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	Liberty Plan Direct™	Oxford® Exclusive Plan Metro™	Oxford® HSA Direct™	Oxford® HSA Exclusive™
Network	Liberty	Liberty	Freedom	Freedom
Office Visit Copayment	$30/$50	$25/$50	D & C	D & C
In-network Deductible	$2,000/$4,000	$2,000/$4,000	$2,850/$5,700	$2,000/$4,000
In-network Coinsurance	80% to $10K	90% to $10K	90% to $10K	100%
Out-of-network Deductible	$2,000	In-network Only	$2,850	In-network Only
Out-of-network Coinsurance	60% to $10K	In-network Only	70% to $10	In-network Only
Hospital Inpatient	Deductible Coinsurance	Deductible Coinsurance	Deductible Coinsurance	Deductible Coinsurance
Outpatient Surgery	Deductible Coinsurance	Deductible Coinsurance	Deductible Coinsurance	Deductible Coinsurance
Pharmacy	$15/50% w/$100 Tier 2 deductible	$15/50% w/$100 Tier 2 deductible	$15/50%	$15/50%
Fourth Quarter 2009 Rates – Manhattan, Richmond, Bronx and Suffolk Counties
Single rate	$456.45	$404.36	$383.15	$399.26
Parent / Child(ren) rate	$844.43	$748.07	$708.83	$738.63
Husband / Wife rate	$1,004.19	$889.59	$842.93	$878.37
Family rate	$1,442.39	$1,253.52	$1210.75	$1,237.71
Mental Health Rider - Unlimited Biologically Based Mental Health Services
Single rate	$3.76	$2.31	$3.13	$2.23
Parent / Child(ren) rate	$6.96	$4.27	$5.79	$4.13
Husband / Wife rate	$8.27	$5.08	$6.89	$4.91
Family rate	$11.88	$7.16	$9.89	$6.91
Fourth Quarter 2009 Rates – Kings, Queens and Nassau Counties
Single rate	$467.51	$414.25	$394.64	$411.24
Parent / Child(ren) rate	$864.89	$766.36	$730.08	$760.79
Husband / Wife rate	$1,028.52	$911.35	$868.21	$904.73
Family rate	$1,477.34	$1,284.18	$1,247.06	$1,274.84
Mental Health Rider - Unlimited Biologically Based Mental Health Services
Single rate	$3.87	$2.38	$3.22	$2.30
Parent / Child(ren) rate	$7.16	$4.40	$5.96	$4.26
Husband / Wife rate	$8.51	$5.24	$7.08	$5.06
Family rate	$12.23	$7.38	$10.18	$7.13