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March 12, 2010
Benefits & Eligibility as of (mm/dd/yyyy)  

 
Subscriber Name:HARVEY J SCHNEIDERGroup Number:93705-000-00000-00000
Coverage Type:SingleGroup Name:FULLY INSURED

Please enter a procedure code.
Procedure Code

 

Procedure Code: 00110

COVERAGE LEVELS

ProcedureDelta PremierOut of NetworkComments
110100%100%Deductible does not apply. Allowed at 6 month intervals.