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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

View requirements for Local Plan and BlueCard Out-of-Area members.

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PPO Plans

PW_G259354

Minimum Essential Coverage – Benefit Summaries (effective 1/1/2017)

Fully Insured Groups 
PPO5 500 0 A 
PPO5 500 10 2K A 
PPO5 500 20 2K A 
PPO5 1K 20 4K A 
PPO5 1.5K 20 7.15K A 
PPO5 2.5K 20 A 
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