HEALTH BENEFITS CHART OF OUT-OF-POCKET EXPENSES 5/1/08 - 4/30/09
	Plan 1		Plan 2		Plan 3
Benefits	In-Network	Non-Network	In-Network	Non-Network	In-Network	Non-Network
Calendar Year Deductible	$3,000/person $6,000/family	$9,000/person $18,000/family	$1,500/person $3,000/family	$4,500/person $9,000/family	$1,500/person $3,000/family	$4,500/person $9,000/family
Out-of-Pocket Maximum	$5,000/person $10,000/family	$15,000/person $30,000/family	$3,000/person $6,000/family	$9,000/person $18,000/family	$0/person $0/family	$0/person $0/family
Maximum Policy Benefit	$5 Million	$5 Million	$5 Million	$5 Million	$5 Million	$5 Million
Ambulance - Emergency Only	30% of Eligible Expenses^1	30% of Eligible Expenses^1	30% of Eligible Expenses^1	30% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Dental - Accident Only	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Durable Medical Equipment – $2,500/year	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
ER	$150	$150	$150	$150	$150	$150
Eye Exam	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered
Home Health Care – 100 visits/year	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Hospice Care	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Hospital - Inpatient	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Injections in a Doctor's Office	$5	50% of Eligible Expenses^1	$5	50% of Eligible Expenses^1	$5	30% of Eligible Expenses^1
Maternity / Pre-natal Care	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Mental Health Outpatient - 15 visits	$50	50% of Eligible Expenses^1	$50	50% of Eligible Expenses^1	$50	30% of Eligible Expenses^1
Mental Health Inpatient - 10 days/year	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Substance Abuse Inpatient/Outpatient	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Outpatient Surgery	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Physician's Office Services	$30 Primary Care $50 Specialist	50% of Eligible Expenses^1	$30 Primary Care $50 Specialist	50% of Eligible Expenses^1	$30 Primary Care $50 Specialist	30% of Eligible Expenses^1
Professional Fees - Surgical & Medical	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Prosthetic Devices - $2,500/year	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Reconstructive Procedures	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Rehabilitation Services	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Physical Therapy
Occupational Therapy
Speech Therapy
Pulmonary Rehabilitation
Cardiac Rehabilitation Combined Maximum of 25 visits/year
Skilled Nursing Facility / Inpatient Rehabilitation –60 days/year	30% of Eligible Expenses^1	50% of Eligible Expenses^1	30% of Eligible Expenses^1	50% of Eligible Expenses^1	0% of Eligible Expenses^1	30% of Eligible Expenses^1
Spinal Treatment / Chiropractor – 20 visits/ year	$50	50% of Eligible Expenses^1	$50	50% of Eligible Expenses^1	$50	30% of Eligible Expenses^1
Transplant Services	30% of Eligible Expenses^1	50% of Eligible Expenses^1; Limited to $35k per transplant	30% of Eligible Expenses^1	50% of Eligible Expenses^1; Limited to $35k per transplant	0% of Eligible Expenses^1	30% of Eligible Expenses^1; Limited to $35k per transplant
Urgent Care Center	$50	50% of Eligible Expenses^1	$50	50% of Eligible Expenses^1	$50	30% of Eligible Expenses^1
^1 After payment of deductible
PRESCRIPTION DRUGS
	Plan 1		Plan 2		Plan 3
Type of Drug	Retail Network	Home Delivery 90-day Supply	Retail Network	Home Delivery 90-day Supply	Retail Network	Home Delivery 90-day Supply
Level 1:	$10.00	$25.00	$10.00	$25.00	$10.00	$25.00
Level 2:	$35.00	$87.50	$35.00	$87.50	$35.00	$87.50
Level 3:	$55.00	$137.50	$55.00	$137.50	$55.00	$137.50
Level 4:	25%	2.5 X Retail Cost	25%	2.5 X Retail Cost	25%	2.5 X Retail Cost
These charts offer an overview of benefits and their respective out-of-pocket expenses under Humana’s Plan 1, Plan 2 and Plan 3. Please refer to your Summary Plan Descriptions for a detailed description of benefits. You may contact Gallagher Benefit Services at 512.499.8005 with questions, or you may call Humana’s customer service department at 1.800.232.2006 after May 1, 2008.