Page 17 - APPENDICES for Vic Bosiger
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DEDUCTIBLES
The amount you must pay each year before your plan starts to pay for covered services or drugs.
Health deductible $0
Drug deductible $0.00
MAXIMUM YOU PAY FOR HEALTH SERVICES
Maximum you pay for health services $5,900 In-network
CONTACT INFORMATION
Plan address P.O. Box 30770
Salt Lake City, UT 84130
Bene ts & Costs
DOCTOR SERVICES
View Provider Network Directory
Primary doctor visit In-network: $0 copay
Specialist visit In-network: $40 copay per Limits apply
visit
