2010 General Exclusions and Limitations 0P10E205: Copay 10 Extend 20 0P15E205: Copay 15 Extend 20 0P100V20: Copay 15 Extend 20, $100D +10 0P20E205: Copay 20 Extend 20 0P250V30: Copay 20 Extend 30, $250D +10 0P500V30: Copay 20 Extend 30, $500D +10 0P35E205: Copay 35 Extend 20 0P1GDV30: Copay 35 Extend 30, $1,000D +10
0P10E205: Copay 10 Extend 20
0P15E205: Copay 15 Extend 20
0P100V20: Copay 15 Extend 20, $100D +10
0P20E205: Copay 20 Extend 20
0P250V30: Copay 20 Extend 30, $250D +10
0P500V30: Copay 20 Extend 30, $500D +10
0P35E205: Copay 35 Extend 20
0P1GDV30: Copay 35 Extend 30, $1,000D +10
The schedules of benefits are in PDF format and require Adobe Acrobat Reader to view and print.
2010 Dependent Eligibility Q & A
Other Dependent Eligibility Info
