Page 9 - FlipBuilder Template 2020 ADW
P. 9
In-Network Out-of-Network Benefit Guidlines
$3000 Individual $6000 Individual
Benefit Name 12 months
$6000 Family $9000 Family
$3000 Individual $6000 Individual
Benefit Name 12 months
$6000 Family $9000 Family
Benefit Name 0% after Deductible 0% after Deductible 12 months
Benefit Name 0% after Deductible 0% after Deductible 12 months
Benefit Name Covered Full Covered Full 12 months
Benefit Name Covered Full Covered Full 12 months
Benefit Name Covered Full Covered Full 12 months
$3000 Individual $6000 Individual
Benefit Name 12 months
$6000 Family $9000 Family
$3000 Individual $6000 Individual
Benefit Name 12 months
$6000 Family $9000 Family
Benefit Name 0% after Deductible 0% after Deductible 12 months
$3000 Individual $6000 Individual
Benefit Name 12 months
$6000 Family $9000 Family
$3000 Individual $6000 Individual
Benefit Name 12 months
$6000 Family $9000 Family
Benefit Name 0% after Deductible 0% after Deductible 12 months
Benefit Name 0% after Deductible 0% after Deductible 12 months
Benefit Name Covered Full Covered Full 12 months
Benefit Name Covered Full Covered Full 12 months
Benefit Name Covered Full Covered Full 12 months
$3000 Individual $6000 Individual
Benefit Name 12 months
$6000 Family $9000 Family
$3000 Individual $6000 Individual
Benefit Name 12 months
$6000 Family $9000 Family
Benefit Name 0% after Deductible 0% after Deductible 12 months
$3000 Individual $6000 Individual
Benefit Name 12 months
$6000 Family $9000 Family
Benefit Name 0% after Deductible 0% after Deductible 12 months
ABC COMPANY | 2018 BENEFIT BOOKLET 9
