The Summary of Benefits and Coverage documents below describe what each plan covers and what it costs for coverage. Details contained within these summary pages are for the following plan: Individual | Plan Type: PPO.
The coverage period for the information contained within these documents is from January 1, 2020 through December 31, 2020.
Medicare Carveout Plan
For further information and assistance regarding Summary of Benefits please contact Customer Service at 1-844-728-7896.