Active & Retiree Plan: Trustees of the Milwaukee Roofers Health Fund Coverage Period: 06/01/ /31/2016 Summary of Benefits and Coverage:

Size: px
Start display at page:

Download "Active & Retiree Plan: Trustees of the Milwaukee Roofers Health Fund Coverage Period: 06/01/2015-05/31/2016 Summary of Benefits and Coverage:"

Transcription

1 Summry of Benefits nd Coverge: Wht this Pln Covers & Wht it Costs Coverge for: Single & Fmily Pln Type: NPOS This is only summry. If you wnt more detil bout your coverge nd costs, you cn get the complete terms in the policy or pln document by clling or Importnt Questions Answers Why this Mtters: Wht is the overll deductible? Are there other deductibles for specific services? Is there n out of pocket limit on my expenses? Wht is not included in the out of pocket limit? Is there n overll nnul limit on wht the pln pys? Does this pln use network of providers? Do I need referrl to see specilist? Are there services this pln doesn t cover? PAR providers: $1,000 single/$3,000 fmily. Non-PAR providers: $2,000 single/$6,000 fmily. Copyments nd PAR preventive cre re not subject to the deductible. No. Yes. PAR providers: $2,000 single/$4,000 fmily per pln yer. Non- PAR providers: $5,000 single/$10,000 fmily. Pln Mximum Out-of Pocket PAR: $6,350/$12,700 Non-PAR: Not pplicble Penlties, Copyments, deductible, nd mounts over the llowed mount, premiums, blnce-billed chrges, nd helth cre this pln doesn t cover. No. Yes. See for list of PAR providers. No. Yes. You must py ll the costs up to the deductible mount before this pln begins to py for covered services you use. Check your policy or pln document to see when the deductible strts over (usully, but not lwys, Jnury 1st). See the chrt strting on pge 2 for how much you py for covered services fter you meet the deductible. You don t hve to meet deductibles for specific services, but see the chrt strting on pge 2 for other costs for services this pln covers. The out-of-pocket limit is the most you could py during coverge period (usully one yer) for your shre of the cost of covered services. This limit helps you pln for helth cre expenses. Even though you py these expenses, they don t count towrd the outof-pocket limit. The chrt strting on pge 2 describes ny limits on wht the pln will py for specific covered services, such s office visits. If you use n in-network doctor or other helth cre provider, this pln will py some or ll of the costs of covered services. Be wre, your innetwork doctor or hospitl my use n out-of-network provider for some services. Plns use the term in-network, preferred, or prticipting for providers in their network. See the chrt strting on pge 2 for how this pln pys different kinds of providers. You cn see the specilist you choose without permission from this pln. Some of the services this pln doesn t cover re listed on pge 6. See your policy or pln document for dditionl informtion bout excluded services. OMB Control Numbers , , nd Relesed on April 23, of 9

2 Summry of Benefits nd Coverge: Wht this Pln Covers & Wht it Costs Coverge for: Single & Fmily Pln Type: NPOS Copyments re fixed dollr mounts (for exmple, $15) you py for covered helth cre, usully when you receive the service. Coinsurnce is your shre of the costs of covered service, clculted s percent of the llowed mount for the service. For exmple, if the pln s llowed mount for n overnight hospitl sty is $1,000, your coinsurnce pyment of 20% would be $200. This my chnge if you hven t met your deductible. The mount the pln pys for covered services is bsed on the llowed mount. If n out-of-network provider chrges more thn the llowed mount, you my hve to py the difference. For exmple, if n out-of-network hospitl chrges $1,500 for n overnight sty nd the llowed mount is $1,000, you my hve to py the $500 difference. (This is clled blnce billing.) This pln my encourge you to use PAR providers by chrging you lower deductibles, copyments nd coinsurnce mounts. Common Medicl Event If you visit helth cre provider s office or clinic If you hve test Services You My Need PAR Provider Non-PAR Provider Limittions & Exceptions Primry cre visit to tret n injury or illness $25 copyment/visit 40% fter deductible none Specilist visit $50 copyment/visit 40% fter deductible none Other prctitioner office visit $50 copyment/visit 40% fter deductible Chiroprctor. Preventive cre/screening/immuniztion Dignostic test (x-ry, blood work) No chrge Imging (CT/PET scns, MRIs) 20% fter deductible 40% fter deductible 20% fter deductible 40% fter deductible 40% fter deductible -Limited to 1 mmmogrm nd 1 prostte specific ntigen testing over ge 50 per yer. -Immuniztions for child nd dult re bsed on the Deprtment of Helth nd Humn Services Centers for Disese Control nd Prevention. -PAR provider in clinic: No chrge. -Prior uthoriztion is required for Imging. Filure to do so will cuse coinsurnce to reduce 2 of 9

