Transcription of Summary of Benefits and Coverage: What this Plan …
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Summary of Benefits and Coverage: What this Plan …
Important QuestionsAnswersWhy This Matters: coverage for: Employee + Family | Plan Type: POS 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 . For more information about your coverage , or to get a copy of the complete terms of coverage , or by calling 585-275-2084. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider,or other underlined terms see the Glossary. You can view the Glossary at or call 585-275-2084 to request a Period: 01/01/2018 - 12/31/2018 Summary of Benefits and coverage : What this Plan Covers & What You Pay for Covered ServicesAccountable Health Partners (AHP): Employee (EE) Only$500; EE+ Family (FAM) $1,250.
Primary care visit to treat an injury or illness $20 copay/visit, deductible . doesn't apply $35 copay/visit, deductible doesn't apply 40% coinsurance
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