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 or in some instants, with a Medicare Part A PLAN FEATURES Effective Date prior to 1/1/2020. Pays 100% after Medicare for Medicare covered servicesPLAN FEATURESand after plan deductible is met.Pays 100% after Medicare for Medicare covered services.Includes enhanced Medicare Part D prescriptionPremium may vary by age, gender, discount availability, coverage.and geographic area. Includes enhanced Medicare Part D CONTACT INFORMATION prescription coverage.Cigna Group number: 3345704 CONTACT INFORMATION1-800-244-6224 Cigna Customer Service UnitedHealthcare Group Number: 10891-866-576-8773 Cigna NurseLine/Health Information Line1-800-392-7537 Customer Servicewww.myCigna.com 1-888-543-5630 NurseLine Express Scripts Group number: CTPFRX www.medicare.uhc.com1-800-864-1416 Customer Service Express Scripts Group number: CTPFRXwww.Express-Scripts.com/medd/ctpf 1-800-864-1416 Customer ServiceHOW TO ENROLL www.Express-Scripts.com/medd/ctpfHOW 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 SERVICE AREA online at www.ctpf.org), and return all materials to CTPF.NationwideSERVICE AREAFOREIGN TRAVEL Nationwide (residents in Mass., Minn., and Wis., must call UnitedHealthcare AARP for enrollment options Foreign travel emergency benefits available. or if not age 65 prior to 2020 but Medicare Part A is)PHYSICIAN SELECTION FOREIGN TRAVELChoose any provider who accepts Medicare. Foreign travel emergency benefits available.LIFETIME MAXIMUMPHYSICIAN SELECTIONNo lifetime maximum except foreign travel lifetime maxChoose any provider who accepts Medicare.of $50,000. LIFETIME MAXIMUM OUT-OF-POCKET MAXIMUMNo lifetime maximum except foreign travel lifetime max N/A of $50,000.ANNUAL PLAN YEAR DEDUCTIBLEOUT-OF-POCKET MAXIMUM Part B deductible - CMS changes annually N/ASPECIAL DEDUCTIBLESANNUAL PLAN YEAR DEDUCTIBLE None NoneHOSPITAL SERVICES (Part B deductible applies) * SPECIAL DEDUCTIBLES InpatientNone100% after Medicare pays (including Medicare Part AHOSPITAL SERVICES(Medicare covered services only)deductible) InpatientSkilled Nursing Facility (non-custodial) 100% after Medicare pays (including Medicare Part AMedicare pays all approved amounts for the first 20 days. deductible) Days 21-100, plan pays 100% after Medicare pays. Skilled Nursing Facility (non-custodial) No benefit after day 100 (in benefit period).Medicare pays all approved amounts for the first 20 days. *For Medicare covered services ONLY. Part B deductible must Days 21-100, plan pays 100% after Medicare pays. No be met before Medicare will pay.benefit after day 100 (in benefit period).17CTPF 2025 MEDICARE HEALTH INSURANCE HANDBOOK CTPF 2025 MEDICARE HEALTH INSURANCE HANDBOOK 17'