Health Plan Product Offering
|
|
- Verity Hancock
- 6 years ago
- Views:
Transcription
1 Health Plan Product Offering UnitedHealthcare offers a wide variety of plan options that allow you to tailor your benefit needs to your business needs, choosing what you value in a health plan. / UnitedHealthcare ier Plans Choice+ Core Choice+ Core Coinsurance uctible Pocket Maximum Copay/Per Occurrence <19 Spec 2 4 AH-AT AH-BL AH-CN AH-DF 100% 80% $0 $0 $5,000 $10,000 $1,500 $3,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 $ % AH-AU AH-BM AH-CO AH-DG 100% 80% $250 $500 $5,000 $10,000 $1,750 $3,500 $10,000 $20,000 $20 $20 $0 $20 $40 $75 $ % AH-AV AH-BN AH-CP AH-DH 100% 80% $500 $1,000 $5,000 $10,000 $2,000 $4,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 $ % AH-AW AH-BO AH-CQ AH-DI 100% 80% $1,000 $2,000 $5,000 $10,000 $2,500 $5,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 $ % AH-AX AH-BP AH-CR AH-DJ 100% 80% $1,500 $3,000 $5,000 $10,000 $3,000 $6,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 $ % AH-AY AH-BQ AH-CS AH-DK 100% 80% $2,000 $4,000 $5,000 $10,000 $3,500 $7,000 $10,000 $20,000 $25 $30 $0 $30 $60 $75 $ % AH-AZ AH-BR AH-CT AH-DL 100% 80% $2,500 $5,000 $5,000 $10,000 $4,000 $8,000 $10,000 $20,000 $25 $30 $0 $30 $60 $75 $ % AH-A1 AH-BS AH-CU AH-DM 100% 80% $3,000 $6,000 $5,000 $10,000 $4,500 $9,000 $10,000 $20,000 $25 $30 $0 $30 $60 $75 $ % AH-A2 AH-BT AH-CV AH-DN 100% 80% $5,000 $10,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $25 $30 $0 $30 $60 $75 $ % AH-A3 AH-BU AH-CW AH-DO 80% 60% $0 $0 $5,000 $10,000 $2,500 $5,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 $ % AH-A4 AH-BV AH-CX AH-DP 80% 60% $250 $500 $5,000 $10,000 $3,000 $6,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 $ % AH-A5 AH-BW AH-CY AH-DQ 80% 60% $500 $1,000 $5,000 $10,000 $3,500 $7,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 $ % AH-A6 AH-BX AH-CZ AH-DR 80% 60% $1,000 $2,000 $5,000 $10,000 $4,000 $8,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 $ % AH-A7 AH-BY AH-C1 AH-DS 80% 60% $1,500 $3,000 $5,000 $10,000 $5,000 $10,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 $ % AH-A8 AH-BZ AH-C2 AH-DT 80% 60% $2,000 $4,000 $5,000 $10,000 $6,000 $12,000 $10,000 $20,000 $25 $30 $0 $30 $60 $75 $ % AH-A9 AH-B1 AH-C3 AH-DU 80% 60% $2,500 $5,000 $5,000 $10,000 $6,000 $12,000 $10,000 $20,000 $25 $30 $0 $30 $60 $75 $ % AH-BA AH-B2 AH-C4 AH-DV 80% 60% $3,000 $6,000 $5,000 $10,000 $6,000 $12,000 $10,000 $20,000 $25 $30 $0 $30 $60 $75 $ % AH-BB AH-B3 AH-C5 AH-DW 80% 60% $5,000 $10,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $25 $30 $0 $30 $60 $75 $ % AH-BC AH-B4 AH-C6 AH-DX 60% 50% $0 $0 $5,000 $10,000 $2,500 $5,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 40% 100% +40% AH-BD AH-B5 AH-C7 AH-DY 60% 50% $250 $500 $5,000 $10,000 $3,000 $6,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 40% 100% +40% AH-BE AH-B6 AH-C8 AH-DZ 60% 50% $500 $1,000 $5,000 $10,000 $3,500 $7,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 40% 100% +40% AH-BF AH-B7 AH-C9 AH-D1 60% 50% $1,000 $2,000 $5,000 $10,000 $4,000 $8,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 40% 100% +40% AH-BG AH-B8 AH-DA AH-D2 60% 50% $1,500 $3,000 $5,000 $10,000 $5,000 $10,000 $10,000 $20,000 $20 $20 $0 $20 $40 $75 40% 100% +40% AH-BH AH-B9 AH-DB AH-D3 60% 50% $2,000 $4,000 $5,000 $10,000 $6,000 $12,000 $10,000 $20,000 $25 $30 $0 $30 $60 $75 40% 100% +40% AH-BI AH-CA AH-DC AH-D4 60% 50% $2,500 $5,000 $5,000 $10,000 $6,000 $12,000 $10,000 $20,000 $25 $30 $0 $30 $60 $75 40% 100% +40% AH-BJ AH-CB AH-DD AH-D5 60% 50% $3,000 $6,000 $5,000 $10,000 $6,000 $12,000 $10,000 $20,000 $25 $30 $0 $30 $60 $75 40% 100% +40% AH-BK AH-CC AH-DE AH-D6 60% 50% $5,000 $10,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $25 $30 $0 $30 $60 $75 40% 100% +40% Administrative services provided by United Health Services, Inc. or their affiliates. Health Plan coverage provided by or through UnitedHealthcare of, Inc. MT /17 BROK 2017 United Health Services, Inc
2 UnitedHealthcare PROformance Plans Choice+ Core Choice+ Core Coinsurance uctible Pocket Maximum Copay/Per Occurrence AX-LO AX-LS AX-OF AX-OJ 80% 50% $1,000 $2,000 $5,000 $10,000 $7,150 $14,300 $10,000 $20,000 $0 $10 $0 $40 $80 $25 AX-LP AX-LT AX-OG AX-OK 80% 50% $2,000 $4,000 $5,000 $10,000 $7,150 $14,300 $10,000 $20,000 $0 $10 $0 $40 $80 $25 AX-LQ AX-LU AX-OH AX-OL 80% 50% $3,000 $6,000 $7,500 $15,000 $7,150 $14,300 $15,000 $30,000 $0 $10 $0 $40 $80 $25 AX-LR AX-LV AX-OI AX-OM 80% 50% $5,000 $10,000 $10,000 $20,000 $7,150 $14,300 $20,000 $40,000 $0 $10 $0 $40 $80 $25 AX-LW AX-L1 AX-ON AX-OR 80% 50% $1,000 $2,000 $5,000 $10,000 $7,150 $14,300 $10,000 $20,000 $0 $15 $0 $50 $100 $25 AX-LX AX-L2 AX-OO AX-OS 80% 50% $2,000 $4,000 $5,000 $10,000 $7,150 $14,300 $10,000 $20,000 $0 $15 $0 $50 $100 $25 AX-LY AX-L3 AX-OP AX-OT 80% 50% $3,000 $6,000 $7,500 $15,000 $7,150 $14,300 $15,000 $30,000 $0 $15 $0 $50 $100 $25 AX-LZ AX-K4 AX-OQ AX-OU 80% 50% $5,000 $10,000 $10,000 $20,000 $7,150 $14,300 $20,000 $40,000 $0 $15 $0 $50 $100 $ <19 Spec 2 / $40 $500 $40 $500 $40 $500 $40 $500 UnitedHealthcare ier Value Plans Choice+ Core Choice+ Core Coinsurance uctible Pocket Maximum Copay/Per Occurrence 19+ <19 Spec 2 4 AK-UG AK-UP AK-VH AK-VQ 100% 70% $500 $1,500 $5,000 $15,000 $6,350 $12,700 $10,000 $30,000 $25 $35 $0 $35 $70 $100 $400 $400 AK-UH AK-UQ AK-VI AK-VR 100% 70% $1,000 $3,000 $5,000 $15,000 $6,350 $12,700 $10,000 $30,000 $25 $40 $0 $40 $80 $100 $400 $400 AK-UI AK-UR AK-VJ AK-VS 100% 70% $3,000 $9,000 $5,000 $15,000 $6,350 $12,700 $10,000 $30,000 $25 $45 $0 $45 $90 $100 $400 $400 AK-UJ AK-US AK-VK AK-VT 100% 70% $5,000 $10,000 $10,000 $30,000 $6,350 $12,700 $20,000 $60,000 $25 $45 $0 $45 $90 $100 $400 $400 AK-UK AK-UT AK-VL AK-VU 80% 50% $0 $0 $5,000 $15,000 $6,350 $12,700 $10,000 $30,000 $25 $35 $0 $35 $70 $100 $400 $400 AK-UL AK-UU AK-VM AK-VV 80% 50% $1,250 $3,750 $5,000 $15,000 $6,350 $12,700 $10,000 $30,000 $25 $40 $0 $40 $80 $100 $400 $400 AK-UM AK-UV AK-VN AK-VW 80% 50% $2,000 $6,000 $5,000 $15,000 $6,350 $12,700 $10,000 $30,000 $25 $40 $0 $40 $80 $100 $400 $400 AK-UN AK-UW AK-VO AK-VX 80% 50% $2,500 $7,500 $5,000 $15,000 $6,350 $12,700 $10,000 $30,000 $25 $40 $0 $40 $80 $100 $400 $400 AK-UO AK-UX AK-VP AK-VY 80% 50% $4,000 $12,000 $10,000 $30,000 $6,350 $12,700 $20,000 $60,000 $25 $45 $0 $45 $90 $100 $400 $400 Administrative services provided by United Health Services, Inc. or their affiliates. Health Plan coverage provided by or through UnitedHealthcare of, Inc. MT /17 BROK 2017 United Health Services, Inc
