LAUSD PPO BENEFITS SUMMARY Coverage Amounts PPO In-Network Out of Network Who may enroll Eligibles and their eligible dependents employees, retirees, COBRA, and AB528.

 

County of Santa Barbara Custom Shield SpectrumPPOͽ 500-80/60 Benefit Summary For groups of 300 and above Uniform Health Plan Bene fits.

 

2011 STANDARD PPO 2 Bene®ts at a Glance TABLE 1: Services in this table ARE NOT subject to a deductible, and costs DO NOT APPLY to the annual out-of-pocket maximum. For further.

 

2011 PARTNERSHIP PPO 2 PREVENTIVE CARE Well-Baby, Well-Child visits as recommended by CDCN o Charge 45 copay Adult annual physical exam No Charge.

 

dental plan dental services P3963 ORTHODONTICS Individual Annual Calendar Year Deductible 50 50 0 0 Maximum the sum of all Network and maximum 1000 per person.

 

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Form. 100110Page1of2 GeneseeCounty BENEFITSUMMARY PPOStandardPlan. Pleaseread. Services. Deductible. MemberPays20 Out-of-Network. charges. MemberPays40 Deductible Maximum 250perMember.

 

Member Services 1-877-238-6200 Provider Provider Annual Deductible IndividualNone 50 Family None 150 Preventive Services100 90 Basic Services80 70 Major Services50.

 

City of Ft. Lauderdale Custom PPO 100-100-60 In / 100-60-60Out See a participating dentist dentist Calendar year deductible x Applied to basic and major services x Waived.

 

BENEFIT SUMMARY DENTAL TRADITIONAL/PPO PLAN DESIGN MONTGOMERY COUNTY GOVERNMENT PPlllaaannn PPPaaayyysss CClllaaassssss III Exams X-rays Fluoride Treatments.

 

Member Services 1-877-238-6200 Provider Provider Annual Deductible IndividualNone 50 Family None 150 Preventive Services100 90 Basic Services80 70 Major Services50.

 

PPO Option 1 Schedule of Benefits In-Network Out-of-Network GENERAL BENEFITS Deductible 500/individual 1,000/family combinedin- andout-of - network 500/individual 1,000/family combinedin-.

 

City of Ft. Lauderdale Custom PPO 100-100-60 In / 100-60-60Out See a participating dentist dentist Calendar year deductible x Applied to basic and major services x Waived.

 

Page1of4. x myuhc. com ®. x. x –Needmorehelp. Get. SPD. PLANHIGHLIGHTS TypesofCoverage NetworkBenefits Employee Child ren Deductible 500peryear 750peryear 750peryear 1,000peryear 1,500peryear 2,250peryear.

 

Northrop Grumman Active Plan Benefits Provider Annual Deductible 0 Individual; 0 Family 100 Individual; 300 Family Out-of-py to self-referto specialists YesYes.

 

Northrop Grumman Active Plan Benefits Provider Annual Deductible 300 Individual; 600 Family 800 Individual; 1,600 Family Out-of-py to self-referto specialists.

 

Northrop Grumman Active Plan Benefits Provider Annual Deductible 500 Individual; 1,000 Family 800 Individual; 1,600 Family Out-of-py to self-referto.

 

2011 UNIT BENEFIT SUMMARY SEA, CONFIDENTIAL, SEIU, PSOA, COA Revised November2010 BENEFITS SEA SEIU PSOA COA Contract Term 07/01/08.

 

Summary ofBenefits AetnaGolden M0001_7A_80713 09/2008 Visitus www. aetnamedicare. com MaricopaCounty H0322 OrPartDDrugs. JoinThisPlan ofpharmacies. Wemaynot. anytime. orvisitusatwww. aetnamedicare.

 

Fordham University- Local153 Benefit In-Network 1 Out-of-Network 2,3 Deductible N/A 200/ 400 Coinsurance N/A 20 Coinsurance Stop Loss N/A 3,500/ 7,000 / 700/ 1,400.

 

Annual Deductible Individual 50 Family 100 Preventive Services 100 Basic Services 80 Major Services 60 Annual Benefit Maximum 2,000 Office Visit.

 

Wednesday, September 15, 2010 Wednesday, September 15, 2010 College of the Desert Medical HMO/PPO Benefit Summary at a Glance Anthem Blue Cross.

 

Redlands Unified School District Custom Premier PPO w/o MNSA 500/20/80/60 Effective 7-01-2011 PPO Benefits Explanation of Covered Expense Plan payments.

 

Form. 100110Page1of2 GeneseeCounty BENEFITSUMMARY PPOStandardPlan. Pleaseread. Services. Deductible. MemberPays20 Out-of-Network. charges. MemberPays40 Deductible Maximum 250perMember.

 

Group Insurance Plan of Benefits for Aker Solutions Control 469483 Administered by Aetna Global Benefits Effective Date: January 1, 2011.

 

The Guardian Life Insurance of America 7 Hanover Square, New York, New York 10004 Authors Guild DentalGuard Split Value Program Benefit.

 

covered expense actual charges, as well as any deductible percentage copay. Calendar year deductible for PPO providers 250/member; 500/maximum per family Calendar.

 

Page 1 of 5 Metropolitan Life Insurance Company, New York, NY 10166 L050638L4 exp0606 MLIC-LD Network Primary Dental Plan Design for:.

 

ALDINE INPENDENT SCHOOL DISTRICT PPO Dental Program www. myuhcdental. com Customer Service: 800-232-0990 Dental Options PPO P3945 Covered Dental Services.

 

WASHOE COUNTY SELF- FUNDED PPO PLAN MEDICAL BENEFIT SUMMARY This is a Self-Funded Plan that uses Universal Health Network.

 

INCENTONE Group 9281 - 6001 Delta Dental PPO Preventive Diagnostic 100 Exams, Cleanings Bitewing X-rays each twice in a calendar year.

 

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In addition to dollar and percentage copays, insured persons are responsible for deductibles, as described below. Please review the deductible information to know if a deductible.

 

Annual Deductible Individual 50 Family 100 Preventive Services 100 Basic Services 80 Major Services 60 Annual Benefit Maximum 2,000 Office Visit.

 

Kern High School District SISC Anthem Plan Effective 10-1-10 e.

 

WASHOE COUNTY SELF- FUNDED PPO PLAN MEDICAL BENEFIT SUMMARY This is a Self-Funded Plan that uses Universal Health Network.

 

Page 1 of 5 Metropolitan Life Insurance Company, New York, NY 10166 L050638L4 exp0606 MLIC-LD 1 Out-of-Network1 Type A – Preventive 1 1 00 of PDPFee200 of R CFee 4 Type.