3 Summry of Benefits nd Coverge: Wht this Pln Covers & Wht it Costs Coverge for: Single & Fmily Pln Type: NPOS Common Medicl Event Services You My Need PAR Provider Non-PAR Provider Limittions & Exceptions If you need drugs to tret your illness or condition More informtion bout prescription drug coverge is vilble t Level 1 - Low-cost generic drugs Retil (30 dys) Retil (90 dys) Mil (90 dys) Level 2 - Brnd nme drugs Retil (30 dys) Retil (90 dys) Mil (90 dys) Level 3 - Highest cost drugs Retil (30 dys) Retil (90 dys) Mil (90 dys) Specilty drugs: Drugs purchsed t phrmcy Office dministered nd provided by SpeciltyRx Covered under the medicl pln $20 copyment $60 copyment $60 copyment $45 copyment $135 copyment $135 copyment $60 copyment $180 copyment $180 copyment Sme s Level 1, 2 or 3 No chrge Medicl benefits pply The defult rte minus the copyment, minus 30% The defult rte minus the copyment, minus 30% The defult rte minus the copyment, minus 30% Sme s Level 1, 2 or 3 Not Covered Medicl benefits pply -No chrge for flu nd pneumoni immuniztions, Glucometers, HCR Preventive Mediction nd women s preventive medictions. -Prior uthoriztion, Step Therpy or dispensing limits my be required for some medictions. -If you request brnd-nme drug nd generic is vilble, you will be responsible for the cost differentil between the brnd-nme drug nd the generic plus ny pplicble copyments. -You my fill up to 34 dy supply of Level 1, Level 2 or Level 3 drugs t prticipting phrmcies. Phrmcy Out-of Pocket limit for PAR providers: $6,350 single/$12,700 fmily; Non PAR providers: Not pplicble. The limit pplies to ll levels nd is Not integrted with medicl pln. All Pr phrmcy member cost shre will ccumulte towrds the Pln Mximum Out-of-Pocket, if pplicble, including phrmcy deductible, copyments, nd phrmcy out-of-pockets. 3 of 9

4 Summry of Benefits nd Coverge: Wht this Pln Covers & Wht it Costs Coverge for: Single & Fmily Pln Type: NPOS Common Medicl Event If you hve outptient surgery If you need immedite medicl ttention If you hve hospitl sty If you hve mentl helth, behviorl helth, or substnce buse needs If you re pregnnt Services You My Need Fcility fee (e.g., mbultory surgery center) PAR Provider Non-PAR Provider 20% fter deductible 40% fter deductible Limittions & Exceptions Prior uth is required. Filure to do Physicin/surgeon fees 20% fter deductible 40% fter deductible none No chrge fter No chrge fter PAR Emergency room services deductible nd $150 deductible nd $ none copyment/visit copyment/visit Emergency medicl 20% fter PAR 20% fter deductible trnsporttion deductible none Urgent cre $40 copyment/visit 40% fter deductible none Fcility fee (e.g., hospitl room) No chrge fter deductible nd $250 copyment per dmission. 40% fter deductible Prior uth is required. Filure to do Physicin/surgeon fee 20% fter deductible 40% fter deductible none Mentl/Behviorl helth outptient services $25 copyment/visit 40% fter deductible none Mentl/Behviorl helth inptient services Substnce use disorder outptient services Substnce use disorder inptient services No chrge fter deductible nd $250 copyment per dmission. 40% fter deductible Prior uth is required. Filure to do $25 copyment/visit 40% fter deductible none No chrge fter deductible nd $250 copyment per dmission. 40% fter deductible Prentl nd postntl cre 20% fter deductible 40% fter deductible Delivery nd ll inptient services No chrge fter deductible nd $250 copyment per dmission. 40% fter deductible none Prior uth is required. Filure to do Certin prentl services my be covered under Preventive cre benefits outlined on pge 2. 4 of 9

5 Summry of Benefits nd Coverge: Wht this Pln Covers & Wht it Costs Coverge for: Single & Fmily Pln Type: NPOS Common Medicl Event If you need help recovering or hve other specil helth needs If your child needs dentl or eye cre Services You My Need PAR Provider Non-PAR Provider Home helth cre 20% fter deductible 40% fter deductible Limittions & Exceptions -Limited to 60 visits. -Prior uth is required. Filure to do Rehbilittion services 20% fter deductible 40% fter deductible -Limited to 60 visits per clendr yer combined for physicl, occuptionl, speech nd cognitive Hbilittion services 20% fter deductible 40% fter deductible Skilled nursing cre 20% fter deductible 40% fter deductible Durble medicl equipment 20% fter deductible 40% fter deductible Hospice service 20% fter deductible 40% fter deductible therpies. -Prior uth is required. Filure to do -Limited to 30 dys per confinement within 14 dys of hospitl confinement. -Prior uth is required. Filure to do Prior uth is required. Filure to do Prior uth is required. Filure to do Eye exm Not covered Not covered No coverge for eye exms under the medicl pln. Glsses Not covered Not covered No coverge for glsses. Dentl check-up Not covered Not covered No coverge for dentl check-ups. 5 of 9

