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Your Plan

PLAN 1 DOUBLE SILVER

ACTIVE

Medical Record Number

86660614

Coverage Dates

01 / 01 / 19xx — 12 / 31 / 20xx

Region

Local

Status

Active

Care Services

  • Primary Care Visit
  • Virtual Care
  • Hospital Stay
  • X—Ray
  • Advanced Imaging
  • General Lab Work
  • Therapy
  • Surgery
  • Chiropractic
  • Physical Therapy
  • Speech Therapy
  • Urgent Care
  • Ambulance
  • Eyewear
  • Vision Exam
  • Cancer Screenings
  • Preventative Exams

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Your cost for most services:

You will pay full cost

Costs may vary depending upon your plan.
Once limits have been met, the plan will be adjusted accordingly.
Costs may change to reflect this change.
Change may vary depending upon your situation.