Common Contracts
1 similar null contracts
COMBINED EVIDENCE OF COVERAGE AND DISCLOSURE FORMJuly 24th, 2013
This Combined Evidence of Coverage and Disclosure Form (Evidence of Coverage) constitutes only a summary of the health plan. The Agreement, of which this Evidence of Coverage is a part, must be consulted to determine the exact terms and conditions of coverage. If you have special health care needs, you should read those sections of the Evidence of Coverage that apply to those needs. However, this statement of benefits, exclusions and limitations in this Evidence of Coverage is complete and is incorporated by reference into the Agreement.
