HMO Plans

HMO 20A

HMO 20

HMO 20 Plus

POS Plans

POS 20/2000

POS 20/1000

POS 20/500

GHI
2nd Quarter 2007 Plans

Cost Share

Plan 1 - CS EPO 40/2000

Plan 2 - CS EPO 40/2000A

Plan 3 - CS EPO 40/1000C

Plan 4 - CS EPO 40/1000A

Plan 5 - CS EPO 40/1000B

Plan 6 - CS EPO 40/1000

Plan 7 - CS EPO 30/2000A

Plan 8 - CS EPO 30/2000

Plan 9 - CS EPO 30/1000A

Plan 10 - CS EPO 30/1000B

Plan 11 - CS EPO 30/1000

Plan 12 - CS EPO 30/500A

Plan 13 - CS EPO 30/500

Plan 14 - CS PPO 30/1000

Plan 15 - CS PPO 30/1000A

NON Cost Share

Plan 16 - EPO 20A

Plan 17 - EPO 25/500

Plan 18 - EPO 30/500

Plan 19 - EPO 40/1000

Plan 20 - PPO 25/3000

Plan 21 - PPO 30/1000

Plan 22 - PPO 25/1000

GHI
OLD RENEWAL PLANS

Cost Share

EPO 30/2000 (Renewals Only)

EPO 30/1000 (Renewals Only)

EPO 30/1000A (Renewals Only)

EPO 30/500 (Renewals Only)

EPO 30/500A (Renewals Only)

PPO 30/2000 (Renewals Only)

NON Cost Share

EPO 30/1000B (Renewals Only)

EPO 30/1000C (Renewals Only)

EPO 30/750 (Renewals Only)

EPO 30/750 Plus (Renewals Only)

EPO 30A (Renewals Only)

EPO 30 (Renewals Only)

EPO 20 (Renewals Only)

EPO 15 (Renewals Only)

HIP
2nd Quarter 2007 Plans

Cost Share

EPO Smart Start

EPO Super Value

EPO 30/45 2000 Select

EPO 20/1000

PPO 30/1000

PPO 30/45 3000 Select

PPO 30/1000 Select

PPO 15 IN 1000

HMO Plans

HMO Super Value

HMO 25/40A

HMO Value

HMO 20

HMO 5

HMO 15

HMO 10

POS Plans

POS 20/1000

POS 15/500

POS 10/250

Cost Share

EPO 30/45 2000 Select

PPO 30/45 3000 Select

PPO 30/1000 Select

Cost Share PPO 20/1000/2000

Cost Share PPO 20/500/2000

HMO Plans

HMO Super Value

Direct Access HMO Plans

Direct Access HMO 20

Direct Access HMO 15

Direct Access HMO 10

POS Plans

POS 20/1000

POS 15/500

POS 10/250

HMO Plans

HMO 20A

HMO 20B

HMO 20

HMO 25A

HMO 25

HMO 15

HMO 10

POS Plans

POS 20/1000

POS 10/500

SCHEDULE OF PLAN BENEFITS

MDFlex HMO 20A, 20B, & 20

MDFlex HMO 25

MDFlex HMO 15

MDFlex HMO 10

MDFlex POS 20/1000

MDFlex POS 10/500