Pharmacy Benefits Summary

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Standard Option Rx Benefits for 2009

† Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring.

*50% of the Plan's allowance and any difference between our allowance and the billed amount.

Standard Option Rx Benefits for 2009—No deductible applies You Pay Generic—Network Provider Preferred Brands—Network Provider Non-Preferred Brands—Network Provider Specialty Drugs †--Network Provider All Covered Rx—Non-Network and Paper Claims
Standard Option Rx Benefits for 2009—No deductible applies
Topic You Pay
Topic Generic—Network Provider Preferred Brands—Network Provider Non-Preferred Brands—Network Provider Specialty Drugs †--Network Provider All Covered Rx—Non-Network and Paper Claims
Up to 30-day supply from a network pharmacy $10 copay $40 copay $60 copay $100 copay *50%
Up to 90-day supply through mail order $15 copay $65 copay $90 copay $300 copay Not Covered

Value Plan Rx Benefits for 2009

Value Plan Rx Benefits for 2009—No deductible applies You Pay Generic—Network Provider Non-Generic—Network Provider All Covered Rx—Non-Network Provider and Paper Claims
Value Plan Rx Benefits for 2009—No deductible applies
Topic You Pay
Topic Generic—Network Provider Non-Generic—Network Provider All Covered Rx—Non-Network Provider and Paper Claims
Up to 30-day supply from a network pharmacy $10 copay 50% of the Plan's allowance Not Covered
Up to 90-day supply through mail order $30 copay 50% of the Plan's allowance Not Covered

Consumer Option Rx Benefits for 2009

** $2,000 per person/$4,000 per family combined medical and Rx deductible

Consumer Option Rx Benefits for 2009—Annual deductible applies You Pay Generic—Network Provider Preferred Brands—Network Provider Non-Preferred Brands—Network Provider Non-Network Provider and Paper Claims
Consumer Option Rx Benefits for 2009—Annual deductible applies
Topic You Pay
Topic Generic—Network Provider Preferred Brands—Network Provider Non-Preferred Brands—Network Provider Non-Network Provider and Paper Claims
Annual Deductible Annual Deductible** Annual Deductible** Annual Deductible** Annual Deductible**
Up to 30-day supply from a network pharmacy $10 copay $25 copay $40 copay Not Covered
Up to 90-day supply through mail order $20 copay $50 copay $80 copay Not Covered

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