Effective 1/1/2008

5-tier drug riders

For large and small groups

• 2/5/10/30/60 - for large groups only
• 2/5/15/20/40
• 2/7/15/35/70
• 2/7/20/40/80
• 2/10/25/45/90
• 2/15/30/50/100
• 2/15/50/150
• 2/15/50/150-5000
• 250/50
• 5-tier drug list

3-tier drug riders

For state-mandated plans only

• 10/30/50
• 10/50/100
• 30 (diabetic medication and supplies only)
• 3-tier drug list

3/17/2008