Prepared for Universal Investment GrouZip code 91024Eff date 9/#


Plan
Metal
Network
Deductible
Coinsurance
Out of Pocket Mzx
Ambulance
Chiropractor
Durable Med Equip
Emergency Room
Hospital
Infertility
Lab & X-Ray
Office Visit
Specialist
Outpatient Surgery
Physical Therapy
Inpatient Psych
Outpatient Psych
Rx Tier 1
Rx Tier 2
Rx Tier 3
Rx Tier 4
Links
Charles Palazzolo
Christopher Horsley
Edward James Barrett
Edward J Galvan
Total