Summary of Benefits
The Summary of Benefits
) matrix is intended to be used to help you compare coverage benefits and is a summary only.
Evidence of Coverage
The Evidence of Coverage
) should be consulted for a detailed description of coverage benefits and limitations.
Note: There are no co-payments for preventive visits or for members under the age of 24 months for well-baby care and office visits. There are no co-payments for members who are documented Alaska Natives or Native Americans.