3 / UnitedHealthcare PrimaryAdvantage Plans Choice+ Core Choice+ Core Coinsurance uctible Pocket Maximum Copay/Per Occurrence AN-CN AN-EZ AN-FO AN-F1 80% 50% $1,000 $2,000 $5,000 $10,000 $6,500 $13,000 $10,000 $20,000 $0 $0 $100 $50 AN-CO AN-E1 AN-FP AN-F2 80% 50% $2,000 $4,000 $5,000 $10,000 $6,500 $13,000 $10,000 $20,000 $0 $0 $100 $50 AN-CP AN-E2 AN-FQ AN-F3 80% 50% $3,000 $6,000 $10,000 $20,000 $6,500 $13,000 $20,000 $40,000 $0 $0 $100 $50 AN-CQ AN-E3 AN-FR AN-F4 80% 50% $5,000 $10,000 $10,000 $20,000 $6,500 $13,000 $20,000 $40,000 $0 $0 $100 $50 AN-CR AN-E4 AN-FS AN-F5 50% 50% $1,000 $2,000 $5,000 $10,000 $6,500 $13,000 $10,000 $20,000 $0 $0 $100 $50 AN-CS AN-E5 AN-FT AN-F6 50% 50% $2,000 $4,000 $5,000 $10,000 $6,500 $13,000 $10,000 $20,000 $0 $0 $100 $50 UnitedHealthcare PrimaryAdvantage HSA Plans Coinsurance uctible Pocket Maximum Choice+ Core Choice+ Core Spec AX-T7 AY-Y3 AX-U1 AY-Y5 80% 50% $1,000 $2,000 $5,000 $10,000 $6,500 $13,000 $10,000 $20,000 $0 $100 $50 AX-T8 AY-Y4 AX-U2 AY-Y6 80% 50% $2,000 $4,000 $5,000 $10,000 $6,500 $13,000 $10,000 $20,000 $0 $100 $50 Copayments on Primary Advantage HSA plans will be required only after the deductible has been met and will continue to be required until the annual out-of-pocket maximum is met. "Non-Embedded" deductible means no covered family member will satisfy an individual deductible until the entire family deductible is met. There is no separate additional Rx deductible required for Primary Advantage HSA plans. UnitedHealthcare Primary Advantage Rx Plans Rx Plan Code Copays Tier 1 Tier 2 Tier 3 Tier 4 Mail- Order Ratio Rx Ind/Fam Rx uctible Note 454/454x $0 $50 $100 $ x $250/$500 Tiers 3 & 4 only 455/455x $5 $50 $100 $ x $250/$500 Tiers 3 & 4 only 751/751x $0 $50 $100 $ x N/A For HSA use only Administrative services provided by United Health Services, Inc. or their affiliates. Health Plan coverage provided by or through UnitedHealthcare of, Inc. MT /17 BROK 2017 United Health Services, Inc
4 / UnitedHealthcare FlexFree 17 Plans Choice+ Core Choice+ Core Coinsurance uctible Pocket Maximum Copay/Per Occurrence Spec AK-TB AK-TG AK-TV AK-T1 80% 50% $1,000 $2,000 $5,000 $10,000 $6,850 $13,700 $10,000 $20,000 $25 $0/3 visits combined $0/2 visits AK-TC AK-TH AK-TW AK-T2 80% 50% $2,000 $4,000 $5,000 $10,000 $6,850 $13,700 $10,000 $20,000 $25 $0/3 visits combined $0/2 visits AK-TD AK-TI AK-TX AK-T3 80% 50% $3,000 $6,000 $5,000 $10,000 $6,850 $13,700 $10,000 $20,000 $25 $0/3 visits combined $0/2 visits AK-TE AK-TJ AK-TY AK-T4 80% 50% $5,000 $10,000 $10,000 $20,000 $6,850 $13,700 $20,000 $40,000 $25 $0/3 visits combined $0/2 visits AK-TF AK-TK AK-TZ AK-T5 100% 50% $5,000 $10,000 $10,000 $20,000 $6,850 $13,700 $20,000 $40,000 $25 $0/3 visits combined $0/2 visits UnitedHealthcare Standard Plans Plan Type Choice+ Core Choice+ Core Coinsurance uctible Pocket Maximum Copay/Per Occurrence <19 AG-U4 AG-87 AG-U4 AG-87 50/50 50% 50% $2,000 $4,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $50 $0 $50 $50 $100 AG-U5 AG-88 AG-U5 AG-88 50/50 50% 50% $3,000 $6,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $50 $0 $50 $50 $100 AG-U6 AG-89 AG-U6 AG-89 50/50 50% 50% $5,000 $10,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $50 $0 $50 $50 $100 AH-CD AH-CG AH-D7 AH-EA FlexPoint 6 80% 50% $1,000 $2,000 $5,000 $10,000 $4,000 $8,000 $10,000 $20,000 $25 N/A $25 $50 $100 AH-CE AH-CH AH-D8 AH-EB FlexPoint 6 80% 50% $2,000 $4,000 $5,000 $10,000 $6,000 $12,000 $10,000 $20,000 $30 N/A $30 $60 $100 AH-CF AH-CI AH-D9 AH-EC FlexPoint 6 80% 50% $5,000 $10,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $35 N/A $35 $70 $100 AG-9A AG-9B AG-9A AG-9B Consumer 80% 60% $2,000 $4,000 $5,000 $10,000 $6,000 $12,000 $10,000 $20,000 AG-9C AG-9D AG-9C AG-9D Consumer 80% 60% $5,000 $10,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 AE-3S AG-9E AE-3S AG-9E Consumer 50% 50% $0 $0 $5,000 $10,000 $6,000 $12,000 $10,000 $20,000 50% 50% 50% 50% 50% 50% 50% 50% AG-YF N/A AG-YF N/A Non-Diff 80% 80% $1,000 $2,000 N/A N/A $3,000 $6,000 N/A N/A AG-YG N/A AG-YG N/A Non-Diff 80% 80% $2,000 $4,000 N/A N/A $4,000 $8,000 N/A N/A Spec 2 4 $250 $250 $250 Administrative services provided by United Health Services, Inc. or their affiliates. Health Plan coverage provided by or through UnitedHealthcare of, Inc. MT /17 BROK 2017 United Health Services, Inc
5 / UnitedHealthcare Navigate 8,11 and Charter 8,11 Plans (Chicago market 471 only) Coinsurance Plan Type Navigate Charter uctible Pocket Maximum Single Family Single Family 19+ <19 Spec w/ PCP Referral Copay/Per Occurrence AG-9Y AM-24 Copay 100% $0 $0 $1,500 $3,000 $20 $20 $0 $40 $75 $ % AG-9Z AM-25 Copay 100% $250 $500 $1,750 $3,500 $20 $20 $0 $40 $75 $ % AG-91 AN-K3 Copay 100% $500 $1,000 $2,000 $4,000 $20 $20 $0 $40 $75 $ % AG-92 AM-2V Copay 100% $1,000 $2,000 $2,500 $5,000 $20 $20 $0 $40 $75 $ % AG-93 AM-2W Copay 100% $1,500 $3,000 $3,000 $6,000 $20 $20 $0 $40 $75 $ % AG-94 AM-2X Copay 100% $2,000 $4,000 $3,500 $7,000 $25 $30 $0 $60 $75 $ % AG-95 AM-2Y Copay 100% $2,500 $5,000 $4,000 $8,000 $25 $30 $0 $60 $75 $ % AG-96 AM-2Z Copay 100% $3,000 $6,000 $4,500 $9,000 $25 $30 $0 $60 $75 $ % AG-97 AM-21 Copay 100% $5,000 $10,000 $6,350 $12,700 $25 $30 $0 $60 $75 $ % AG-98 AM-22 Copay 80% $0 $0 $2,500 $5,000 $20 $20 $0 $40 $75 $ % AG-99 AM-23 Copay 80% $250 $500 $3,000 $6,000 $20 $20 $0 $40 $75 $ % AH-AA AM-26 Copay 80% $500 $1,000 $3,500 $7,000 $20 $20 $0 $40 $75 $ % AH-AB AM-27 Copay 80% $1,000 $2,000 $4,000 $8,000 $20 $20 $0 $40 $75 $ % AH-AC AM-28 Copay 80% $1,500 $3,000 $5,000 $10,000 $20 $20 $0 $40 $75 $ % AH-AD AM-29 Copay 80% $2,000 $4,000 $6,000 $12,000 $25 $30 $0 $60 $75 $ % AH-AE AM-3A Copay 80% $2,500 $5,000 $6,000 $12,000 $25 $30 $0 $60 $75 $ % AH-AF AM-3B Copay 80% $3,000 $6,000 $6,000 $12,000 $25 $30 $0 $60 $75 $ % AH-AG AM-3C Copay 