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HSA Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

Basic equipment that meets medical needs.

Repair and replacement not covered unless due to normal wear and tear, if there is a change in medical condition or if growth-related.

Preauthorization by medical plan required for prostheses over $1,000.


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