b'Plan Comparisons: Medicare-Eligible MembersCigna Surround Group Supplement Plan AARP Medicare Supplement Insurance Plan F (UnitedHealthcare) with Express Scripts with Express Scripts Medicare (PDP) (mirrors Plan G) Medicare (PDP) for CTPF Available to Medicare recipients who turned 65Available to Medicare recipients who turned 65 on or after 2020 (or Part A effective date on or after 1/1/2020). prior to 2020. BEHAVIORAL HEALTH SERVICESBEHAVIORAL HEALTH SERVICES(Medicare covered services only)(Medicare covered services only)(Part B deductible applies)Outpatient: 100% after Medicare paysOutpatient: 100% after Medicare pays Inpatient: 100% after Medicare paysInpatient: 100% after Medicare pays PRESCRIPTION DRUG BENEFITSPRESCRIPTION DRUG BENEFITS Preferred Value Network Pharmacy* Preferred Value Network Pharmacy*(up to 31-Day supply)(up to 31-Day supply) $10Generic copay$10Generic copay $30Preferred brand copay$30Preferred brand copay $50Non-preferred brand copay$50Non-preferred brand copay $50Specialty drugs$50Specialty drugs Preferred Value Network Pharmacy* Preferred Value Network Pharmacy*(up to 90-Day Supply)(up to 90-Day Supply) $25Generic copay$25Generic copay $75Preferred brand copay$75Preferred brand copay $125Non-preferred brand copay $125Non-preferred brand copay$125Specialty drugs$125Specialty drugsExpress Scripts Mail Order (up 90-Day Supply)Express Scripts Mail Order (up 90-Day Supply) $20 Generic copay$20 Generic copay $60 Preferred brand copay$60 Preferred brand copay $100Non-preferred brand copay $100Non-preferred brand copay $100Specialty drugs $100Specialty drugsCoverageCoverage Prescription coverage is provided through the Initial Prescription coverage is provided through the Initial CoverageCoverage gap and generally stays the same as the copays stage and generally stays the same as the copays listed above.listed above. For 2025, you will stay in this stage until the For 2025, you will stay in this stage until the total cost of yourtotal cost of your Part D drugs reaches $2,000. Once you Part D drugs reaches $2,000. Once you reach this limit, youreach this limit, you move on to the Catastrophic move on to the Catastrophic Coverage stage. Most members willCoverage stage. Most members will not reach the not reach the Catastrophic Coverage stage. Catastrophic Coverage stage.Non-Medicare Part D drugs are not covered (for example,Non-Medicare Part D drugs are not covered (for example, lifestyle drugs for ED).lifestyle drugs for ED). Medicare Part B drugs, including diabetic supplies, are processedMedicare Part B drugs, including diabetic supplies, are by your medical plan.processed by your medical plan. VaccinationsVaccinations Flu shots and shots to prevent pneumococcal infections areFlu shots and shots to prevent pneumococcal infections covered under Part B. Contact your Medicare drug plan for moreare covered under Part B. Contact your Medicare drug information about vaccines. plan for more information about vaccines.Important Pharmacy Notes Important Pharmacy NotesOnce your true out-of-pocket cost reaches $2,000, your copay willOnce your true out-of-pocket cost reaches $2,000,be reduced. Once you meet this cost threshold, the plan pays theyour copay will be reduced. Once you meet this cost full cost for your covered Part D drugs. If your plan coversthreshold, the plan pays the full cost for your covered Part additional drugs not normally covered by Medicare, you may haveD drugs. If your plan covers additional drugs not normally a cost share for such drugs covered under an enhanced benefit. covered by Medicare, you may have a cost share for such drugs covered under an enhanced benefit.*Non-preferred network copays are $5 more than stated copays CTPF 2025 MEDICARE HEALTH INSURANCE HANDBOOK CTPF 2025 MEDICARE HEALTH INSURANCE HANDBOOK 21'