For coverage becoming effective on or after September 1, 2011

5-tier drug riders

• 2/7/15/35/20%
• 2/7/20/40/20%
• 2/7/20/40/80
• 2/10/25/45/20%
• 2/10/25/45/90
• 2/15/30/50/20%
• 2/15/30/50/100
• 2/15/45/90/20%
• 5-tier drug list

11/17/2011