% 80% I 60960 5696- None None $5 None None / None 350 / 31,500 L N/A N/A / N/A Option 4; PPO Max 1500 100% None $50/ $1.500 Option 5; Active PPO 100% 80% i 50% 60% 50% None None None I None $5 None $50 / $1,500 None $50/ $1,000 Option 8: Freedom of Choice; PPO 1500 100% 90%