HMO Core Plans - Only for plans with a renewal date prior to Sept. 1, 2008

  Plan Code  Plan    Deductible   Coinsurance   Out of Pocket  Copay
 Single  Family   NHP - Member Single  Family  OV 
 HMO1023 HMO 1   N/A   N/A  N/A  N/A  N/A  N/A  $10 
 HMO1025 HMO 2 $250  $500  90%  10%  $500  $1,000  $15 
 HMO1026 HMO 3  $250  $500  90%  10%  $2,000  $4,000  $20 
 HMO1027 HMO 4 $250  $500  80%  20%  $2,000  $4,000  $20 
 HMO1029 HMO 5  $500  $1,500  80%  20%  $2,500  $5,000  $20 
 HMO1031 HMO 6 $750  $2,250  70%  30%  $5,000  $10,000  $20 
 HMO1032 HMO 7 $1,000  $3,000  70%  30%  $6,000  $12,000  $30 
 HMO1033 HMO 8 $2,000  $6,000  70%  30%  $9,000  $18,000  $30 
 HMO1019 HMO 20 co pay N/A  N/A  N/A  N/A  $1,000  $2,000  $20/$45 
 HMO1075 HMO 30 co pay N/A  N/A  N/A  N/A  $2,000  $4,000  $30/$55 
 
 HMO1016 CDHMO 1 $1,500  $3,000  90%  10%  $2,000  $4,000  D/C 
 HMO1017 CDHMO 2 $2,500  $5,000  90%  10%  $3,500  $7,000  D/C 
 HMO1018 CDHMO 3 $3,500  $7,000  90%  10%  $5,000  $10,000  D/C 
 
 HMO1006 HMO 250 CO-CHOICE $250  $500  80%  20%  $1,250  $2,500  $20/$45 
 HMO1007 HMO 500 CO-CHOICE $500  $1,000  80%  20%  $1,500  $3,000  $20/$45 
 HMO1008 HMO 750 CO-CHOICE $750  $1,500  80%  20%  $1,750  $3,500  $20/$45 
 HMO1009 HMO 1000 CO-CHOICE $1,000  $2,000  80%  20%  $2,000  $4,000  $20/$45 
 HMO1053 HMO 1000 CO-CHOICE (Extra) $1,000  $2,000  70%  30%  $2,500  $5,000  $20/$45 
 HMO1010 HMO 1500 CO-CHOICE $1,500  $3,000  80%  20%  $2,500  $5,000  $20/$45 
 HMO1061 HMO 2000 CO-CHOICE $2,000  $4,000  80%  20%  $3,000  $6,000  $20/$45 
 HMO1062 HMO 2500 CO-CHOICE  $2,500  $5,000  80%  20%  $3,500  $7,000  $20/$45 
 HMO1063 HMO 3000 CO-CHOICE $3,000  $6,000  80%  20%  $4,000  $8,000  $20/$45 
 HMO1064 HMO 3500 CO-CHOICE $3,500  $7,000  80%  20%  $4,500  $9,000  $20/$45 
 HMO1065 HMO 4000 CO-CHOICE $4,000  $8,000  80%  20%  $5,000  $10,000  $20/$45 
 HMO1066 HMO 4500 CO-CHOICE $4,500  $9,000  80%  20%  $5,500  $11,000  $20/$45 
 HMO1067 HMO 5000 CO-CHOICE $5,000  $10,000  80%  20%  $6,000  $12,000  $20/$45 
 
 HSAHMO1001 HSAHMO 1500 - 100% $1,500  $3,000  N/A  N/A  $1,500  $3,000  D 
 HSAHMO1004 HSAHMO 1500 - 90% $1,500  $3,000  90%  10%  $2,000  $4,000  D/C 
 HSAHMO1005 HSAHMO 1500 - 80% $1,500  $3,000  80%  20%  $2,500  $5,000  D/C 
 HSAHMO1006 HSAHMO 2000 - 100% $2,000  $4,000  N/A  N/A  $2,000  $4,000  D 
 HSAHMO1007 HSAHMO 2000 - 90% $2,000  $4,000  90%  10%  $2,500  $5,000  D/C 
 HSAHMO1008  HSAHMO 2000 - 80% $2,000  $4,000  80%  20%  $3,000  $6,000  D/C 
 HSAHMO1009 HSAHMO 2500 - 100% $2,500  $5,000  N/A  N/A  $2,500  $5,000  D 
 HSAHMO1010 HSAHMO 2500 - 90% $2,500  $5,000  90%  10%  $3,000  $6,000  D/C 
 HSAHMO1011 HSAHMO 2500 - 80% $2,500  $5,000  80%  20%  $3,500  $7,000  D/C 
 HSAHMO1012 HSAHMO 3000 - 100% $3,000  $6,000  N/A  N/A  $3,000  $6,000  D 
 HSAHMO1013 HSAHMO 3000 - 90%  $3,000  $6,000  90%  10%  $3,500  $7,000  D/C 
 HSAHMO1014 HSAHMO 3000 - 80% $3,000  $6,000  80%  20%  $4,000  $8,000  D/C 
 HSAHMO1025 HSAHMO 3500 - 100% $3,500  $7,000  N/A  N/A  $3,500  $7,000  D 
 HSAHMO1029 HSAHMO 3500 - 80% $3,500  $7,000  80%  20%  $4,500  $9,000  D/C 
 HSAHMO1026 HSAHMO 4000 - 100% $4,000  $8,000  N/A  10%  $4,000  $8,000  D 
 HSAHMO1030 HSAHMO 4000 - 80% $4,000  $8,000  80%  20%  $5,000  $10,000  D/C 
 HSAHMO1027 HSAHMO 4500 - 100% $4,500  $9,000  N/A  N/A  $4,500  $9,000  D 
 HSAHMO1031 HSAHMO 4500 - 80% $4,500  $9,000  80%  20%  $5,500  $11,000  D/C 
 HSAHMO1028 HSAHMO 5000 - 100% $5,000  $10,000  N/A  N/A  $5,000  $10,000  D 
 HSAHMO1032 HSAHMO 5000 - 80% $5,000  $10,000  80%  20%  $5,600  $11,200  D/C