80% $5,000 $10,000 $6,350 $12,700 $25 $30 $0 $60 $75 $ % AH-AH AM-3D Copay 60% $0 $0 $2,500 $5,000 $20 $20 $0 $40 $75 40% 100% +40% +40% AH-AI AM-3E Copay 60% $250 $500 $3,000 $6,000 $20 $20 $0 $40 $75 40% 100% +40% +40% AH-AJ AM-3F Copay 60% $500 $1,000 $3,500 $7,000 $20 $20 $0 $40 $75 40% 100% +40% +40% AH-AK AM-3G Copay 60% $1,000 $2,000 $4,000 $8,000 $20 $20 $0 $40 $75 40% 100% +40% +40% AH-AL AM-3H Copay 60% $1,500 $3,000 $5,000 $10,000 $20 $20 $0 $40 $75 40% 100% +40% +40% AH-AM AM-3I Copay 60% $2,000 $4,000 $6,000 $12,000 $25 $30 $0 $60 $75 40% 100% +40% +40% AH-AN AM-3J Copay 60% $2,500 $5,000 $6,000 $12,000 $25 $30 $0 $60 $75 40% 100% +40% +40% AH-AO AM-3K Copay 60% $3,000 $6,000 $6,000 $12,000 $25 $30 $0 $60 $75 40% 100% +40% +40% AH-AP AM-3L Copay 60% $5,000 $10,000 $6,350 $12,700 $25 $30 $0 $60 $75 40% 100% +40% +40% AX-T9 AX-UA HSA 80% $2,800 $5,600 $6,350 $12,700 80% 80% N/A 80% 80% 80% 80% 80% 80% AH-AR AM-3N HSA 80% $3,500 $7,000 $6,350 $12,700 80% 80% N/A 80% 80% 80% 80% 80% 80% AH-AS AM-3O HSA 80% $5,000 $10,000 $6,350 $12,700 80% 80% N/A 80% 80% 80% 80% 80% 80% Administrative services provided by United Health Services, Inc. or their affiliates. Health Plan coverage provided by or through UnitedHealthcare of, Inc. MT /17 BROK 2017 United Health Services, Inc
6 / UnitedHealthcare Charter Primary Advantage 8,11 Plans (Chicago market 471 only) Charter Coinsurance uctible Pocket Maximum Copay/Per Occurrence Single Family Single Family Spec AX-ZC 80% 50% $1,000 $2,000 $6,500 $13,000 $0 $0 $50 $75 AX-ZD 80% 50% $2,000 $4,000 $6,500 $13,000 $0 $0 $50 $75 AX-ZE 80% 50% $3,000 $6,000 $6,500 $13,000 $0 $0 $50 $75 AX-ZF 80% 50% $5,000 $10,000 $6,500 $13,000 $0 $0 $50 $75 UnitedHealthcare Primary Advantage Rx Plans Rx Plan Code Copays Tier 1 Tier 2 Tier 3 Tier 4 Mail-Order Ratio Rx Ind/Fam Rx uctible Note 454/454x $0 $50 $100 $ x $250/$500 Tiers 3 & 4 only 455/455x $5 $50 $100 $ x $250/$500 Tiers 3 & 4 only UnitedHealthcare Advanced Tier Plans Choice+ Core Choice+ Core Physician Physician 2 2 Coinsurance uctible Pocket Maximum Copay/Per Occurrence Facility,2 Spec 2 4 AH-CJ N/A AH-ED N/A 80% 50% 80% 50% $1,500 $3,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $25 $50 $50 $100 $100 $250 AH-CK N/A AH-EE N/A 80% 50% 80% 50% $2,000 $4,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $25 $50 $50 $100 $100 $250 AH-CL N/A AH-EF N/A 80% 50% 80% 50% $1,500 $3,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $35 $70 $70 $100 $100 $250 AH-CM N/A AH-EG N/A 80% 50% 80% 50% $2,000 $4,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $35 $70 $70 $100 $100 $250 Administrative services provided by United Health Services, Inc. or their affiliates. Health Plan coverage provided by or through UnitedHealthcare of, Inc. MT /17 BROK 2017 United Health Services, Inc
