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STATEWIDE |
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Send Me The Application |
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| BENEFITS | COVERAGES |
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| Covered Benefits | |
| (Benefit Period=Calendar Year) | |
| Lifetime Maximum | $1,000,000.00 |
| Deductible (Choice) | $100 to $5000 per policy |
| 1 per person | |
| Doctor Office Visits | 80% after deductible |
| All miscellaneous | 80% after deductible |
| Preventive & Wellness | n/a |
| Prescription Drug | Discount Rx Card |
| Pregnancy Care | N/A |
| Out-of-Pocket Maximum | $1,000 plus deductible |
| Emergency Room | $50 (waived if admitted) |
| Ambulatory Surgical Center | 80% after deductible |
| Inpatient Hospital | 80% after deductible |
| GO TO RATES | |