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20161010110718038 · Buy-Up Plan $1,000 Deductible 80% co-insurance (0/0 paid by BCBS) $3,000 annual maximum co-insurance $30/S40 office visit co-pays Pharmacy co-pays 1st tier $10

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Page 1: 20161010110718038 · Buy-Up Plan $1,000 Deductible 80% co-insurance (0/0 paid by BCBS) $3,000 annual maximum co-insurance $30/S40 office visit co-pays Pharmacy co-pays 1st tier $10
Page 2: 20161010110718038 · Buy-Up Plan $1,000 Deductible 80% co-insurance (0/0 paid by BCBS) $3,000 annual maximum co-insurance $30/S40 office visit co-pays Pharmacy co-pays 1st tier $10
Page 3: 20161010110718038 · Buy-Up Plan $1,000 Deductible 80% co-insurance (0/0 paid by BCBS) $3,000 annual maximum co-insurance $30/S40 office visit co-pays Pharmacy co-pays 1st tier $10
Page 4: 20161010110718038 · Buy-Up Plan $1,000 Deductible 80% co-insurance (0/0 paid by BCBS) $3,000 annual maximum co-insurance $30/S40 office visit co-pays Pharmacy co-pays 1st tier $10
Page 5: 20161010110718038 · Buy-Up Plan $1,000 Deductible 80% co-insurance (0/0 paid by BCBS) $3,000 annual maximum co-insurance $30/S40 office visit co-pays Pharmacy co-pays 1st tier $10
Page 6: 20161010110718038 · Buy-Up Plan $1,000 Deductible 80% co-insurance (0/0 paid by BCBS) $3,000 annual maximum co-insurance $30/S40 office visit co-pays Pharmacy co-pays 1st tier $10

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