6 Summry of Benefits nd Coverge: Wht this Pln Covers & Wht it Costs Coverge for: Single & Fmily Pln Type: NPOS Excluded Services & Other Covered Services: Services Your Pln Does NOT Cover (This isn t complete list. Check your policy or pln document for other excluded services.) Acupuncture Infertility tretment Routine eye cre (Adult nd child) Britric surgery Long-term cre Routine foot cre Dentl cre (dult nd child) Hering ids Non-emergency cre when trveling outside the U.S. Weight loss progrms Other Covered Services (This isn t complete list. Check your policy or pln document for other covered services nd your costs for these services.) Chiroprctic cre (Mintennce not covered) Cosmetic surgery (Requires prior uth. Services will only be considered if due to bodily injury or illness nd functionl impirment is present.) Eye exmintions (covered under vision rider) Privte-duty nursing (inptient only) Your Rights to Continue Coverge: If you lose coverge under the pln, then, depending upon the circumstnces, Federl nd Stte lws my provide protections tht llow you to keep helth coverge. Any such rights my be limited in durtion nd will require you to py premium, which my be significntly higher thn the premium you py while covered under the pln. Other limittions on your rights to continue coverge my lso pply. For more informtion on your rights to continue coverge, contct the pln t or You my lso contct your stte insurnce deprtment, the U.S. Deprtment of Lbor, Employee Benefits Security Administrtion t or or the U.S. Deprtment of Helth nd Humn Services t x61565 or Your Grievnce nd Appels Rights: If you hve complint or re disstisfied with denil of coverge for clims under your pln, you my be ble to ppel or file grievnce. For questions bout your rights, this notice, or ssistnce, you cn contct: Deprtment of Lbor Employee Benefits Security Administrtion: EBSA (3272) or 6 of 9

7 Summry of Benefits nd Coverge: Wht this Pln Covers & Wht it Costs Coverge for: Single & Fmily Pln Type: NPOS Does this Coverge Provide Minimum Essentil Coverge? The Affordble Cre Act requires most people to hve helth cre coverge tht qulifies s minimum essentil coverge. This pln or policy does provide minimum essentil coverge. Does this Coverge Meet the Minimum Vlue Stndrd? The Affordble Cre Act estblishes minimum vlue stndrd of benefits of helth pln. The minimum vlue stndrd is 60% (cturil vlue). This helth coverge does meet the minimum vlue stndrd for the benefits it provides. To see exmples of how this pln might cover costs for smple medicl sitution, see the next pge. 7 of 9

8 Coverge Exmples Coverge for: Single & Fmily Pln Type: NPOS About these Coverge Exmples: These exmples show how this pln might cover medicl cre in given situtions. Use these exmples to see, in generl, how much finncil protection smple ptient might get if they re covered under different plns. This is not cost estimtor. Don t use these exmples to estimte your ctul costs under this pln. The ctul cre you receive will be different from these exmples, nd the cost of tht cre will lso be different. See the next pge for importnt informtion bout these exmples. Hving bby (norml delivery) Amount owed to providers: $7,540 Pln pys $5,760 Ptient pys $1,780 Smple cre costs: Hospitl chrges (mother) $2,700 Routine obstetric cre $2,100 Hospitl chrges (bby) $900 Anesthesi $900 Lbortory tests $500 Prescriptions $200 Rdiology $200 Vccines, other preventive $40 Totl $7,540 Ptient pys: Deductibles $1,000 Copys $270 Coinsurnce $360 Limits or exclusions $150 Totl $1,780 Mnging type 2 dibetes (routine mintennce of well-controlled condition) Amount owed to providers: $5,400 Pln pys $3,320 Ptient pys $2,080 Smple cre costs: Prescriptions $2,900 Medicl Equipment nd Supplies $1,300 Office Visits nd Procedures $700 Eduction $300 Lbortory tests $100 Vccines, other preventive $100 Totl $5,400 Ptient pys: Deductibles $1,000 Copys $670 Coinsurnce $330 Limits or exclusions $80 Totl $2,080 8 of 9

9 Coverge Exmples Coverge for: Single & Fmily Pln Type: NPOS Questions nd nswers bout the Coverge Exmples: Wht re some of the ssumptions behind the Coverge Exmples? Costs don t include premiums. Smple cre costs re bsed on ntionl verges supplied by the U.S. Deprtment of Helth nd Humn Services, nd ren t specific to prticulr geogrphic re or helth pln. The ptient s condition ws not n excluded or preexisting condition. All services nd tretments strted nd ended in the sme coverge period. There re no other medicl expenses for ny member covered under this pln. Out-of-pocket expenses re bsed only on treting the condition in the exmple. The ptient received ll cre from innetwork providers. If the ptient hd received cre from out-of-network providers, costs would hve been higher. Wht does Coverge Exmple show? For ech tretment sitution, the Coverge Exmple helps you see how deductibles, copyments, nd coinsurnce cn dd up. It lso helps you see wht expenses might be left up to you to py becuse the service or tretment isn t covered or pyment is limited. Does the Coverge Exmple predict my own cre needs? No. Tretments shown re just exmples. The cre you would receive for this condition could be different bsed on your doctor s dvice, your ge, how serious your condition is, nd mny other fctors. Does the Coverge Exmple predict my future expenses? No. Coverge Exmples re not cost estimtors. You cn t use the exmples to estimte costs for n ctul condition. They re for comprtive purposes only. Your own costs will be different depending on the cre you receive, the prices your providers chrge, nd the reimbursement your helth pln llows. Cn I use Coverge Exmples to compre plns? Yes. When you look t the Summry of Benefits nd Coverge for other plns, you ll find the sme Coverge Exmples. When you compre plns, check the Ptient Pys box in ech exmple. The smller tht number, the more coverge the pln provides. Are there other costs I should consider when compring plns? Yes. An importnt cost is the premium you py. Generlly, the lower your premium, the more you ll py in out-ofpocket costs, such s copyments, deductibles, nd coinsurnce. You should lso consider contributions to ccounts such s helth svings ccounts (HSAs), flexible spending rrngements (FSAs) or helth reimbursement ccounts (HRAs) tht help you py out-of-pocket expenses. 9 of 9

