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:
Standard Text (PDF formatted document)
Download Standard Text
Large Text (PDF formatted document)
Download Large Text
Spanish Text (PDF formatted document)
Download Spanish Text
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updated 10/1/10
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