OPEN ENROLLMENT?

  CURRENT PLAN NEW PLAN

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

$ $

Will your current hemophilia treatment center
(HTC) or physician be in "network" for this plan?

Will the plan cover your total HTC visit,
including physical therapist, social worker, etc?

What is your office co-pay for the
plan(s) you are considering?

$ $

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

What is the co-pay for your factor product
for the plan(s) you are considering?

$ $