Anthem Blue Cross Life and Health Insurance Company University of Southern California Custom Premier PPO 800/20%/20%

Anthem Blue Cross Life and Health Insurance Company University of Southern California Custom Premier PPO 800/20%/20% Anthem Blue Cross Life nd Helth Insurnce Compny University of Southern Cliforni Custom Premier 800/20%/20% Summry of Benefits nd Coverge: Wht this Pln Covers & Wht it Costs Coverge Period: 01/01/2015-12/31/2015

More information

Health insurance marketplace What to expect in 2014

Health insurance marketplace What to expect in 2014 Helth insurnce mrketplce Wht to expect in 2014 33096VAEENBVA 06/13 The bsics of the mrketplce As prt of the Affordble Cre Act (ACA or helth cre reform lw), strting in 2014 ALL Americns must hve minimum

More information

Health insurance exchanges What to expect in 2014

Health insurance exchanges What to expect in 2014 Helth insurnce exchnges Wht to expect in 2014 33096CAEENABC 02/13 The bsics of exchnges As prt of the Affordble Cre Act (ACA or helth cre reform lw), strting in 2014 ALL Americns must hve minimum mount

More information

Humana Critical Illness/Cancer

Humana Critical Illness/Cancer Humn Criticl Illness/Cncer Criticl illness/cncer voluntry coverges py benefits however you wnt With our criticl illness nd cncer plns, you'll receive benefit fter serious illness or condition such s hert

More information

Health insurance exchanges What to expect in 2014

Health insurance exchanges What to expect in 2014 Helth insurnce exchnges Wht to expect in 2014 33096CAEENABC 11/12 The bsics of exchnges As prt of the Affordble Cre Act (ACA or helth cre reform lw), strting in 2014 ALL Americns must hve minimum mount

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.iees.com or by calling 1-866-433-7462. Important Questions

More information

2015 WPEG Coinsurance Plan Coverage Period: 1/1/2015-12/31/2015

2015 WPEG Coinsurance Plan Coverage Period: 1/1/2015-12/31/2015 2015 WPEG Coinsurance Plan Coverage Period: 1/1/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage

More information

Coverage for: Group Plan Type: HMO. Important Questions Answers Why this Matters: What is the overall deductible?

Coverage for: Group Plan Type: HMO. Important Questions Answers Why this Matters: What is the overall deductible? This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at sutterhealthplus.org or by calling 1-855-315-5800. Important

More information

Individual Plan: Silver 1 93-95 Coverage Period: 01/01/2014-12/31/2014

Individual Plan: Silver 1 93-95 Coverage Period: 01/01/2014-12/31/2014 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.cchpsc.org or by calling 1-800-580-8736 or TTY 1-800-545-8279

More information

You can see the specialist you choose without permission from this plan.

You can see the specialist you choose without permission from this plan. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.[insert] or by calling 1-800-[insert]. Important Questions

More information

Maricopa Country Medical Society: Medical Plan Coverage Period: 1/1/2013 12/31/2013

Maricopa Country Medical Society: Medical Plan Coverage Period: 1/1/2013 12/31/2013 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.mcmsbenefits.com or by calling 1-855-321-3167. Important

More information

Important Questions Answers Why this Matters: Network: $500 Individual / $1,500 Family;

Important Questions Answers Why this Matters: Network: $500 Individual / $1,500 Family; This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthscopebenefits.com or by calling 1-866-208-4281.

More information

Vantage Health Plan, Inc:

Vantage Health Plan, Inc: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.vantagehealthplan.com or by calling 1-888-823-1910. Important

More information

CA Short Term Counseling: Cigna Health and Life Insurance Co Coverage Period: 01/01/2013-12/31/2013

CA Short Term Counseling: Cigna Health and Life Insurance Co Coverage Period: 01/01/2013-12/31/2013 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://apps.cignabehavioral.com/web/acref/pmrscontroller?cat=initial

More information

Avera Health Employee Health Plan Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage:

Avera Health Employee Health Plan Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www. or by calling 1 (888) 322-2115. Important Questions

More information

Coverage for: Individual Plan Type: PPO. Important Questions Answers Why this Matters:

Coverage for: Individual Plan Type: PPO. Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.chpstudent.com or by calling 1-800-633-7867. Important

More information

Important Questions Answers Why this Matters: What is the overall deductible?

