b'Plan Comparisons: Medicare-Eligible MembersCigna Surround Group Supplement Plan AARP Medicare Supplement Insurance with Express Scripts Medicare (PDP) (mirrors Plan G) Plan F(UnitedHealthcare)with Express Scripts Available to Medicare recipients who turned 65Medicare (PDP) for CTPF on or after 2020 (or Part A effective date on or afterAvailable to Medicare recipients who turned 65 1/1/2020). prior to 2020. PLAN FEATURES PLAN FEATURESPays 100% after Medicare for Medicare covered servicesPays 100% after Medicare for Medicare covered services.and after plan deductible is met.Premium may vary by age, gender, discount availability, Includes enhanced Medicare Part D prescriptionand geographic area. Includes enhanced Medicare Part D coverage.prescription coverage.CONTACT INFORMATION CONTACT INFORMATIONCigna Group number: 3345704 UnitedHealthcare Group Number: 10891-800-244-6224 Cigna Customer Service 1-800-392-7537 Customer Service1-866-576-8773 Cigna NurseLine/Health Information Line1-888-543-5630 NurseLine www.myCigna.com www.medicare.uhc.comExpress Scripts Group number: CTPFRX Express Scripts Group number: CTPFRX1-800-864-1416 Customer Service 1-800-864-1416 Customer Servicewww.Express-Scripts.com/medd/ctpf www.Express-Scripts.com/medd/ctpfHOW TO ENROLL HOW TO ENROLLCompleted CTPF Form 350 (available in the center of thisCall UnitedHealthcare at 1-800-392-7537 and request an book or online at www.ctpf.org), and return all materialsenrollment kit for CTPF Plan #1089. Complete the kit, to CTPF. CTPF Form 350 (available in the center of this book or online at www.ctpf.org), and return all materials to CTPF.SERVICE AREA SERVICE AREANationwideNationwide (residents in Mass., Minn., and Wis., FOREIGN TRAVEL must call UnitedHealthcare AARP for enrollment options)Foreign travel emergency benefits available. FOREIGN TRAVELPHYSICIAN SELECTION Foreign travel emergency benefits available.Choose any provider who accepts Medicare. PHYSICIAN SELECTIONLIFETIME MAXIMUMChoose any provider who accepts Medicare.No lifetime maximum except foreign travel lifetime maxLIFETIME MAXIMUM of $50,000. No lifetime maximum except foreign travel lifetime max OUT-OF-POCKET MAXIMUMof $50,000.N/A OUT-OF-POCKET MAXIMUM ANNUAL PLAN YEAR DEDUCTIBLEN/APart B deductible - CMS changes annually ANNUAL PLAN YEAR DEDUCTIBLE SPECIAL DEDUCTIBLESNoneNone SPECIAL DEDUCTIBLES HOSPITAL SERVICES (Part B deductible applies) * NoneInpatientHOSPITAL SERVICES(Medicare covered services only)100% after Medicare pays (including Medicare Part AInpatientdeductible) 100% after Medicare pays (including Medicare Part A Skilled Nursing Facility (non-custodial) deductible) Medicare pays all approved amounts for the first 20 days. Skilled Nursing Facility (non-custodial) Days 21-100, plan pays 100% after Medicare pays. Medicare pays all approved amounts for the first 20 days.No benefit after day 100 (in benefit period).Days 21-100, plan pays 100% after Medicare pays. No *For Medicare covered services ONLY. Part B deductible must benefit after day 100 (in benefit period).CTPF 2024 MEDICARE HEALTH INSURANCE HANDBOOK be met before Medicare will pay.CTPF 2024 MEDICARE HEALTH INSURANCE HANDBOOK 1717'