State
County
Organization Name
Plan Name
Contract ID
Plan ID
Segment ID
Organization Type
Plan Type
Special Needs Plan
Special Needs Plan Type
Benefit Type
Part D Basic Premium Below Regional Benchmark?
National PDP
Part C Premium2
Part D Basic Premium3
Part D Supplemental Premium4
Part D Total Premium5
Part D Premium Obligation with Full Premium Assistance6
Part D Premium Obligation with 75% Premium Assistance
Part D Premium Obligation with 50% Premium Assistance
Part D Premium Obligation with 25% Premium Assistance
Part D Drug Deductible
Extra Coverage in Gap
Type of Extra Coverage in the Gap