2010 General Exclusions and Limitations HMO 0HRN1250: Single $1,250D 0HRN2500: Single $2,500D 0HRN5000: Single $5,000D 0HRF2500: Family $2,500D 0HRF5000: Family $5,000D 0HRF10GD: Family $10,000D POS 0PHRGNPG: Single Ext 20/40, $1,250/5,000D 0PHRHNPG: Single Ext 20/40, $2,500/$5,000D 0PHR5NPG: Single Ext 40, $5,000D 0PHRHFPH: Family Ext 20/40, $2,500/$7,500D 0PHR5FPH: Family Ext 20/40, $5,000/$7,500D 0PHRTFPH: Family Ext 40, $10,000D
HMO 0HRN1250: Single $1,250D 0HRN2500: Single $2,500D 0HRN5000: Single $5,000D
0HRF2500: Family $2,500D 0HRF5000: Family $5,000D 0HRF10GD: Family $10,000D
POS 0PHRGNPG: Single Ext 20/40, $1,250/5,000D 0PHRHNPG: Single Ext 20/40, $2,500/$5,000D 0PHR5NPG: Single Ext 40, $5,000D
0PHRHFPH: Family Ext 20/40, $2,500/$7,500D 0PHR5FPH: Family Ext 20/40, $5,000/$7,500D 0PHRTFPH: Family Ext 40, $10,000D
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
