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Page 3 <br /> LINCOLN NATIONAL <br /> HEALTH PLAN MAXICARE PACIFICARE <br /> (LNHP) (MAX) (PAC) <br /> Plan Monthly Plan Monthly Plan Monthly <br /> Code Rate Code Rate Code Rate <br /> Basic(B) <br /> Emp.only 2241 $148.49 431 $166.64 2381 $142.58 <br /> Emp. & 1 dep. 2242 304.41 432 310.06 2382 292.31 <br /> Emp. & 2+deps. 2243 415.77 433 416.28 2383 420.05 <br /> Supplement To Medicare(SM) <br /> Emp. only 2251 125.05 441 155.80 2391 34.52 <br /> Emp. & 1 dep. 2252 250.10 442 290.89 2392 69.04 <br /> Emp. & 2+deps. 2253 375.15 443 382.15 2393 103.56 <br /> Combination (B&SM) <br /> Emp.(SM), 1 dep. (B) 2254 280.97 444 299.22 2394 184.25 <br /> Emp. (SM), 2+deps. (B) 2255 392.33 445 405.44 2395 311.99 <br /> Emp. & 1 dep. (SM), 1+deps. (B) 2256 361.46 446 397.11 2396 196.78 <br /> Emp. (B), 1 dep. (SM) 2257 273.54 447 301.73 2397 177.10 <br /> Emp. (B), 2+deps. (SM) 2258 398.59 448 392.99 2398 211.62 <br /> Emp. & 1+dep. (B), 1 dep. (SM) 2259 384.90 449 407.95 2399 304.84 <br /> PCA <br /> HEALTH PLANS PORAC PERS-CARE <br /> (PCA) (PORAC) (PC) <br /> Plan Monthly Plan Monthly Plan Monthly <br /> Code Rate Code Rate Code Rate <br /> Basic (B) <br /> Emp. only 701 $162.83 2071 $210.17 2721 $234.00 <br /> Emp. & 1 dep. 702 303.47 2072 371.18 2722 443.00 <br /> Emp. & 2+deps. 703 411.53 2073 521.30 2723 590.00 <br /> Supplement To Medicare(SM) <br /> Emp.only 711 95.14 2081 129.06 2731 152.00 <br /> Emp. & 1 dep. 712 190.28 2082 258.14 2732 305.00 <br /> Emp. & 2+deps. 713 285.42 2083 371.51 2733 423.00 <br /> Combination (B&SM) <br /> Emp. (SM), 1 dep. (B) 714 235.78 2084 290.07 2734 361.00 <br /> Emp. (SM), 2+deps. (B) 715 343.84 2085 440.19 2735 508.00 <br /> Emp. & 1 dep. (SM), 1+deps. (B) 716 298.34 2086 408.26 2736 452.00 <br /> Emp. (8), 1 dep. (SM) 717 257.97 2087 339.25 2737 387.00 <br /> Emp. (B), 2+deps. (SM) 718 353.11 2088 452.62 2738 505.00 <br /> Emp. & 1+ dep. (B), 1 dep. (SM) 719 366.03 2089 489.37 2739 534.00 <br />