7 / UnitedHealthcare Health Savings Account (HSA) Plans Choice+ Core Navigate 8,11 Charter 8,11 Coinsurance uctible Pocket Maximum Copay/Per Occurrence 9 5 Spec Type Rx Plan 9 AG-9G AG-9F 100% 80% $2,000 $4,000 $5,000 $10,000 $3,000 $6,000 $10,000 $20, % 100% 100% 100% Non-Emb 10/35/60 AG-9I AG-9H 100% 80% $2,500 $5,000 $5,000 $10,000 $2,500 $5,000 $10,000 $20, % 100% 100% 100% Non-Emb 100% AX-T4 AX-TZ 100% 80% $2,800 $5,600 $5,000 $10,000 $2,800 $5,600 $10,000 $20, % 100% 100% 100% Emb 100% AX-T5 AX-T1 100% 80% $2,800 $5,600 $5,000 $10,000 $3,500 $7,000 $10,000 $20, % 100% 100% 100% Emb 10/35/60 AX-T6 AX-T2 100% 80% $2,800 $5,600 $5,000 $10,000 $5,000 $10,000 $10,000 $20,000 $30 9 $60 9 $75 9 $300 9 Emb 10/35/60 AG-9J AG-9K 100% 80% $3,000 $6,000 $5,000 $10,000 $4,000 $8,000 $10,000 $20, % 100% 100% 100% Emb 10/35/60 AG-9L AG-9M 100% 80% $5,000 $10,000 $5,000 $10,000 $6,000 $12,000 $10,000 $20, % 100% 100% 100% Emb 10/35/60 AG-9N AG-9O 100% 80% $5,000 $10,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $30 9 $60 9 $75 9 $300 9 Emb 10/35/60 AG-9P AG-9Q 100% 80% $6,350 $12,700 $10,000 $20,000 $6,350 $12,700 $20,000 $40, % 100% 100% 100% Emb 100% AX-TY AX-T3 AX-T9 AX-UA 80% 60% $2,800 $5,600 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 80% 80% 80% 80% Emb 10/35/60 AG-9S AG-9T 80% 60% $3,000 $6,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 80% 80% 80% 80% Emb 10/35/60 AG-9U AG-9V AH-AR AM-3N 80% 60% $3,500 $7,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 80% 80% 80% 80% Emb 10/35/60 AG-9W AG-9X AH-AS AM-3O 80% 60% $5,000 $10,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 80% 80% 80% 80% Emb 10/35/60 AE-3Q AG-9R 50% 50% $3,000 $6,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 50% 50% 50% 50% Emb 10/35/60 Administrative services provided by United Health Services, Inc. or their affiliates. Health Plan coverage provided by or through UnitedHealthcare of, Inc. MT /17 BROK 2017 United Health Services, Inc
8 UnitedHealthcare Health Savings Account (HSA) Plans Choice+ Core Coinsurance uctible Pocket Maximum Copay/Per Occurrence Spec / AG-9G AG-9F 100% 80% $2,000 $4,000 $5,000 $10,000 $3,000 $6,000 $10,000 $20, % 100% 100% 100% Non-Emb 10/35/60 AG-9I AG-9H 100% 80% $2,500 $5,000 $5,000 $10,000 $2,500 $5,000 $10,000 $20, % 100% 100% 100% Non-Emb 100% AX-UX AX-UT 100% 80% $2,800 $5,600 $5,000 $10,000 $2,800 $5,600 $10,000 $20, % 100% 100% 100% Emb 100% AX-UV AX-UU 100% 80% $2,800 $5,600 $5,000 $10,000 $3,500 $7,000 $10,000 $20, % 100% 100% 100% Emb 10/35/60 AX-UW AX-UY 100% 80% $2,800 $5,600 $5,000 $10,000 $5,000 $10,000 $10,000 $20,000 $30 9 $60 9 $75 9 $300 9 Emb 10/35/60 AG-9J AG-9K 100% 80% $3,000 $6,000 $5,000 $10,000 $4,000 $8,000 $10,000 $20, % 100% 100% 100% Emb 10/35/60 AG-9L AG-9M 100% 80% $5,000 $10,000 $5,000 $10,000 $6,000 $12,000 $10,000 $20, % 100% 100% 100% Emb 10/35/60 AG-9N AG-9O 100% 80% $5,000 $10,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 $30 9 $60 9 $75 9 $300 9 Emb 10/35/60 AG-9P AG-9Q 100% 80% $6,350 $12,700 $10,000 $20,000 $6,350 $12,700 $20,000 $40, % 100% 100% 100% Emb 100% AX-US AX-UZ 80% 60% $2,800 $5,600 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 80% 80% 80% 80% Emb 10/35/60 AG-9S AG-9T 80% 60% $3,000 $6,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 80% 80% 80% 80% Emb 10/35/60 AG-9U AG-9V 80% 60% $3,500 $7,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 80% 80% 80% 80% Emb 10/35/60 AG-9W AG-9X 80% 60% $5,000 $10,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 80% 80% 80% 80% Emb 10/35/60 AE-3Q AG-9R 50% 50% $3,000 $6,000 $5,000 $10,000 $6,350 $12,700 $10,000 $20,000 50% 50% 50% 50% Emb 10/35/60 5 Type Rx Plan 9 Pharmacy Plans Rx Plan Code Copays Tier 1 Tier 2 Tier 3 Tier 4 Mail-Order Ratio H9* $10 $30 $ V* $10 $35 $ EU* $10 $40 $75 $ B* $15 $35 $ IU* $15 $40 $ DS* $15 $45 $85 $ * $20 $50 $ *Access PDL is available on these pharmacy plans starting Aug. 1, Click here for additional information on Access vs Advantage PDL. Administrative services provided by United Health Services, Inc. or their affiliates. Health Plan coverage provided by or through UnitedHealthcare of, Inc. MT /17 BROK 2017 United Health Services, Inc
9 / Navigate plans available to employers sitused in the following counties only: Boone, Cook, Dekalb, Dupage, Grundy, Iroquis, Kane, Kankakee, Kendall, Lake, LaSalle, McHenry, Winnebago, Will. Charter plans available to employers sitused in the following counties only: Cook, Dupage, Kane, Kendall, Lake, McHenry, Will. 1 Primary Physicians include Family Practice, Internal Medicine, Obstetrics-Gynecology, and Pediatrics. 2 This tier of benefits applies to UnitedHealth ium Tier 1 ignated Providers. Please visit myuhc.com for details. 3 This tier of benefit applies to Physicians that are not UnitedHealth ium Tier 1 ignated. 4 Plan deductible is waived for Emergency Room visits on plans where copay or copay+coinsurance is listed. 5 Embedded deductible means once an individual meets their portion of the deductible, services are paid for that person without the entire family deductible being met. Non-Embedded deductible means no covered family member will satisfy an individual deductible until the entire family deductible is met. 6 Flexpoint plans feature a copay for office visits one through four during the calendar year or plan year, depending on plan type selected. Office visits five and over will be subject to plan deductible/coinsurance. This is a separate limit for both Physician Office and visits. Plans feature one Preventive visit per year, which does not count against the office visit copay limit. 8 Navigate and Charter plans require referrals for certain services. Failure to obtain a referral may result in either non-payment of claims or in a reduction of benefits. 9 Copayments on HSA plans will be required after the deductible has been met and will continue to be required until the annual out-of-pocket maximum is met. 11 Navigate, Charter, and HMO plans exclude coverage for services provided by Providers with the exception of (1) Services performed in a Facility by hospital-based providers; and (2) Services performed under the Emergency benefit. 17 FlexFree plans feature $0 copay for the first 3 PCP and/or Specialist office visits during the Calendar or Plan Year. Office visits 4+ will be subject to plan deductible/ coinsurance. Plans also feature $0 copay for the first 2 visits during the Plan Year. visits 3+ will be subject to plan deductible/coinsurance. Preventive visits do not count against the office visit copay limit. Administrative services provided by United Health Services, Inc. or their affiliates. Health Plan coverage provided by or through UnitedHealthcare of, Inc. MT /17 BROK 2017 United Health Services, Inc
