Policy Specifics
The line of business for this member.
What is Commercial?
Original effective date on the policy.
What is 06/01/2020?
Network Status of GILLETTE CHILDRENS HOSPITAL
What is INN?
Number of members on the policy.
What is 5?
Group Number
What is 918806?
Copay for Outpatient Professional /Medical Services
What is 20% co-ins after deductible is met?
Group name for the policy
What is Shutterfly LLC?
Type of policy
What is POS Choice Plus?
Copay for Inpatient hospital
What is 20% co-ins after deductible is met?
Funding Arrangement
What is Self insured ASO?
Market Type
What is 50?
Deductible and Out of Pocket for the member
What is $800 deductible and $3,500 out of pocket?
Relation to the subscriber
What is child?
Product Year
What is 2018?
Copay for specialist office visit
What is $40 copay per visit?