Jan 1, 2023 · Summary of Benefits 2023 UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 Look inside to take advantage of the health services and drug coverages the plan provides. 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) - H5322-025-0 in TX Plan Benefits Details HHSC approved Medicare Advantage and Dual eligible Plans 01/01/2023-12/31/2023 Medicare Advantage Plan HHSC Contract Number CMS Code Plan ID Plan Name Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Hmm … it looks like your browser is out of date. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244 Number of Members enrolled in this plan in (H5322 - 025): 25,188 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: Insufficient data to rate this plan. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split ... HHSC approved Medicare Advantage and Dual eligible Plans 01/01/2023-12/31/2023 Medicare Advantage Plan HHSC Contract Number CMS Code Plan ID Plan Name 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details • H5322-025-000 UnitedHealthcare Dual Complete (HMO-POS D-SNP) Title: 2023 TX United Healthcare Dual Complete Plan Quick Reference Guide: H5322-025 Author: Number of Members enrolled in this plan in (H5322 - 025): 9,816 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Premium:$25.1. This page features plan details for 2022 UnitedHealthcare Dual Complete (HMO D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT: This page features the 2022 version of this plan. See the 2023 version using the link below: 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 - 025 - 0. 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details 2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details Plan ID: H5322-025-000 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium In-Network: Preventive Dental Services: $0.00 copay. This plan covers: 2 oral exam (s), 2 cleaning (s), 1 dental X-ray (s), 1 fluoride treatment (s) every year. Medicare Covered Dental: $0.00 copay. Comprehensive Dental Services: $0.00 copay. This plan covers up to a $4,500.00 allowance for covered comprehensive dental services every year. Jan 1, 2022 · 3 ©2021 WellMed Medical Management, Inc. El Paso Waco H4527-005- AARP Medicare Advantage (HMO) H4527-002W-AARP Medicare Advantage (HMO) 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Explained H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.Premium:$25.1. This page features plan details for 2022 UnitedHealthcare Dual Complete (HMO D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT: This page features the 2022 version of this plan. See the 2023 version using the link below: 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 - 025 - 0. H5322 - 025 - 0. 1-866-944-4983 TTY users 711. — This plan information is for research purposes only. — Click here to see plans for the current plan year. 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete (HMO D-SNP) benefit details. UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars. UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H5322-025. $ 0.00.H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com Premium:$25.1. This page features plan details for 2022 UnitedHealthcare Dual Complete (HMO D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT: This page features the 2022 version of this plan. See the 2023 version using the link below: 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 - 025 - 0. We would like to show you a description here but the site won’t allow us. UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars* for plan year 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H5322-025-0002022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2. UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars* for plan year 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H5322-025-000 Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete LP (HMO-POS D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify ... Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244 UnitedHealthcare offers Texas 2023 UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools.To watch the debate live on Wednesday from 0900 local time click on the link below. For more information, click on the link below: To see some of them in action, click on the link below. To watch the plenary live and to get more information on the debates and votes, click on the links below. To see today's agenda and watch the Plenary click on ... 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H5322-025-000 no QMB card Subject: UnitedHealthcare Dual Complete additional benefit overview for health care professionals. Created Date: 20221229012412Z UnitedHealthcare offers Texas 2023 UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools. Mar 13, 2023 · Hospitalization Coverage. Inpatient hospital-acute: In-network: $0 or $1,556 per stay. $0 per day for days 91 and beyond. Out-of-network: Not Applicable. Inpatient hospital psychiatric: In-network: $0 or $1,556 per stay. Out-of-network: Not Applicable. 2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO-POS D-SNP) Location: Webb, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711. Guía de Inscripción 2023 Aproveche todo lo que su plan Medicare Advantage tiene para ofrecer UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 Área de servicio: Texas - condados de Anderson, Andrews, Angelina, Archer, Armstrong, Austin, Edit your h5322 025 form form online. Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more. Add your legally-binding signature. Draw or type your signature, upload a signature image, or capture it with your digital camera. Email, fax, or share your h5322 025 form form via URL. H4590-033- UnitedHealthcareDual Complete Plan 2 (HMO D-SNP) H4513-009 - Cigna Fundamental Medicare (HMO) H4590-803-Group Retiree Plan(s) H4527-013-AARP Medicare Advantage (HMO) UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars* for plan year 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H5322-025-000 Jan 1, 2023 · Summary of Benefits 2023 UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 Look inside to take advantage of the health services and drug coverages the plan provides. 