1Benefits effective 2/1/2006Benefits effective 2/1/2006

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• Lifetime maximum of up to $5 million

• RX Card

• Wide choice of plans

• Family Flex® – Each family member can apply for a different plan on the same application

• Preventive Care

• Out-of-Pocket Maximums provide protection against catastrophic expenses

• MedCall® 24-hour nurse hotline

• HealthyExtensions SM – Discounts on services and products your clients want and need

• No claim forms with network providers

UniCare’s Individual FIT Plans Offer

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Individual Plan Choices

• UniCare FIT Health Plans choice of deductibles:

- $ 500 - $ 2,000 - $ 1,000 - $ 3,000

- $ 1,500 - $ 5,000

• UniCare Saver 2000 Plan

UniCare offersplan options based on

plan design and premium!

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• Six separate plans with a choice of deductibles and in-network coinsurance levels

• Unlimited office visits with a $30 co-pay per member at participating providers

with Annual Deductible Waived• 100% coverage up to $300 per member

with Annual Deductible Waived* for Preventive Care for children (through age 6) and Pap smear, mammograms and PSA for adults.

UniCare FIT PlanFeatures

* After maximum benefit is met, deductible and coinsurance will apply

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Deductibles: Coinsurance:– $5,000– $3,000– $2,000– $1,500– $1,000– $ 500

• After Deductible is met, UniCare pays 70% Coinsurance up to Maximum in-network Out-of-Pocket (OOP) expenses

• After Deductible is met, UniCare pays 80% Coinsurance up to Maximum in-network Out-of-Pocket (OOP) expenses

UniCare FIT PlansShare of Costs

7*After deductible is met

Office VisitsUnlimited office visits with $30 copay does not include lab and x-rays lab and x-rays

All FIT Plans

Annual Out-of-Pocket (OOP) Maximum*

Individual•$3,000* on all plans for in-network charges•$10,000* on all plans for out-of-network charges

Family•$6,000* on all plans for in-network charges•$20,000* on all plans for out-of-network charges

8*After deductible is met

No Limitations on Infusion Therapy

All FIT Plans

Inpatient & Outpatient Hospital Services*

UniCare FIT 500 & 1000

80%UniCare FIT 1500-5000

70%

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500 1000 1500 2000 3000 5000

Member $500 $1,000 $1,500 $2,000 $3,000 $5,000Family

Member

Family

100% 100% 100% 100% 100% 100%

80% 80% 70% 70% 70% 70%

$300 Maximum payment, w ith deductible w aived. After max; deductible and coinsurance w ill apply.

80% 80% 70% 70% 70% 70%

AmbulanceServices

Physical & Occ Therapy, and Acupuncture

of Maximum Covered Expense After DeductibleGround services up to a maximum covered espense of $1,000 per trip

Air services up to maximum covered expense of $5,000 per trip

$30 Max per visit / 12 visits per year combined (additional 24 visits w hen medically necessary)

Lifetime Maximum

Professional Svcs, Lab & Xray, Infusion Therapy

and Out & Inpatient Care

Preventive Care(Deductible Waived)

Office Visits

UniCare FIT Plans (PPO)ILLINOISIndividual & Family Plans

All benefits shown for In-network services. For Out-of-network services an additionaldeductible of $2,000 will apply (in addition to the deductible shown above)

$30 Co-pay per visit per member, Unlimited number of visits with Deductible waived

$6,000 plus Deductible per yearMax Out of

Pocket

$5 Million per memberAnnual

Deductible Maximum 2 deductibles per family per year

$3,000 plus Deductible per year

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UniCare FIT PlansPrescription Drug Share of Costs

Brand Name Only Deductibles by Plan:

Plan Deductible

UniCare FIT 500 $250UniCare FIT 1000 $250UniCare FIT 1500 $250UniCare FIT 2000 $250UniCare FIT 3000 $500UniCare FIT 5000 $500

Drug Co-Paysfor all plans

You pay (per 30-day supply)

$10 Generic Drugs (No Deductible)$30 Brand Name (Formulary)$50 Brand Name (Non-formulary)20% Self-Injectables (500-1000 Plans)30% Self-Injectables (1500-5000 Plans)

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• This is a hospital plan with two office visits and some limited outpatient Pharmacy and Lab & Xray

• Benefits include 2 office visits per member, per year, at a $30 Copay for Participating Providers with the deductible waived

• Limited preventive care benefit

UniCare Saver 2000 PlanFeatures

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• $2,000 medical deductible• UniCare pays 70%, you pay

30% for inpatient facility and eligible professional charges

• $200 Brand Name drug deductible

• $500 Drug Maximum, per member per year (in- and out- of network)

Drug Co-pays:Drug Co-pays:

Retail (30-day supply):$10 Generic Drugs$25 Brand Name Drugs

UniCare Saver 2000 PlanShare of Costs

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