MEDICAL PLAN
SUMMARY OF COVERAGE
Plan Features
IN NETWORK
Calendar Year Deductibles (Indiv / Family)
Preventive Care
Primary Care Visit
Specialist Visit
Diagnostic Exam
X-Rays
Complex Images
Outpatient Procedure
Inpatient Visit
Emergency Room
Urgent Care
Pharmacy / RX (30 Day Supply)
Pharmacy / RX (90 Day Supply)
Calendar Year Out-of-Pocket Max (Indiv / Family) OUT OF NETWORK
Calendar Year Deductibles (Indiv / Family)
Preventive Care
Primary Care Visit
Specialist Visit
Diagnostic Exam
X-Rays
Complex Images
Outpatient Procedure
6
I
GARAN BENEFITS GUIDE
MEDICAL PLAN
6
Inpatient Visit
Emergency Room
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