| Document Date: 2014-02-25 08:53:55
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City Concord / / Company PET / Anthem / / Country United States / / Currency USD / / / Facility Facility Charges / clinic Your Cost / Health Facility Mental/Behavioral Visit-Facility Health Facility Visit-Facility Charges Charges / / IndustryTerm use disorder outpatient services / health outpatient services / term in-network / use disorder inpatient services / state insurance department / medical transportation / retail pharmacy / inpatient services / depending on services / retail / room services / excluded services / health insurance coverage / covered services / health inpatient services / / MedicalCondition Infertility / Substance use disorder / diabetes / injury / illness / coinsurance Substance use disorder / morbid obesity / / MedicalTreatment immunization / Cosmetic surgery / occupational therapy / Chiropractic / Acupuncture / speech therapy / surgery / physical therapy / Bariatric Surgery / / Organization New Hampshire Department of Insurance / New Hampshire Insurance Department / Limitations & Exceptions Lab / / / Position Physician /surgeon / sales representative / illness Specialist / administrator / Chiropractor / / ProvinceOrState Connecticut / New Hampshire / / Technology x-ray / / URL www.anthem.com / www.bcbs.com/bluecardworldwide / www.nh.gov/insurance / http /
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Anthem Blue Cross and Blue Shield Anthem Bronze DirectAccess with HSA - caax Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: [removed] – [removed]Coverage for: Individual + F