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Summary of Benefits and Coverage: What this Plan Covers ...

Summary of Benefits and Coverage: What this Plan Covers ...

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• Pre-service authorization required for imaging services Imaging (CT/ PET scans, MRIs) 20% coinsurance 50% coinsurance If you need drugs to treat your illness or condition More information about prescription drug coverage is available at express-scripts.com Generic drugs • $10 copay per retail prescription • $20 copay per Express

  Imaging

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