Important Questions Answers Why this Matters: What is the overall deductible? This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://knowyourbenefits.dfa.ms.gov or by calling 1-866-586-2781.

More information

Primary Select Platinum Plan: Health Republic Insurance of New York Coverage Period: 01/01/2015 12/31/2015

Primary Select Platinum Plan: Health Republic Insurance of New York Coverage Period: 01/01/2015 12/31/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this

More information

Not applicable because there s no out-of-pocket limit on your expenses. You can see the specialist you choose without permission from this plan.

Not applicable because there s no out-of-pocket limit on your expenses. You can see the specialist you choose without permission from this plan. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.njcf.org or by calling 1-800-624-3096. Important Questions

More information

Aetna HMO 1525 Local Government Active Private Rx

Aetna HMO 1525 Local Government Active Private Rx Important Questions This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.state.nj.us/treasury/pensions/health-benefits.shtml

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.boonchapman.com or by calling 1-800-252-9653. Important

More information

What is the overall deductible? $250 per person/$500 per family. Are there other deductibles for specific services? No.

What is the overall deductible? $250 per person/$500 per family. Are there other deductibles for specific services? No. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions

More information

ADVANCED SCIENCE BASIC HEALTH CARE PLAN

ADVANCED SCIENCE BASIC HEALTH CARE PLAN This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.loomisco.com or by calling 1-800-346-1223. Important

More information

Yes, $100 individual/$300 family for speech therapy. There are no other specific deductibles. Is there an out of pocket limit on my expenses?

Yes, $100 individual/$300 family for speech therapy. There are no other specific deductibles. Is there an out of pocket limit on my expenses? Yale Health Plan: Faculty, Managerial & Professional, Post-doctoral Associates and Fellows Coverage Period: 1/1/2015 12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage

More information

What is the overall deductible? Are there other deductibles for specific services?

What is the overall deductible? Are there other deductibles for specific services? This is only a summary. If you want more detail about your medical/vision coverage and costs, you can get the complete terms in the policy or plan document at www.mycigna.com, by calling 1-800-Cigna24,

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the Summary Plan Description (SPD) or Plan Document at www.pebtf.org or by calling 1-800-522-7279.

More information

Cherokee Insurance High Deductible Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs

Cherokee Insurance High Deductible Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-800-201-0450 Important Questions Answers Why this

More information

You can see the specialist you choose without permission from this plan.

You can see the specialist you choose without permission from this plan. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.sas-mn.com or by calling 1-800-328-2739. Important Questions

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.

More information

Manhattan School of Music: BCS Insurance Company Coverage Period: 8/27/2014-8/27/2015 Summary of Benefits and Coverage:

Manhattan School of Music: BCS Insurance Company Coverage Period: 8/27/2014-8/27/2015 Summary of Benefits and Coverage: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.cirstudenthealth.com/msmnyc or by calling 1-800-322-9901.

More information

Board of Huron County Commissioners : BASIC

Board of Huron County Commissioners : BASIC This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at MedMutual.com/SBC or by calling 800.540.2583. Important Questions

More information

Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?

Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services? This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions

More information

Coverage for: Individual, Family Plan Type: PPO. Important Questions Answers Why this Matters:

Coverage for: Individual, Family Plan Type: PPO. Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bbsionline.com or by calling 1-866-927-2200. Important

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.thehealthplan.com or by calling 1-800-504-0443. Important

More information

Important Questions Answers Why this Matters: $3,000/ person $6,000/family Benefits not subject to deductible include: preventive care.

Important Questions Answers Why this Matters: $3,000/ person $6,000/family Benefits not subject to deductible include: preventive care. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this

More information

Bowling Green State University : Plan B Summary of Benefits and Coverage: What This Plan Covers & What it Costs

Bowling Green State University : Plan B Summary of Benefits and Coverage: What This Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at MedMutual.com/SBC or by calling 800.540.2583. Important Questions

More information

Gundersen Health Plan: MN NJ Silver $2000-0% Coverage Period: 01/01/2015-12/31/2015

Gundersen Health Plan: MN NJ Silver $2000-0% Coverage Period: 01/01/2015-12/31/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.gundersenhealthplan.org or by calling 1-800-897-1923.

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this

More information

RIT Blue Point2 POS B No Drug Coverage Period: 01/01/2016-12/31/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs

RIT Blue Point2 POS B No Drug Coverage Period: 01/01/2016-12/31/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a summary. If you want more detail about your medical coverage and costs, you can get the complete terms in the policy or plan document at www.excellusbcbs.com or by calling 1-800-499-1275/V.

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this

More information

Student Health Insurance Plan Insurance Company Coverage Period: 07/01/2015-06/30/2016

Student Health Insurance Plan Insurance Company Coverage Period: 07/01/2015-06/30/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.summitamerica-ins.com/wscc or by calling 1-800-955-1991.

More information

Coverage Period: 8/1/2013-7/31/2014 Coverage for: Insured Student+Dependent Plan Type: PPO. Important Questions Answers Why this Matters:

Coverage Period: 8/1/2013-7/31/2014 Coverage for: Insured Student+Dependent Plan Type: PPO. Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.gallagherkoster.com/colgate or by calling 1 877-371-9621.

