Page 67 - APPENDICES for Mr. Henry Stiepel
P. 67
% + % . / 0'12 & 3 + # 12 6 12 6 $ $ )'12 6 P
8 3:%
$ 5 6 3 0''$%/ 9'' 3 # 1
!"#$%&! %$ # '()*, $- " #, $4, $7, $) , $7
4'KL $" 1%
@
? !"#$%&! %$ # '()*4'1 6% )KL $" 41% ! 5 !L $" 1%
% + % . / 0'12 & 3 + # " # 6 4'K
;< =>ABCD
E
F G H IJ
$ &M$ # !5 $ &
K#
$ 5 6 3 0''12 NO 1%L #$+2
In this plan, none of P P P
your Rx drugs will
require prior
authorizations by
your physicians.
