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Patient Name: BOB PATIENT



2004 USS Choice Select Plus_Merge_v08.06.doc

COINSURANCE

 

Situation

CHOICE PLUS

NETWORK

CHOICE PLUS

NON-NETWORK

Coinsurance

 

 

The percentage of Eligible Expenses you are required to pay for certain Covered Health Services after you meet the annual deductible.

 

In-Network Plan Level Coinsurance-

 

90% of eligible expenses until Out-of-Pocket is reached.

 

 

 

Out-of-Network Plan Level Coinsurance-

 

80% of eligible expenses after satisfying $300 deductible until Out-of-Pocket is reached.