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United Commercial Travelers of America (UCT) Medicare Supplement Plan Information
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United Commercial Travelers of America (UCT) Medicare Supplement Rates Annual Rates effective 6/1/2010 Plan A Plan F Plan G Plan N Male / 65yr / Non-tobacco / zip codes 970-972 $1,545.05 $2,263.22 $1,884.37 $1,584.25 Female / 65yr / Non-tobacco / zip codes 970-972 $1,344.09 $1,966.73 $1,638.94 $1,376.71 Male / 65yr / Tobacco / zip codes 970-972 $1,932.14 $2,828.20 $2,357.11 $1,979.74 Female / 65yr / Tobacco / zip codes 970-972 $1,680.12 $2,459.23 $2,049.09 $1,721.46 Male / 65yr / Non-tobacco / zip codes 973-979 $1,358.90 $1,990.54 $1,657.34 $1,393.38 Female / 65yr / Non-tobacco / zip codes 973-979 $1,182.15 $1,729.77 $1,441.48 $1,210.84 Male / 65yr / Tobacco / zip codes 973-979 $1,699.35 $2,487.45 $2,073.12 $1,741.22 Female / 65yr / Tobacco / zip codes 973-979 $1,477.70 $2,162.94 $1,802.21 $1,514.06 Benefits Plan A Plan F Plan G Plan N Medicare Part A Coinsurance and Hospital Benefits Medicare Part A Deductible   Medicare Part B Coinsurance or Co-payment 2 Medicare Part B Deductible       Medicare Part B Excess Charges     Blood (First Three Pints) Hospice Care Coinsurance or Co-payment Skilled Nursing Coinsurance   Foreign Travel Emergency (Up to Plan Limits)3   Medicare Preventive Care Part B Coinsurance MODAL FACTORS: Semi-Annual – 0.51500 / Quarterly – 0.26250 / Direct Monthly – 0.10000 / Monthly EFT – 0.08333

1. Medigap Plan F offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,070 in 2012) before your Medigap policy pays anything
2. 100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.
3. You must also pay a separate deductible for foreign travel emergency ($250 per year).
4. After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($140 in 2012) the plan pays 100% of covered services for the rest of the calendar year (This applies only to plans K & L)
5. Modified Plan F offers an individual assistance program, as well as coverage for preventive dental care (available in some states)

• 2012 Out of Pocket Limit for Plan K is $4,660.
• 2012 Out of Pocket Limit for Plan L is $2,330.