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2011 Medical Plans Summary Comparison
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Benefit
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Providence Choice
(Medical Home)
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PEBB Statewide PPO
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Kaiser Permanente
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Kaiser
Part time
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Providence Choice Part Time
(Medical Home)
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PEBB Statewide PPO Part Time
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Service Area
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Clackamas, Clark, Curry, Deschutes, Lane, Linn-Benton, Marion-Polk, Multnomah, Washington and Yamhill counties
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Statewide and nationwide
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Zip codes in Benton, Clackamas, Columbia, Hood River, Linn, Marion, Multnomah, Polk, Washington and Yamhill counties
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Clackamas, Clark, Curry, Deschutes, Lane, Linn-Benton, Marion-Polk, Multnomah, Washington, and Yamhill counties
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Statewide and nationwide
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Provider Status
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Medical home
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Out of Network
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In network
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Out of network
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Kaiser Permanente
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Kaiser Permanente
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Medical home
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Out of network
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In network
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Out of network
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Deductible
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$0
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$0
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$0
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$0
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$0
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$0
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$0
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$0
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50% of first $1000/ individual, first $3000/family
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50% of first $1000/ individual, first $3000/family
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Out of Pocket Maximum
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$1000/individual
$3000/family
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$2000/individual $6000/family
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$1000/ individual
$3000/family
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$2000/ individual
$6000/family
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$600/individual $1200/family
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$1500/individual $3000/family
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$2000/individual $6000/family
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$4000/ individual $12000/family
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$2000/individual $6000/family
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$4000/individual $12000/family
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Lifetime Maximum
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Unlimited
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Unlimited
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Unlimited
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Unlimited
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Unlimited
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Unlimited
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Unlimited
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Unlimited
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Unlimited
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Unlimited
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Primary services
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$5
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30%
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15%
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30%
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$5
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$30
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$30
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50%
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20%
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50%
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Specialty services*
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$5*
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30%*
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15%*
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30%*
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$5
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$30
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$30*
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50%*
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20%*
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50%*
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Mental health services
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Cost as for physical health services
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Cost as for physical health services
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Cost as for physical health services
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Cost as for physical health services
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Cost as for physical health services
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Cost as for physical health services
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Cost as for physical health services
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Cost as for physical health services
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Cost as for physical health services
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Cost as for physical health services
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Maternity & childbirth medical services
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$0
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30%
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15%
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30%
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$0
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$0
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$0
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50%
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20%
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50%
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Preventive services
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$0
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30%
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$0
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30%
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$0
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$0
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$0
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50%
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$0
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50%
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Lab & X-ray services
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$0
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30%
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15%
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30%
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$0
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$10
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20%
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50%
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20%
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50%
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MRI, CT, PET services
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$100
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$100 + 30%
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$100 + 15%
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$100 + 30%
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$0
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$10
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$100 + 20%
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$100 + 50%
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$100 + 20%
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$100 + 50%
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Sleep study services
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$100
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$100 + 30%
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$100 + 15%
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$100 + 30%
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$0
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$10
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$100 + 20%
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$100 + 50%
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$100 + 20%
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$100 + 50%
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Inpatient Hospital
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$50/day to $250
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30%
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15%
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30%
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$50/day to $250
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$500/admission
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$500/admission
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50%
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20%
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50%
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Emergency Department
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$75
$100*
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$75
$100*
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15% +$100*
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15% +$100*
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$75
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$100
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$100
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$100
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20%
+$100*
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20%
+$100*
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Durable med equipment
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15%
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30%
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15%
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30%
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$0
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50%
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20%
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50%
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20%
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50%
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Insulin, diabetic supplies
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$0
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$0
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$0
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$0
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$0
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$10, 20%
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$0
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$0
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$0
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$0
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Prescription Drugs
| $0 value, $5 generic, $15 preferred brand, $50 or 50% whichever is greater for non-preferred brand. x 2.5 for 90-day
| Member reimbursed as if filled in network; Member pays diff. btw network & billed amt +coinsurance.
x 2.5 mail order
| $0 value, $5 generic, $15 preferred brand, $50 or 50% whichever is greater for non-preferred brand. x 2.5 for 90-day
| Member reimbursed as if filled in network; Member pays diff. btw network & billed amt +coinsurance.
x 2.5 mail order
| $1 generic, $15 brand name. x 2 for 90-day mail order or 1 copay for maintenance drugs
| $10 generic, $25 brand name. x 2 for 90-day mail order or 1 copay for maintenance drugs
| $0 value, $10 generic, $25 preferred brand, $50 or 50% whichever is greater for non-preferred brand.
x 2.5 for 90-day
| Member reimbursed as if filled in network; Member pays diff. btw network & billed amt +coinsurance.
x 2.5 mail order
| $0 value, $10 generic, 20% preferred brand, $50 or 50% whichever is greater non-preferred brand. x 2.5 for 90-day
| Member reimbursed as if filled in network; Member pays diff. btw network & billed amt +coinsurance.
x 2.5 mail order
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Vision
| VSP. $10 exam;
$200 annual allowance for contacts or frames & lenses
| VSP reimburses exam amt to $42. $200 annual allowance for contacts or frames & lenses
| VSP. $10 exam.
$200 annual allowance for contacts or frames & lenses
| VSP reimburses exam amt to $42. $200 annual allowance for contacts or frames & lenses
| HMO. $5 exam
$200 allowance in 24 months for contacts or frames & lenses
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Kaiser Permanente. $30 exam only
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Not covered
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Not covered
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Not covered
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Not covered
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Chiropractic, acupuncture, naturopathic services
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$10; limited to the lesser of $1000 or 60 visits/yr*
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$10; limited to the lesser of $1000 or 60 visits/yr*
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30%; limited to 60 visits/yr*
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30%; limited to 60 visits/yr*
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$10; benefit limited to $1000
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Not covered
| 50%; limited to 60 visits/yr* |
50%; limited to 60 visits/yr*
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50%; limited to 60 visits/yr*
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50%; limited to 60 visits/yr*
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