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<br />çom~rehens.i ve Medic:al <br /> <br />Employe. <br /> <br />Employee/Spouse <br /> <br />Employee/Children <br /> <br />Employee/Family <br /> <br />Medic:are Supplement <br /> <br />Com~rehensive Dental <br /> <br />Employe. <br /> <br />E~ployee/Spouse <br /> <br />Employee/Children <br /> <br />Employee/Family <br /> <br />Medic:are Supplement <br /> <br />- Prescription Drug Coverage Rider ($4.00 per <br />prescription). See TBPRX 10/87 section of the <br />specil8en contract. Monthly Premium <br /> <br />Deductible 1 $ 5.41 <br />Ceduct'.ible 2 $ BIA <br /> <br />Ceduct'.ible 1 $ 11.90 <br /> <br />Ceduct'.ible 2 $ MIA- <br /> <br />Deductible 1 $ 10.81 <br />Deductible 2 $ N/A <br /> <br />Deductible 1 $ 17.09 <br /> <br />Deductible 2 $ MIA <br /> <br />Deductible 1 $ BIA <br /> <br />Deductible 2 $ N/A <br /> <br /> Monthly Premium <br />Deductible 1 $ B/A <br />Deciuctible 2 $ MIA <br />Deduct'.ible 1 $ RIA <br />Deductible 2 $ MIA <br />Deductible 1 $ RIA <br /> <br />Deductible 2 $ RIA <br />Deductible 1 $ MIA <br /> <br />Deductible 2 $ MIA <br /> <br />Deductible 1 $ MIA <br /> <br />Deduc:tible 2 $ BIA <br /> <br />B-2 <br />