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Plan Comparison
- FFS Benefits -

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Plan
(acronym only) 		spacer
Benefit
Type 		Medical Surgical - You pay
Deductible Copay ($)/Coinsurance (%)
Per person spacer
Per
stay
hospital
in-
patient 		spacer
Doctors
&
out-
patient
tests 		Hospital Prescription Drugs
Inpatient spacer
Out-
patient
other 		spacer
Gen-
eric 		spacer
Brand
name 		spacer
Non-
form-
ulary 		Home
Delivery
spacer

Cal-
endar
year 		Pre-
scrip-
tion
drug spacer
 spacer
R&B 		spacer
Oth-
er 		spacer
Gen-
eric 		spacer
Brand
name