See xxx xxXxxxx.xxx or call 1-800-Cigna24 for a list of network providers. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a xxxx from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services. Do you need a referral to see a specialist? No. You can see the specialist you choose without a referral. All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies. Common Medical Event Services You May Need What You Will Pay In-Network Provider Out-of-Network Provider (You will pay the least) (You will pay the most) Limitations, Exceptions, & Other Important Information If you visit a health care provider's office or clinic Primary care visit to treat an injury or illness $30 copay/visit 20% coinsurance None Specialist visit $40 copay/visit 20% coinsurance None Preventive care/ screening/ immunization No charge/visit No charge/screening No charge/immunizations 20% coinsurance/visit 20% coinsurance/screening 20% coinsurance/ immunizations None None None You may have to pay for services that aren’t preventive. Ask your provider if the services you need are preventive. Then check what your plan will pay for. If you have a test Diagnostic test (x-ray, blood work) No charge 20% coinsurance None Imaging (CT/PET scans, MRIs) $75 copay per type of scan/day (up to a maximum of $375) 20% coinsurance None Common Medical Event Services You May Need What You Will Pay In-Network Provider Out-of-Network Provider (You will pay the least) (You will pay the most) Limitations, Exceptions, & Other Important Information If you need drugs to treat your illness or condition More information about prescription drug coverage is available at xxx.xxXxxxx.xxx Generic drugs (Tier 1) $10 copay/prescription (retail 30 days), $20 copay/prescription (retail & home delivery 90 days) $10 copay/prescription (retail 30 days); Not covered (home delivery) Coverage is limited up to a 90-day supply (retail and home delivery); up to a 30-day supply (retail and home delivery) for Specialty drugs. Certain limitations may apply, including, for example: prior authorization, step therapy, quantity limits. Preferred brand drugs (Tie...
See xxx xxxxxxxxxxxxxxxxxxx.xxx for a listing of CTII 100 Series Rules and Direct Service Points. - - -
See xxx xxxxxxxxxxxxx.xxx.xx for information on rooms & facilities at The Hall Or Email xxxx@xxxxxxxxxxxxx.xxx.xx OR call 00000 000000 NOTES: All heating & lighting plus Wi-Fi use are included in the hire fees. SHARED USE of the Kitchenette, Cloakrooms, Car Parking, Lobby is included, unless agreed otherwise. Rectangular trestle tables and chairs are included and available to all hirers. Children’s tables & chairs available. Please confirm any booking with us prior to making payment or advertising an event/activity.
See xxx xxx.xxx for the latest industry news, take a free trial at xxxx://xxx.xxx.xxx/SignUp.html?LS=AFA814 or call the subscription hotline on 000-000-0000 or 000-000-0000.
See xxx xxxx.xxx) at the completion of the experience and supervision hours. When there are multiple supervisors supervising a supervisee, they may both sign a single Experience Verification Form, attesting the experience as a whole. Note: The supervisor needs to keep a copy of this form for 7 years, as the BACB® may audit the supervisor at any time.
See xxx xxxxxxxxx.xxx for the football game schedule and incorporate these dates into the construction schedule.
See xxx xxxxxxxxxxxxx.xxx.xx for information on facilities available at The Hall Email us at xxxx@xxxxxxxxxxxxx.xxx.xx or call 00000 000000 NOTES: All heating & lighting plus Wi-Fi use are included in the hire fees. Shared use of the Kitchenette, Cloakrooms, Car Parking, Lobby is included, unless agreed otherwise. Rectangular trestle tables and chairs are included and available to all hirers. Children’s tables & chairs available. Please confirm any booking with us prior to making payment or advertising an event/activity. PARTIES WITH DISCO/LIVE BAND – Whole Building hire rate applies even if only one space is used USE OF KITCHEN: Use of the small Kitchenette for tea/coffee making, serving cake/biscuits etc is included in the hire of any space Main Kitchen for the preparation/service of hot or cold food- hire includes use of crockery, cutlery, glassware & equipment. Hire £50 (£40 concs) flat fee (or included in whole premises hire).
See xxx xxxxxxxxxxxxxxxxx.
