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Summary of Benefits and Coverage: What this Plan …

Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018 12/31/2018 NALC Health Benefit Plan Value Option: KM Coverage for: Self Only, Self Plus One or Self and Family | Plan Type: FFS 1 of 6 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a Summary . Please read the FEHB Plan brochure (RI 71-009) that contains the complete terms of this plan. All Benefits are subject to the definitions, limitations, and exclusions set forth in the FEHB Plan brochure. Benefits may vary if you have other coverage, such as Medicare.

2 of 6 For more information about limitations and exceptions, see the FEHB Plan brochure RI 71-009 at www.nalchbp.org. plan does not cover, penalties for

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