Benefit Contract Sample Contracts

GROUP LIMITED BENEFIT CONTRACT
Benefit Contract • October 4th, 2023 • Louisiana

It is my pleasure to welcome You to Your new plan. If You are renewing Your plan, welcome back! We are honored You chose the Cross and Shield for Your health insurance needs. Please read this booklet for important information about Your plan and how it works. If You have questions, We are here to help. Simply call the number on the ID card and We will do our best to assist You.

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Variable Income Plan
Benefit Contract • October 5th, 2023

THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. THIS POLICY DOES NOT SATISFY THE REQUIREMENT OF MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT. LACK OF MAJOR MEDICAL COVERAGE OR OTHER MINIMUM ESSENTIAL COVERAGE MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES.

LIMITED BENEFIT CONTRACT
Benefit Contract • August 26th, 2020 • Louisiana

a retiree who satisfies any criteria designated by Us, and if shown as covered in this Group’s Benefit Plan Schedule of Dental Benefits.

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