Summary of Benefits
Summary of Benefits includes the following information:
- Monthly premium
- Service area
- Applicable conditions and limitations
- Conditions associated with use of benefits
- Copayments, coinsurance, and deductibles
- Out-of-network coverage
Download the Summary of Benefits:
Download Summary of Benefits (Select Plan) - English
Download Summary of Benefits (Enhanced Plan) - English
Download Summary of Benefits (Select Plan) - Español
Download Summary of Benefits (Enhanced Plan) - Español
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