Common Contracts

SUMMARY PLAN DESCRIPTION (“SPD”) 2 MEDICAL ADMINISTRATIVE SERVICES AGREEMENT (“ASA”) 2 CONFLICT WITH EXISTING LAW 2 IDENTIFICATION CARD 2 HOW TO USE THE NETWORK 2 ABOUT THE NETWORK 3 STEP THERAPY OVERRIDE PROCESS 4

Medical Benefit Plan • October 22nd, 2022

• Contract Type
  Medical Benefit Plan
• Filed
  October 22nd, 2022

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections and Pediatric Acute-Onset Neuropsychiatric Syndrome Treatment 33

SUMMARY PLAN DESCRIPTION (“SPD”) 2 MEDICAL ADMINISTRATIVE SERVICES AGREEMENT (“ASA”) 2 CONFLICT WITH EXISTING LAW 2 IDENTIFICATION CARD 2 HOW TO USE THE NETWORK 2 ABOUT THE NETWORK 3 STEP THERAPY OVERRIDE PROCESS 4

Medical Benefit Plan • August 29th, 2022

• Contract Type
  Medical Benefit Plan
• Filed
  August 29th, 2022

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections and Pediatric Acute-Onset Neuropsychiatric Syndrome Treatment 33