XXX D. XXXXX Choices 2 $500/$1000 deductible (subject to annual IRS changes) 3-Tier Rx Prescription Plan, 20% co-insurance, co-pays ($20 for office visit, $25 for urgent care, and $50 for emergency room services), Adult Immunization Rider, Preventative Care Rider
Appears in 4 contracts
Samples: Master Agreement, Master Agreement, Master Agreement