COVERAGE GUIDELINES. 50% Cov for OP BHCD for RI or Othr Plans Non-Ntwk PPO Prov; 80% Cov all Othr RI or Othr Plans Non-Ntwk PPO Prov up to an OOP Mx $3000 1/3 Per Fam Calyr Aggr BT Hosp & Surg- Med LOB Excl Pedi/lVF/BH/CD; Cov infertility Treatment
Appears in 1 contract
Sources: Master Agreement
COVERAGE GUIDELINES. 50% Cov for OP BHCD for RI or Othr Plans Non-Ntwk PPO Prov; 80% Cov all Othr RI or Othr Plans Non-Ntwk PPO Prov up to an OOP Mx $3000 1/3 Per Fam Calyr Aggr BT Hosp & Surg- Med SurgMed LOB Excl Pedi/lVF/BH/CD; Cov infertility Treatment
Appears in 1 contract
Sources: Master Agreement