More information

Nationwide Life Insurance Company: Ochsner Clinical School Coverage Period: 1/1/15 12/31/15

Nationwide Life Insurance Company: Ochsner Clinical School Coverage Period: 1/1/15 12/31/15 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.chpstudent.com or by calling 1-800-633-7867. Important

More information

UMC Health Plan Operations Coverage Period: 01/01/2013-12/31/2013

UMC Health Plan Operations Coverage Period: 01/01/2013-12/31/2013 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthplanoperations@umchealthsystem.com or by calling

More information

You can see the specialist you choose without permission from this plan.

You can see the specialist you choose without permission from this plan. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.wmimutual.com or by calling 1-800-748-5340. Important

More information

Advantage Gold EPO Coverage Period: 01/01/2016 12/31/2016

Advantage Gold EPO Coverage Period: 01/01/2016 12/31/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://infonet.upmc.com/spd or by calling 1-800-994-2752,

More information

PPO Option 2: Highmark BCBS Coverage Period: 01/01/2016-12/31/2016

PPO Option 2: Highmark BCBS Coverage Period: 01/01/2016-12/31/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-800-472-1506. Important

More information

$0 See the chart starting on page 2 for your costs for services this plan covers.

$0 See the chart starting on page 2 for your costs for services this plan covers. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/ca/lausd or by calling 1-800-700-3739. Important

More information

Important Questions Answers Why this Matters: What is the overall deductible?

Important Questions Answers Why this Matters: What is the overall deductible? Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services? Is there an out of pocket limit on my expenses? What is not included in

More information

St Olaf College Coverage Period: Beginning on or after 09-01-2014

St Olaf College Coverage Period: Beginning on or after 09-01-2014 St Olaf College Summary of Benefits and Coverage: What this Plan covers & What it Costs Coverage Period: Beginning on or after 09-01-2014 Coverage for: Single and family coverage Plan Type: PPO This is

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.arml.org\benefit_programs.html or by calling 1-501-978-6137.

More information

State Health Plan: Savings Plan Coverage Period: 01/01/2015-12/31/2015

State Health Plan: Savings Plan Coverage Period: 01/01/2015-12/31/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.eip.sc.gov or by calling 1-888-260-9430. Important Questions

More information

Why this Matters: Even though you pay these expenses, they don t count toward the outof-pocket limit.

Why this Matters: Even though you pay these expenses, they don t count toward the outof-pocket limit. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/ca/sisc or by calling 1-855-333-5730. Important

More information

Your cost if you use a Participating Provider 20% coinsurance subject to deductible. 20% coinsurance subject to deductible

Your cost if you use a Participating Provider 20% coinsurance subject to deductible. 20% coinsurance subject to deductible CareFirst BlueCross BlueShield Medical & Express Scripts Pharmacy (Faculty/Staff) Coverage Period: 01/01/2016 12/31/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.sharphealthplan.com or by calling 1-800-359-2002. Important

More information

You can see the specialist you choose without permission from this plan.

You can see the specialist you choose without permission from this plan. : Blue Option / Gold 800 Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual / Family Plan Type: EPO This is only a summary.

More information

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.kaiserpermanente.org or by calling 1-800-464-4000. Important

More information

Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?

Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services? : VIVA HEALTH Access Plan Coverage Period: 01/01/2015 12/31/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document

More information

Physicians Plus Insurance Corporation Coverage Period: 2015 Summary of Benefits and Coverage: WPE Traditional Uniform Benefits Plan Code: EHSTWWPE

Physicians Plus Insurance Corporation Coverage Period: 2015 Summary of Benefits and Coverage: WPE Traditional Uniform Benefits Plan Code: EHSTWWPE This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions

More information

Massachusetts. HPHC Insurance Company The Harvard Pilgrim Tiered Copayment PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs

Massachusetts. HPHC Insurance Company The Harvard Pilgrim Tiered Copayment PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Massachusetts HPHC Insurance Company The Harvard Pilgrim Tiered Copayment PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 6/1/2013 5/31/2014 Coverage for: Individual

More information

Coverage for: Individual/Individual + Family What this Plan Covers & What it Costs

Coverage for: Individual/Individual + Family What this Plan Covers & What it Costs Connecticut General Life Insurance Co.: Open Access 1000 Plan Coverage Period: Beginning on or after 9/23/2012 Coverage for: Individual/Individual + Family What this Plan Covers & What it Costs! This is

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this

More information

LGC HealthTrust: MT Blue 5-RX10/20/45 Coverage Period: 07/01/2013 06/30/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs

LGC HealthTrust: MT Blue 5-RX10/20/45 Coverage Period: 07/01/2013 06/30/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com or by calling 1-800-870-3057. Important Questions

More information

Personal Plans Health Choice 2000: GuideStone Coverage Period: 01/01/2013 12/31/2013 Summary of Benefits and Coverage:

