2010 | Small Group PPO
2010 General Exclusions and Limitations
0A20G20T: Copay $20, Extend 20, $250D
0A20G30V: Copay $20, Extend 30, $500D+10
0A20G40Z: Copay $20, Extend 40, $500D +20
0A25G20U: Copay $25, Extend 20, $500D
0A35G30M: Copay $35, Extend 30, $1,000D +10
0A35G40S: Copay $35, Ext 40, $1,000D + 20
2010 | Large Group PPO
2010 General Exclusions and Limitations
0AD720AA: $1,250D, Extend 40
0AD910BB: $2,500D, Extend 30
0A20G20A: Copay $20, $250D, Extend 20
0A25G30F: Copay $25, $250D, Extend 30
0A25G40D: Copay $25, $500D, Extend 40
0A35G30W: Copay $35, $1,500D, Extend 30
Three-Tier Plans
0A25F20M: Copay $25/$50, $500D
0A35F20M: Copay $35/$70, $500D
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