Policy Specifics
The line of business for this member.
What is Medicare?
Effective dates on the policy.
What is 01/01/2025?
Network status of ALIGN SPINE AND PAIN INSTITUTE
What is OON?
Number of members on the policy.
What is one?
Group Number
What is 12473?
Copay for Outpatient Professional /Medical Services
What is $0 copay?
Group name for the policy
What is GA DEPT OF COMMUNITY HEALTH?
Type of policy
What is PPO?
Copay for Inpatient hospital
What is 20% Coinsurance per admit for Medicare-covered hospital care?
DIV for the policy
What is KEN?
Referral Requirements
What is no referral required?
Deductible and Out of Pocket for the member
What is $0 deductible and $2,500 oop?
Funding Arrangement
What is fully funded/insured?
Delegation on Policy
What is no delegation/not delegated?
Copay for specialist office visit in a clinic
What is a $25 copay?