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Family Member Premium Ann. Out of Pocket Annual Deduct Plan Name Lifetime Maximum Office Visits Profess. Services Hospital Inpatient Emerg. Services Well Child Regular Check-ups
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Family Member Maternity Coverage Pap & Mammo Ambulance Benefits Phys / Occup. Therapy Accupunct & Chiropact Brand Drugs Generic Drugs Cust. Serv. Phone Insurer Policy Number Notes