Personal Plans Health Choice 2000: GuideStone Coverage Period: 01/01/2013 12/31/2013 Summary of Benefits and Coverage: Personal Plans Health Choice 2000: GuideStone Coverage Period: 01/01/2013 12/31/2013 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family Plan Type: PPO

More information

Massachusetts. Coverage Period: 01/01/2015 12/31/2015 Coverage for: Individual + Family Plan Type: PPO

Massachusetts. Coverage Period: 01/01/2015 12/31/2015 Coverage for: Individual + Family Plan Type: PPO Massachusetts The HPHC Insurance Company PPO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Coverage Period: 01/01/2015 12/31/2015 Coverage for: Individual + Family Plan Type: PPO This

More information

MNHG: Fallon Select Care Network

MNHG: Fallon Select Care Network MNHG: Fallon Select Care This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.fchp.org. or by calling 1-800-868-5200.

More information

Massachusetts. HPHC Insurance Company The Harvard Pilgrim Tiered Copayment PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs

Massachusetts. HPHC Insurance Company The Harvard Pilgrim Tiered Copayment PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs HPHC Insurance Company The Harvard Pilgrim Tiered Copayment PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Massachusetts Coverage Period: 6/1/2013 5/31/2014 Coverage for: Individual

More information

Massachusetts. Coverage Period: 01/01/2015 12/31/2015 Coverage for: Individual + Family Plan Type: PPO

Massachusetts. Coverage Period: 01/01/2015 12/31/2015 Coverage for: Individual + Family Plan Type: PPO Massachusetts The HPHC Insurance Company PPO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Coverage Period: 01/01/2015 12/31/2015 Coverage for: Individual + Family Plan Type: PPO This

More information

Highmark Blue Cross Blue Shield: PPOBlue Coverage Period: 08/01/2013-07/31/2014

Highmark Blue Cross Blue Shield: PPOBlue Coverage Period: 08/01/2013-07/31/2014 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-800-241-5704. Important

More information

Ambetter Balanced Care 2 Summary of Benefits and Coverage: What this Plan Covers & What it Costs

Ambetter Balanced Care 2 Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://ambetter.sunshinehealth.com/ or by calling 877-687-1169,

More information

TotalFreedom 20/80 Platinum Plan: Health Republic Insurance of New York Coverage Period: 4/1/15 12/31/15 Summary of Benefits and Coverage:

TotalFreedom 20/80 Platinum Plan: Health Republic Insurance of New York Coverage Period: 4/1/15 12/31/15 Summary of Benefits and Coverage: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this

More information

Are there services this Yes. Some of the services this plan doesn t cover are listed on page 6. See your policy or plan

Are there services this Yes. Some of the services this plan doesn t cover are listed on page 6. See your policy or plan : SAIF Corporation All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest Coverage Period: January 1, 2016-December 31, 2016 Summary of Benefits and Coverage: What this Plan

More information

Important Questions Answers Why this Matters: What is the overall deductible?

Important Questions Answers Why this Matters: What is the overall deductible? This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.cirstudenthealth.com/udmercy or by calling 1-800-322-9901.

More information

Silver Basic Plus: QCA Health Plan, Inc. Coverage Period: Beginning on or after 01/01/2014

Silver Basic Plus: QCA Health Plan, Inc. Coverage Period: Beginning on or after 01/01/2014 Silver Basic Plus: QCA Health Plan, Inc. Coverage Period: Beginning on or after 01/01/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual or Family Plan

More information

GREATER HOUSTON RETAILERS: Plan 1 Coverage Period: 01/01/2015 12/31/2015

GREATER HOUSTON RETAILERS: Plan 1 Coverage Period: 01/01/2015 12/31/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the plan document at www.assurantselffunded.com or by calling 1-888-292-0272. Important

More information

Bronze HSA 3250 Coinsurance 50

Bronze HSA 3250 Coinsurance 50 Bronze HSA 3250 Coinsurance 50 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: Beginning on or after 01/01/2016 Coverage for: Individual and Individual + Family

More information

TotalIndependence Silver Plan: Health Republic Insurance of New York Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage:

TotalIndependence Silver Plan: Health Republic Insurance of New York Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this

More information

Monumental Life Insurance Company: Northpoint Bible College Student Injury and Sickness Plan Coverage Period: 08/20/2013 08/20/2014

Monumental Life Insurance Company: Northpoint Bible College Student Injury and Sickness Plan Coverage Period: 08/20/2013 08/20/2014 Summary of Benefits and Coverage: What this Covers & What it Costs Coverage for: Individual Type: PPO This is only a summary. If you want more detail about your coverage and costs, you can get the complete

More information

Town of Auburn: Fallon Select Care Network

Town of Auburn: Fallon Select Care Network This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.fallonhealth.org. or by calling 1-800-868-5200. Important

More information

$ 500 Individual $1,000 Family. $ No

$ 500 Individual $1,000 Family. $ No Important Questions This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020.

