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Combined Evidence of Coverage - Valley Health Plan
VALLEY HEALTH PLAN EVIDENCE OF COVERAGE AND DISCLOSURE FORM □ ... Urgent Care Services: Urgent care is care you need within 24 to 48 hours.
[ VHP_CCP_IFP_EOC.pdf - Read/Download File

IDEALCARE HANDBOOK - Sendero Health Plans
Sendero's network of care includes physicians, specialty providers, urgent care ... Benefits and Coverage (SBC) for a listing of benefits, covered services, ...
[ IdealCareHandbook.pdf - Read/Download File

Uniform Glossary of Health Coverage and Medical Terms
services. Co-insurance. Your share of the costs of a covered health care service ... Ambulance services for an emergency medical condition. Emergency Room ...
[ sbcuniformglossary.pdf - Read/Download File

SBC template
share the cost for covered health care services. ... All copayment and coinsurance costs shown in this chart are after your deductible ... Emergency room care.
[ SBC-Template.pdf - Read/Download File

SBC Template - Anthem
Jun 30, 2015 ... CU Health Plan - Medicare ... primary payer for this plan; any medical covered services payable ... you pay for covered services after you meet the deductible. .... Contact your Primary Care Provider (PCP) within 48 hours.
[ pw_e214638.pdf - Read/Download File

Get the Care You Need - Health Center - UC Merced
The Student Health Services (SHS) is an outpatient health center that provides ... and urgent care services anywhere in the world. .... Coverage (SBC).” 100%.
[ shipbrochure.pdf - Read/Download File

Summary of Benefits and Coverage - IU Health
Jan 1, 2016 ... SBC-33380IN0020002-01. IU Health Plans: IU ... you pay for covered services after you meet the deductible. Are there other ... services. This limit helps you plan for health care expenses. .... Emergency medical transportation.
[ SBC_33380IN0020002-01-English.pdf - Read/Download File

Blue Shield Silver 87 PPO
was an emergency medical condition, Benefits will be paid at the applicable .... Benefits 12. All Services provided through Blue Shield's Mental Health Service.
[ Blue Shield Silver 87 PPO_Dual.pdf - Read/Download File

if you applied through Connect for Health Colorado
This Evidence of Coverage should be used in conjunction with your SBC. ..... In unusual cases where you have an urgent need for health care services, you ...
[ EOC-Individual-Exchange.pdf - Read/Download File

Horizon BCBSNJ: OMNIA Health Plan - State of New Jersey
Jan 1, 2016 ... If you use an in-network doctor or other health care provider, this .... See separate Prescription Drug Plan SBC. ... Emergency room services.
[ sbc019.pdf - Read/Download File

BLUECROSS BLUESHIELD OF TENNESSEE PERSONAL HEALTH
Jan 1, 2016 ... time You receive medical services, especially whenever a Provider ... any Emergency admissions to BlueCross within 24 hours or the next.
[ B04P_Policy.pdf - Read/Download File

2016 PERSCare Basic Plan Summary of Benefits and - CalPERS
Jan 1, 2016 ... much you pay for covered services after you meet the deductible. ... $50/Visit for Emergency Room ... services, and health care this plan doesn't cover. ... at www. dol.gov/ebsa/pdf/sbcuniformglossary.pdf or call 1-877-737-7776 ...
[ 2016-perscare-summary-benefits-coverage.pdf - Read/Download File

Zoom Health Plan, Inc. (ZOOM+): ZOOM+ Gold Plan - ZoomCare.com
Jan 1, 2016 ... you pay for covered services after you meet the deductible. Are there other ... Primary and urgent care services are combined under this plan.
[ izgd01.pdf - Read/Download File

Blue Care Network Member Handbook - BCBSM.com
Find a doctor, urgent care facility or hospital that participates in BlueCard®, our care program ..... treatment or services from another health care provider. Referrals .... To view your SBC online, log in to your account at bcbsm.com. To request a ...
[ bcn-member-toolkit.pdf - Read/Download File

2016 Medical plan benefit table - Moda Health
1 For services as required under the Affordable Care Act ... Urgent care visit ... It is not considered a Summary of Benefits and Coverage (SBC), and should not ...
[ Moda_Select_BeSecure_2016_AK.pdf - Read/Download File

Summary of Benefits - Blue Cross and Blue Shield of Texas
for covered services after you meet the deductible. ... If you use an in-network doctor or other health care provider, this plan will pay ... www.dol.gov/ebsa/pdf/ SBCUniformGlossary.pdf or call 1-855-756-4448 to ... GYN or for emergency care .
[ 33602TX0770002-01.PDF - Read/Download File

ME Aetna Whole Health Bronze $35 Copay PD
HealthReformPlanSBC.com or by calling 1-866-253-8885. If you want more detail ... and urgent care in designated network. You must pay all ... chart starting on page 2 for how much you pay for covered services after you meet the ... If you use an in-network doctor or other health care provider, this plan will pay some or all of ...
[ ME_SBC_711251.pdf - Read/Download File

Illinois POS - Health Alliance
Alliance to provide health care services to Health Alliance HMO Members. ... Choosing to receive services, other than Emergency Services, from a Non- ... a Description of Coverage and the Summary of Benefits and Coverage (SBC), describe.
[ 2015_IL_GRP_DIR_POL_SG_POS.pdf - Read/Download File

Premier Bronze Saver 3300 - Tufts Health Plan
In the following pages, you'll learn about the many services we offer, and learn how to manage your plan ... Preventive Care including routine Maternity care Covered in Full ... Emergency Room ... the Summary of Benefits and Coverage ( SBC).
[ premier-bronze-3300-saver - Read/Download File

OMNIA HSA Silver-On Exchange - Horizon Blue Cross Blue Shield
Jan 1, 2016 ... If you use an in-network doctor or other health care provider, this plan will pay some or all of the ... Some of the services this plan doesn't cover are listed on the Services Your Plan. Does Not .... Emergency room services. 10%.
[ sbc-omnia-silver-hsa-standard - Read/Download File

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