Total Blue Office VisitPrescription Drugs Dental CoverageMonthly Cost Primary Care $35 Co-Pay Specialist $50 Co-Pay Generics: 30 days $10 co pay Preferred Brand: 30 days $60 co pay Dental $17 additional Per month $ Deductible $750

Individual Coverage Classic Blue Individual Coverage Office Visit Prescription Drugs Dental CoverageMonthly Cost Primary Care: $40 Co-Pay Specialist $60 Co-Pay Generics: $15 Co-pay Preferred Brand: $75 Co-pay Dental $17.00 additional Per Month $ Deductible $1,500.00

Family Coverage-2012 Retiree + 1 Total Blue Family Coverage Office Visit Prescription Drugs Dental CoverageMonthly Cost Primary Care: $35 Co-Pay Specialist $50 Co-Pay Generics: $10 Co-pay Preferred Brand: $60Co-pay Dental $47.00 additional Per Month $ Deductible $ Individual; 2,250 family aggregate

Family Coverage-2012 Retiree + 1 Classic Blue Family Coverage Office Visit Prescription Drugs Dental CoverageMonthly Cost Primary Care: $40 Co-Pay Specialist $60 Co-Pay Generics: $15 Co-pay Preferred Brand: $75Co-pay Dental $47.00 additional Per Month $ Deductible $ Individual; 4,500 family aggregate

C-Plus (65 and Older) All Individual Medicare SelectOffice Visit (PCP) Drug CoverageMonthly Cost Plan B$0 co pay After you meet your Medicare Part B deductible None—has to be purchase separately $165.00