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H5322-025-000 no QMB card Subject: UnitedHealthcare Dual Complete additional benefit overview for health care professionals. Created Date: 20221229012412Z Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of our plan This document gives you the details about your Medicare health care and prescription drug• H5322-025-000 UnitedHealthcare Dual Complete (HMO-POS D-SNP) Title: 2023 TX United Healthcare Dual Complete Plan Quick Reference Guide: H5322-025 Author: Jan 1, 2023 · UnitedHealthcare Dual Complete® (HMO-POS D-SNP) Premiums and Benefits In-Network Out-of-Network Monthly Plan Premium $35.90 Annual Medical Deductible Your deductible is $233 per year for covered medical 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details Mar 13, 2023 · Hospitalization Coverage. Inpatient hospital-acute: In-network: $0 or $1,556 per stay. $0 per day for days 91 and beyond. Out-of-network: Not Applicable. Inpatient hospital psychiatric: In-network: $0 or $1,556 per stay. Out-of-network: Not Applicable. VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2. H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage 2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO-POS D-SNP) Location: Webb, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711.Sep 26, 2022 · H5322-025-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_025_000_2023_M Jan 1, 2022 · 3 ©2021 WellMed Medical Management, Inc. El Paso Waco H4527-005- AARP Medicare Advantage (HMO) H4527-002W-AARP Medicare Advantage (HMO) 2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO-POS D-SNP) Location: Webb, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711.Maximum 3 visits every year. Copayment for Fluoride Treatment $0.00. Maximum 2 visits every year. Copayment for Dental X-Rays $0.00. Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3000.00 every year for Preventive and Non-Medicare Covered Comprehensive combined. 2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details The UnitedHealthcare Dual Complete (HMO D-SNP) (H5322 - 025) currently has 35,217 members. There are 259 members enrolled in this plan in Hood, Texas. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4.5 stars. The detail CMS plan carrier ratings are as follows: Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. 2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details 2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO-POS D-SNP) Location: Webb, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711. UnitedHealthcare Dual Complete (H5322-025) • Submit claims to WellMed. WellMed will reimburse you for the member’s medical services. UnitedHealthcare will reimburse you for the applicable member cost s hare. Mar 13, 2023 · Hospitalization Coverage. Inpatient hospital-acute: In-network: $0 or $1,556 per stay. $0 per day for days 91 and beyond. Out-of-network: Not Applicable. Inpatient hospital psychiatric: In-network: $0 or $1,556 per stay. Out-of-network: Not Applicable. This page features plan details for 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT : This page has been updated with plan and premium data for 2023. Mar 13, 2023 · Hospitalization Coverage. Inpatient hospital-acute: In-network: $0 or $1,556 per stay. $0 per day for days 91 and beyond. Out-of-network: Not Applicable. Inpatient hospital psychiatric: In-network: $0 or $1,556 per stay. Out-of-network: Not Applicable. H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com Number of Members enrolled in this plan in (H5322 - 025): 35,217 members : Plan’s Summary Star Rating: 4.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... 2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO-POS D-SNP) Location: Webb, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711. Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of our plan This document gives you the details about your Medicare health care and prescription drug2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) - H5322-025-0 in TX Plan Benefits Details Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Number of Members enrolled in this plan in (H5322 - 025): 35,217 members : Plan’s Summary Star Rating: 4.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete LP (HMO-POS D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify ... • H5322-025-000 UnitedHealthcare Dual Complete (HMO-POS D-SNP) Title: 2023 TX United Healthcare Dual Complete Plan Quick Reference Guide: H5322-025 Author: Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of our plan This document gives you the details about your Medicare health care and prescription drugUnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars* for plan year 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H5322-025-000 We would like to show you a description here but the site won’t allow us. 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details Number of Members enrolled in this plan in (H5322 - 025): 9,816 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... Jan 1, 2023 · UnitedHealthcare Dual Complete® (HMO-POS D-SNP) Premiums and Benefits In-Network Out-of-Network Monthly Plan Premium $35.90 Annual Medical Deductible Your deductible is $233 per year for covered medical 2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO-POS D-SNP) Location: Webb, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711.
H4590-033- UnitedHealthcareDual Complete Plan 2 (HMO D-SNP) H4513-009 - Cigna Fundamental Medicare (HMO) H4590-803-Group Retiree Plan(s) H4527-013-AARP Medicare Advantage (HMO) . Mandp 15 22 magazine 100 round in stock
UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars* for plan year 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H5322-025-000H1416_2023_TN_SB_DSNP_104494E_M ©Wellcare 2023 TN3IMRSOB04494E_0285 2023 Summary of Benefits Tennessee Wellcare Dual Access (HMO D-SNP) H1416 | 035 Plan ID: H5322-025-000 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2.Edit your h5322 025 form form online. Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more. Add your legally-binding signature. Draw or type your signature, upload a signature image, or capture it with your digital camera. Email, fax, or share your h5322 025 form form via URL. 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details Sep 1, 2023 · UnitedHealthcare Dual Complete (HMO-POS D-SNP) You're viewing plan details for. 27053 Alamance County. Update your ZIP Code to view accurate plan details for your area. Monthly Premium. $ 0 - $ 38.40. Primary Care Provider. $ 0 copay - 20 % of the cost. Out-of-Pocket Maximum. To watch the debate live on Wednesday from 0900 local time click on the link below. For more information, click on the link below: To see some of them in action, click on the link below. To watch the plenary live and to get more information on the debates and votes, click on the links below. To see today's agenda and watch the Plenary click on ... UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars* for plan year 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H5322-025-000Number of Members enrolled in this plan in (H5322 - 025): 9,816 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... .
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