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., • <br />i <br />INSURANCE <br />• <br />PLAN 5 <br />SUMMARY OF BENEFITS: <br />$40 room for 30 days <br />ICU in full <br />$25 Med-Surg Deductible <br />$500 Surgical Schedule <br />20~ Anesthesia ' <br />$150 AIS <br />$250,000 Major Medical <br />$60 room limit <br />$100 Deductible <br />Out-patient drugs in full <br />Out-patient psychiatric $12.50 weekly maximum <br />• Individual $22.59 + $4.20 <br />Emp. & Children 24.58 <br />Emp. & Spouse 31.64 <br />Family 40.04 <br />AMOUNT OF <br />INCREASE <br />$ 2.28 <br />New <br />9.60 <br />11.52 <br />f <br />• <br />