OPEN ENROLLMENT?

  CURRENT PLAN NEW PLAN

What will your monthly premium be
for the plan(s) you are considering?

$
$

Will your current HTC or physician be
in "network" for this plan?

Will the plan cover your total hemophilia
treatment center visit? Including
physical Therapist, social worker, etc?

What is your office copay for the
plan(s) you are considering?

$
$

Is your factor covered for the plan(s)
you are considering?

What is the copay for your factor product
for the plan(s) you are considering?

$
$