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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.