| Document Date: 2014-03-11 09:48:59
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Company PET / Procedures Education Laboratory / / Country United States / / Currency USD / / IndustryTerm health outpatient services / to inpatient services / term in-network / use disorder inpatient services / coinsurance other services / medical transportation / inpatient services / room services / excluded services / covered services / use disorder substance abuse outpatient services / imaging / / MedicalCondition Infertility / accidental injury / Substance use disorder / diabetes / injury / illness / / MedicalTreatment immunization / Cosmetic surgery / Chiropractic / Acupuncture / surgery / Bariatric surgery / / Organization U.S. Department of Health and Human Services / Blue Cross and Blue Shield Association / Limitations & Exceptions Office / Medicare / / Person Failure / / / Position coinsurance Physician / surgeon / illness Specialist / Chiropractor / cost estimator / / ProvinceOrState Iowa / / Technology x-ray / / URL www.wellmark.com / www.cciio.cms.gov / /
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State of Iowa Retiree Program 3 Plus Coverage Period: [removed] – [removed]Coverage for: Single & Family | Plan Type: Indemnity Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a