Page 41 - APPENDICES for Vic Bosiger
P. 41
DEDUCTIBLES
The amount you must pay each year before your plan starts to pay for covered services or drugs.
Health deductible $0
Drug deductible $150.00
MAXIMUM YOU PAY FOR HEALTH SERVICES
Maximum you pay for health services $4,000 In-network
CONTACT INFORMATION
Plan address 4417 Corporation Lane
Virginia Beach, VA 23462
Bene ts & Costs
DOCTOR SERVICES
View Provider Network Directory
Primary doctor visit $0 copay
Specialist visit $20 copay per visit
