Common use of Coverage Under the Base Medical Plan Clause in Contracts

Coverage Under the Base Medical Plan. From July 1, 2021 through December 31, 2021 coverage under the current UPlan will continue at the level in effect on June 30, 2021. a. Effective for the 2022 insurance contract year, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. Effective for the 2022 insurance contract year: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)

Coverage Under the Base Medical Plan. From July 1, 2021 2022 through December 31, 2021 2022 coverage under the current UPlan plan will continue at the level in effect on June 30, 20212022. a. Effective for the 2022 2023, 2024, 2025 insurance contract yearyears, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. Effective for the 2022 2023, 2024, 2025 insurance contract yearyears: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)

Coverage Under the Base Medical Plan. From July 1, 2021 2015 through December 31, 2021 2015 coverage under the current UPlan will continue at the level in effect on June 30, 20212015. a. a) Effective for the 2022 2016 insurance contract year, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. b) Effective for the 2022 2016 insurance contract year: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)

Coverage Under the Base Medical Plan. From July 1, 2021 2019 through December 31, 2021 2019 coverage under the current UPlan will continue at the level in effect on June 30, 20212019. a. Effective for the 2022 2020 insurance contract year, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. Effective for the 2022 2020 insurance contract year: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)

Coverage Under the Base Medical Plan. From July 1, 2021 2007 through December 31, 2021 2007 coverage under the current UPlan will continue at the level in effect on June 30, 20212007. a. a) Effective for the 2022 2008 insurance contract year, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. b) Effective for the 2022 2008 insurance contract year: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)

Coverage Under the Base Medical Plan. From July 1, 2021 2011 through December 31, 2021 2011 coverage under the current UPlan will continue at the level in effect on June 30, 20212011. a. a) Effective for the 2022 2012 insurance contract year, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. b) Effective for the 2022 2012 insurance contract year: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)

Coverage Under the Base Medical Plan. From July 1, 2021 2022 through December 31, 2021 2022 coverage under the current UPlan plan will continue at the level in effect on June 30, 20212022. a. a) Effective for the 2022 2023, 2024, 2025 insurance contract yearyears, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. b) Effective for the 2022 2023, 2024, 2025 insurance contract yearyears: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)

Coverage Under the Base Medical Plan. From July 1, 2021 2017 through December 31, 2021 2017 coverage under the current UPlan will continue at the level in effect on June 30, 20212017. a. a) Effective for the 2022 2018 insurance contract year, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. b) Effective for the 2022 2018 insurance contract year: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)

Coverage Under the Base Medical Plan. From July 1, 2021 2017 through December 31, 2021 2107 coverage under the current UPlan will continue at the level in effect on June 30, 20212017. a. a) Effective for the 2022 2018 insurance contract year, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. b) Effective for the 2022 2018 insurance contract year: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)

Coverage Under the Base Medical Plan. From July 1, 2021 through December 31, 2021 coverage under the current UPlan will continue at the level in effect on June 30, 2021. a. a) Effective for the 2022 insurance contract year, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. b) Effective for the 2022 insurance contract year: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)

Coverage Under the Base Medical Plan. From July 1, 2021 2018 through December 31, 2021 2018 coverage under the current UPlan will continue at the level in effect on June 30, 20212018. a. a) Effective for the 2022 2019 insurance contract year, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. b) Effective for the 2022 2019 insurance contract year: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)

Coverage Under the Base Medical Plan. From July 1, 2021 2019 through December 31, 2021 2019 coverage under the current UPlan will continue at the level in effect on June 30, 20212019. a. a) Effective for the 2022 2020 insurance contract year, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. b) Effective for the 2022 2020 insurance contract year: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)

Coverage Under the Base Medical Plan. From July 1, 2021 2017 through December 31, 2021 2017 coverage under the current UPlan will continue at the level in effect on June 30, 202130,2017. a. a) Effective for the 2022 2018 insurance contract year, the Base Medical Plan will cover allowable charges for the following eligible services subject to the copayments and coverage limits stated. Services provided through this plan are subject to standards of medical necessity and appropriate practice. b. b) Effective for the 2022 2018 insurance contract year: (Benefit amounts reflect Base Plan amounts only. See Summary of Benefits for a full description of coverages.)