More information

Standard Life And Accident Insurance Company: PremiumSaver

Standard Life And Accident Insurance Company: PremiumSaver This is only a summary. This plan is supplemental to your group s major medical plan. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document

More information

RIT Blue Point2 POS B Coverage Period: 01/01/2016-12/31/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs

RIT Blue Point2 POS B Coverage Period: 01/01/2016-12/31/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a summary. If you want more detail about your medical coverage and costs, you can get the complete terms in the policy or plan document at www.excellusbcbs.com or by calling 1-800-499-1275/V;

More information

Monumental Life Insurance Company: Bennington College Student Injury and Sickness Plan Coverage Period: 08/15/2013 08/15/2014

Monumental Life Insurance Company: Bennington College Student Injury and Sickness Plan Coverage Period: 08/15/2013 08/15/2014 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bollingercolleges.com/bennington or by calling 1-866-267-0092.

More information

Utilization of Smoking Cessation Benefits in Medicaid Managed Care, 2009-2013

Utilization of Smoking Cessation Benefits in Medicaid Managed Care, 2009-2013 Utiliztion of Smoking Cesstion Benefits in Medicid Mnged Cre, 2009-2013 Office of Qulity nd Ptient Sfety New York Stte Deprtment of Helth Jnury 2015 Introduction According to the New York Stte Tocco Control

More information

Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts

Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Massachusetts The Harvard Pilgrim Best Buy HMO Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Coverage for: Individual + Family Plan Type: HMO This

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this

More information

Important Questions Answers Why this Matters: In-network: $2,000 Single / $4,000 Family Out-of-network: $3,000 Single / $6,000 Family

Important Questions Answers Why this Matters: In-network: $2,000 Single / $4,000 Family Out-of-network: $3,000 Single / $6,000 Family This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.independenthealth.com or by calling 1-800-501-3439. Important

More information

National Guardian Life Insurance Company: Kenyon College Student Health Insurance Plan Coverage Period: 08/15/2015-08/15/2016

National Guardian Life Insurance Company: Kenyon College Student Health Insurance Plan Coverage Period: 08/15/2015-08/15/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.

More information

Health Alliance Plan. Coverage Period: 01/01/2015-12/31/2015. document at www.hap.org or by calling 1-800-422-4641.

Health Alliance Plan. Coverage Period: 01/01/2015-12/31/2015. document at www.hap.org or by calling 1-800-422-4641. Health Alliance Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015 Coverage for: Individual+Family Plan Type: HMO This is only a summary.

More information

Monumental Life Insurance Company: Millsaps College Student Injury and Sickness Plan Coverage Period: 08/20/2013 08/20/2014

Monumental Life Insurance Company: Millsaps College Student Injury and Sickness Plan Coverage Period: 08/20/2013 08/20/2014 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bollingercolleges.com/millsaps or by calling 1-866-267-0092.

More information

Massachusetts. Coverage Period: 01/01/2013 12/31/2013 Coverage for: Individual + Family Plan Type: HMO

Massachusetts. Coverage Period: 01/01/2013 12/31/2013 Coverage for: Individual + Family Plan Type: HMO Massachusetts Harvard Pilgrim Health Care, Inc. The Harvard Pilgrim Best Buy HMO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2013 12/31/2013 Coverage

More information

Preferred PPO Blue Options Health Insurance Plan Coverage Period: 04/01/2015 03/31/2016

Preferred PPO Blue Options Health Insurance Plan Coverage Period: 04/01/2015 03/31/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://icubabenefits.org or by calling 1-866-377-5102. In

More information

Group Health Cooperative: The Hearthstone

Group Health Cooperative: The Hearthstone Group Health Cooperative: The Hearthstone Coverage Period: 7/1/2015 to 7/1/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Group Plan Type: HMO This is only a

More information

Massachusetts. Coverage Period: 7/1/2013 6/30/2014 Coverage for: Individual + Family Plan Type: HMO

Massachusetts. Coverage Period: 7/1/2013 6/30/2014 Coverage for: Individual + Family Plan Type: HMO Harvard Pilgrim Health Care, Inc. The Harvard Pilgrim Best Buy Tiered Copayment ChoiceNet HMO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Massachusetts Coverage Period: 7/1/2013

More information

Group Health Cooperative: Seattle University Summary of Benefits and Coverage: What this Plan Covers & What it Costs

Group Health Cooperative: Seattle University Summary of Benefits and Coverage: What this Plan Covers & What it Costs Group Health Cooperative: Seattle University Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 1/1/2016 to 1/1/2017 Coverage for: Group Plan Type: HMO This is only

More information

National Guardian Life Insurance Company Maine College of Art Student Health Insurance Plan Coverage Period: 09/01/2015-08/31/2016

National Guardian Life Insurance Company Maine College of Art Student Health Insurance Plan Coverage Period: 09/01/2015-08/31/2016 J3A59 National Guardian Life Insurance Company This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com

More information

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this

More information

a FL Basic HMO Coinsurance Plan 1-10 Summary of Benefits and Coverage: What this Plan Covers & What it Costs

a FL Basic HMO Coinsurance Plan 1-10 Summary of Benefits and Coverage: What this Plan Covers & What it Costs What is the overall deductible? Are there other deductibles for specific services? Is there an out-of-pocket limit on my expenses? In-network: Individual $1,500 / Family $4,500 Does not apply to office

More information