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Reminder. You selected:
Custom Choice Fund 500, Employee + Family
Custom Choice Fund 500, Employee Only
Custom Choice Fund 500, Employee + Spouse
This benefit applies to your Primary Care Physician (PCP)
coinsurance
. This is a portion of eligible expenses that you are responsible for paying when seeing a physician who provides a broad range of routine medical services and refers patients to specialists, hospitals and other providers as necessary.
Choose Your PCP Coinsurance
In-Network
Out-of-Network
10%
30%
20%
30%
What's covered
™
PCP Office Visit
Review the
plan summary
for more information
How it adds up
™
Weekly
Bi-Weekly
Semi-Monthly
Monthly
Annual
Total Plan Cost
Medical
$630.93
Employer Contribution
Medical
$500.00
Your Contribution
Medical
$130.93
For All Benefits
$130.93
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Privacy Policy, (06/10/2006)
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