EFTA00316296Set 9
2016-12-1418p4,259w
pocket plan doesn't cover, penalties for failure to obtain
limit? Pre-Notification for services , copays and
prescription drugs.
Is there an overall No. The chart starting on page ... Manipulative (Chiropractic) Services
visit ded and is limited to 20 visits per policy period.
Pre-Notification required for non-network or benefit reduces to
50% of allowed.
Preventive No Charge ... drugs, from a pharmacy designated by us.
More information Certain drugs may have a Pre-Notification requirement or may
copay
about prescription result in a higher cost.
drug coverage
https://www.justice.gov/epstein/files/DataSet%209/EFTA00316296.pdf