|
ELDERLY PHARMACEUTICAL INSURANCE COVERAGE (EPIC)
PROGRAM EXPANSION
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|
Effective January 1, 2001
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FEE PLAN
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DEDUCTIBLE PLAN
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IF YOU ARE SINGLE
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IF YOU ARE SINGLE
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Annual Income
|
Old Enrollment Fee
|
New Enrollment Fee
|
Old Co-Pay Maximum
|
New Co-Pay Maximum
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|
Annual Income
|
New Deductible
|
New Co-Pay Maximum
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|
$5,000 or less
|
$10
|
$8
|
$400
|
$340
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|
$20,001-$21,000
|
$530
|
$1,050
|
|
$5,001-$6,000
|
10
|
8
|
480
|
408
|
|
$21,001-$22,000
|
550
|
1,100
|
|
$6,001-$7,000
|
20
|
16
|
560
|
476
|
|
$22,001-$23,000
|
580
|
1,150
|
|
$7,001-$8,000
|
30
|
22
|
640
|
544
|
|
$23,001-$24,000
|
720
|
1,200
|
|
$8,001-$9,000
|
40
|
28
|
720
|
612
|
|
$24,001-$25,000
|
750
|
1,250
|
|
$9,001-$10,000
|
44
|
36
|
720
|
700
|
|
$25,001-$26,000
|
780
|
1,300
|
|
$10,001- $10,800
|
44
|
40
|
720
|
720
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|
$26,001-$27,000
|
810
|
1,350
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|
$10,801-$11,000
|
80
|
40
|
798
|
720
|
|
$27,001-$28,000
|
840
|
1,400
|
|
$11,001-$12,000
|
110
|
46
|
870
|
827
|
|
$28,001-$29,000
|
870
|
1,450
|
|
$12,001-$13,000
|
130
|
54
|
943
|
896
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|
$29,001-$30,000
|
900
|
1,500
|
|
$13,001-$14,000
|
160
|
60
|
1,015
|
964
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|
$30,001-$31,000
|
930
|
1,550
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|
$14,001-$15,000
|
180
|
80
|
1,088
|
1,016
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$31,001-$32,000
|
960
|
1,600
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|
$15,001-$16,000
|
200
|
110
|
1,088
|
1,034
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|
$32,001-$33,000
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1,160
|
1,650
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|
$16,001-$17,000
|
220
|
140
|
1,088
|
1,052
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|
$33,001-$34,000
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1,190
|
1,700
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|
$17,001-$18,000
|
240
|
170
|
1,088
|
1,070
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$34,001-$35,000
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1,230
|
1,750
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$18,001-$18,500
|
240
|
200
|
1,088
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1,088
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|
|
|
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$18,501-$19,000
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|
200
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|
1,088
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|
|
|
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$19,001-$20,000
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|
230
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1,160
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|
|
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|
|
|
|
|
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IF YOU ARE MARRIED
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IF YOU ARE MARRIED
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Annual Income
|
Old Enrollment Fee
|
New Enrollment Fee
|
Old Co-Pay Maximum
|
New Co-Pay Maximum
|
|
Annual Income
|
New Deductible
|
New Co-Pay Maximum
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|
$5,000 or less
|
$8
|
$8
|
$300
|
$291
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|
$26,001-$27,000
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$650
|
$1,080
|
|
$5,001-$6,000
|
8
|
8
|
360
|
342
|
|
$27,001-$28,000
|
675
|
1,120
|
|
$6,001-$7,000
|
18
|
12
|
420
|
399
|
|
$28,001-$29,000
|
700
|
1,160
|
|
$7,001-$8,000
|
28
|
16
|
480
|
456
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|
$29,001-$30,000
|
725
|
1,200
|
|
$8,001-$9,000
|
36
|
20
|
540
|
513
|
|
$30,001-$31,000
|
900
|
1,240
|
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$9,001-$10,000
|
40
|
24
|
600
|
570
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|
$31,001-$32,000
|
930
|
1,280
|
|
$10,001-$11,000
|
40
|
28
|
660
|
622
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$32,001-$33,000
|
960
|
1,320
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$11,001-$12,000
|
40
|
32
|
720
|
641
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$33,001-$34,000
|
990
|
1,360
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$12,001-$13,000
|
40
|
36
|
720
|
660
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$34,001-$35,000
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1,020
|
1,400
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|
$13,001-$14,000
|
40
|
40
|
720
|
684
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|
$35,001-$36,000
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1,050
|
1,440
|
|
$14,001-$14,400
|
40
|
40
|
720
|
710
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$36,001-$37,000
|
1,080
|
1,480
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|
$14,401-$15,000
|
80
|
40
|
815
|
710
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|
$37,001-$38,000
|
1,110
|
1,520
|
|
$15,001-$16,000
|
110
|
84
|
869
|
826
|
|
$38,001-$39,000
|
1,140
|
1,560
|
|
$16,001-$17,000
|
130
|
106
|
923
|
877
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|
$39,001-$40,000
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1,170
|
1,600
|
|
$17,001-$18,000
|
160
|
126
|
977
|
928
|
|
$40,001-$41,000
|
1,200
|
1,640
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|
$18,001-$19,000
|
180
|
150
|
1,032
|
980
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|
$41,001-$42,000
|
1,230
|
1,680
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|
$19,001-$20,000
|
200
|
172
|
1,086
|
990
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|
$42,001-$43,000
|
1,260
|
1,720
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|
$20,001-$21,000
|
220
|
194
|
1,086
|
1,008
|
|
$43,001-$44,000
|
1,290
|
1,760
|
|
$21,001-$22,000
|
240
|
216
|
1,086
|
1,026
|
|
$44,001-$45,000
|
1,320
|
1,800
|
|
$22,001-$23,000
|
260
|
238
|
1,086
|
1,044
|
|
$45,001-$46,000
|
1,575
|
1,840
|
|
$23,001-$24,400
|
280
|
260
|
1,086
|
1,062
|
|
$46,001-$47,000
|
1,610
|
1,880
|
|
$24,401-$25,000
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|
275
|
|
1,080
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|
$47,001-$48,000
|
1,645
|
1,920
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|
$25,001-$26,000
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|
300
|
|
1,150
|
|
$48,001-$49,000
|
1,680
|
1,960
|
|
|
|
|
|
|
|
$49,001-$50,000
|
1,715
|
2,000
|
|