33,1713,2103,2463,2883,3263,3660.2650If appyling during Open Enrollment or GI situation use Preferred rates3To calculate household discount:Annual premium x modal factor modal premium (round to nearest whole cent)Modal premium x .95 discounted premiumAttainedPreferredAgePlan APlan BPlan FPlan HFUnder 76993,0333,8364,4601,593Modal Factors:Semi-Annual:The rates do not include the 20 policy fee.Plan 34,0094,0584,1074,1584,2084,257Annual Attained Age PremiumsFor Use in ZIP Codes: 913, 917, 921, 924, 928StandardPlan FPlan Monthly:Continental Life Insurance Company of Brentwood, TennesseePlan ,1164,1684,2184,2694,3194,3690.0833Plan 13,3143,3553,4013,4423,4873,532
Plan ,5583,6003,6433,6883,7323,7760.5200Plan 42,8632,8992,9382,9743,0123,050AttainedAgeUnder 8990919293949596979899Quarterly:Plan 53,0413,0783,1133,1533,1893,2280.2650If appyling during Open Enrollment or GI situation use Preferred rates4To calculate household discount:Annual premium x modal factor modal premium (round to nearest whole cent)Modal premium x .95 discounted premiumAttainedPreferredAgePlan APlan BPlan FPlan HFUnder 992,9093,6784,2781,528Modal Factors:Semi-Annual:The rates do not include the 20 policy fee.Annual Attained Age PremiumsFor Use in ZIP Codes: 941, 943, 946-948, 951Plan 03,8453,8913,9383,9874,0354,082StandardPlan FPlan nthly:Continental Life Insurance Company of Brentwood, TennesseePlan ,9483,9974,0454,0944,1424,1900.0833Plan 73,1783,2183,2623,3013,3443,387
Plan ,3453,3853,4253,4673,5093,5500.5200Plan 52,6922,7262,7622,7962,8312,868AttainedAgeUnder 8990919293949596979899Quarterly:Plan 52,8592,8942,9272,9652,9993,0350.2650If appyling during Open Enrollment or GI situation use Preferred rates5To calculate household discount:Annual premium x modal factor modal premium (round to nearest whole cent)Modal premium x .95 discounted premiumAttainedPreferredAgePlan APlan BPlan FPlan HFUnder 7353,4584,0221,437Modal Factors:Semi-Annual:The rates do not include the 20 policy fee.Annual Attained Age PremiumsFor Use in ZIP Codes: 919, 925, 933, 942Plan 33,6153,6593,7033,7493,7943,838StandardPlan FPlan y:Continental Life Insurance Company of Brentwood, TennesseePlan ,7113,7583,8033,8493,8943,9390.0833Plan 92,9883,0253,0673,1033,1443,185
Plan ,0413,0773,1143,1523,1903,2270.5200Plan 42,4472,4782,5112,5422,5742,607AttainedAgeUnder 8990919293949596979899Quarterly:Plan 82,5992,6312,6612,6952,7262,7590.2650If appyling during Open Enrollment or GI situation use Preferred rates6To calculate household discount:Annual premium x modal factor modal premium (round to nearest whole cent)Modal premium x .95 discounted premiumAttainedPreferredAgePlan APlan BPlan FPlan HFUnder 443,6561,306Modal Factors:Semi-Annual:The rates do not include the 20 policy fee.Plan 83,2863,3263,3663,4083,4493,489Annual Attained Age PremiumsFor Use in ZIP Codes: 920, 922, 930-931, 937-938, 944, 958StandardPlan FPlan ntinental Life Insurance Company of Brentwood, TennesseePlan ,3743,4163,4573,4993,5403,5810.0833Plan 12,7162,7502,7882,8212,8582,895
Plan ,8892,9232,9582,9943,0313,0660.5200Plan 32,3252,3542,3852,4152,4452,477AttainedAgeUnder 8990919293949596979899Quarterly:Plan 02,4692,4992,5282,5602,5902,6210.2650If appyling during Open Enrollment or GI situation use Preferred rates7To calculate household discount:Annual premium x modal factor modal premium (round to nearest whole cent)Modal premium x .95 discounted premiumAttainedPreferredAgePlan APlan BPlan FPlan HFUnder 4731,241Modal Factors:Semi-Annual:The rates do not include the 20 policy fee.Annual Attained Age PremiumsFor Use in ZIP Codes: Rest of StatePlan 63,1223,1603,1983,2383,2773,315StandardPlan FPlan ental Life Insurance Company of Brentwood, TennesseePlan ,2053,2453,2843,3243,3633,4020.0833Plan N2,4511,2231,2731,3251,3791,4351,4941,5581,6251
of Brentwood, Tennessee An Aetna Company 800 Crescent Centre Dr. Suite 200 Franklin, TN 37067 800 264.4000 aetnaseniorproducts.com Continental Life Insurance Company of Brentwood, Tennessee An Aetna Company BENEFIT PLANS A, B, F, High Deductible F, G, N Californi
