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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: Beginning on or after 01/01/2018. Capital BlueCross1 Gold PPO 2000/10/20 STD coverage For: Individual and Family | Plan Type: PPO. 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 , go to or call 1-800-730-7219.

Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: Beginning on or after 01/01/2018

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