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PVlLlC '[)CPLCTŒS' ÞŒDICl.L I. KOS"ITAL Cl.RE .u:T PW c:IlES ,un) ~EMI~S IJ.SJC I. SlJPf'LÐEITAl. P'WS . WQJST 1, r'991. ATTACHMENT 0 IAT !'ACmc UJD~T PL.UI tA1.1f on JA .' KEÅl. TN PL.U BLUE SNIELD IIiIO FOIt MULTI! CJcaA FJ aE FlI:ICTU,~ (BP) (BS) (BIt) (CIC) (C'FA) . PLA. PØiTHLT PLIJI PØiTHLT PLIJI PØiTHL": PLA. ÞO(THLT PLAII IOCTKLT OJ) E RATE c::ro E RATE c::ro E UTE-- c::ro E tATE CtDE tATE Basic (11) Ere. onl Y 22(1) $151.80 Z05(1) $1/.9.~ 78(1) $153.:>0 . 5a(1) $151.95 2~(1) SZ15.oo Ere. :. 1 dep. (Z) :m . 2.3 C2) 29S .30 (Z) 3O6.bO (2) 297.26 (2) "5.00 E~. :. 2+~. m /'00.35 (3) 389.13 m 386.32 m 399.03 (3) 5/'5.00 supplement to "ediC8r~ (SM) ., E~. only 2.3 (1) 85.00 Z06( 1) 119.91 79(1) 75.00 68(1) 101.63 290(1) 132.00 Ere. I. 1 cIe? (2) 170.00 (2) 2.39.!!2 CZ> 150.00. (Z) 211.60 (2) 232.00 Ere. :. 2+~. m Z3I. . 00 (3) 359.13 m 225.00 (11 y.9.30 (3) 356.00 C:JI'binatlon (11 :. SM) E~. (SM), 1 dep. (8) 2.3C(,) 2(,.(,.(,3 206(1,) 265.32 7'9«(,) 228.30 £,ð(/,) 2f.6.9/. 290CI.) 332.00 Emp. CSM), 2. deps. (B) C5) 313.55 (5) 359. 7S (5) 3O8.tJ2 CS> y.a.71 (5) ~.oo Emp. :. ~. de-ps. (~), 1+ deps. C8) (6) 259.12 (6) 334.25 (6) 229 . 12 (6) 313.37 (6) :>62.00 .. Ere. (8), 1 dep. (SM) (7) 2.36.&1 (7) 269.&1 m US.30 m 261.92 (7) 315.00 Emp. (5), 2+ deps. CSM) (8) 300.&1 ca) 389.71 ca) 303.~0' ca) 399.62 (8) /'39.00 Ere. :. 1+ de-ps. (8), 1 òe? CSM) C9) 325.92 (9) 36/..2.3 (9) 308.02 (9) 363.69 C9) /"/'5.00 HEALTH PLA. FHP, INC. FOUNDATION HEALTH HEALS HEAL TII PLAII HEALTH IIET OF .vIER!c:A. CFHP) (fOil) (HE) (HI) CHI"') Basic (8) - E~. only 59(1) $1/.1.1.10 M(1) $159.(,0 220(1) $156.53 86(1) $157.00 209C 1) $151. 1.. Ere. :. 1 dep. (Z) 2!l.!!7 (2) 318.81 CZ> 316.56 CZ> m.OO m m.('1 Ere. :. 2+~. . C3> 381.88 C:3> ' 17.65 (3) /, 16.16 (3) 397.(,2 (3) 390.16 supplement to "ediCAr~ CSM) Ere. only 61(1) 10.72 85(1) 130.69 221 (1) 1Z0.11 81(1) 117.bO 210C 1) 9/0.08 ~. :. 1 dep. (2) 21.1.10 (2) 26 1 .3a CZ> 21,0.22 CZ> 2.35.20 (2) 1U.'6 Ere. :. 2+ deps. C3> 32.16 (3) 392.07 (3) 360.33 m 352.'7 (3) Z93 . 06 CClllbiNtion (8 :. SM) Ere. (SM), 1 dep. (B) 61«(,) 152.15 !!S(t,) 290.10 221(') 2aD.14 87(1,) 252.60 210«(,) 2.35."1 Emp. CSM), 2+ dcps. C8) C5) 251.16 <5) 3U . 9/. C5) 379.7&. (5) 35a.02 C5) 333.10 ~. :. 1+ deps. CSM), 1. deps. (B) (6) 120.(,5 (6) 3óI) . 22 C6) 339.!12 C6) Yoo.62 C6) 285.8S ~. (8), 1 dep. (SM) m 152.16 (7) 290.09 (7) 276.¡'¡' (7) 27".60 (7) 2(,5.22 ~. (I). Z+ deps. (SM) CIS) 162.88 (IS) '20.78 (IS) 396.75 CIS) 391.a7 (IS) 350.12 ~. I. 1. deps. (8), 1 dep.(SM) (9) 251.17 (9) 3U.93 (9) 316.2' (9) J.8.Q.02 (9) y.Z.91 PAC£ 1 '. ',.