Coinsurance Deductible Out-of-Pocket Maximum Copay/Per Occurrence. Network Out of Network Network Out of Network
Health Plan Product Offering UnitedHealthcare offers a wide variety of plan options that allow you to tailor your benefits to your business needs, choosing what you value in a health plan. / UnitedHealthcare
More informationBulk Upload Standard File Format
Bulk Upload Standard File Format QLD Motor Vehicle Register May 2017 1800 773 773 confirm@citec.com.au Innovative Information Solutions Standard CSV Result Format A Comma Separated Values (CSV) file will
More informationOversight Board Meeting of the Successor Agency City of Foster City SPECIAL MEETING
1. Call to Order 2. Roll Call Oversight Board Meeting of the Successor Agency City of Foster City 3. Public Comment SPECIAL MEETING Monday, August 28, 2017; 9 a.m. Location: Council Chambers Conference
More information2018 Health Plan Product Offering
UnitedHealthcare Multi-Choice allows you to purchase one health plan package with multiple benefit design options to meet a variety of health care and financial needs. Your employees can choose the option
More informationAnnex 1: Background: The Oil and Gas Sector in Somalia
S/AC.29/2015/SEMG/OC.31 1 Annex 1: Background: The Oil and Gas Sector in Somalia Oil and Gas as a Threat to Peace and Security The SEMG discussed the threat to peace and security posed by the extractives
More informationALCATEL ALENIA SPACE FRANCE
International Report Supplied on 22 MARCH 2006 Client Reference SALES Graydon Order Number 5223902 Identification Details ALCATEL ALENIA SPACE FRANCE 12 RUE DE LA BAUME 75008 PARIS Phone Number : 01.40.76.10.10
More informationRewriting the Income Tax Act: Exposure Draft. Foreword
Foreword The Government welcomes the publication of this exposure draft of the rewritten Parts A to E of the Income Tax Act 1994. Legislation that is clear, written in plain language, and easy to use has
More informationCollege Loan Corporation Trust I Quarterly Servicing Report. Distribution Period: 7/26/ /25/2016 Collection Period: 7/1/2016-9/30/2016
Quarterly Servicing Report Distribution Period: 7/26/2016 10/25/2016 Collection Period: 7/1/2016 9/30/2016 I. Deal Parameters Student Loan Portfolio Characteristics 7/1/2016 Activity 9/30/2016 A i Portfolio
More informationCollege Loan Corporation Trust I Quarterly Servicing Report. Distribution Period: 10/26/2017-1/25/2017 Collection Period: 10/1/ /31/2016
Quarterly Servicing Report Distribution Period: 10/26/2017 1/25/2017 Collection Period: 10/1/2016 12/31/2016 I. Deal Parameters Student Loan Portfolio Characteristics 10/1/2016 Activity 12/31/2016 A i
More informationPage 1 of 5. Principal. Maturity Date. Yield/Coupo. Issuer Category of Investment CUSIP
Rule 2a-7(c)(12) Schedule of Investments TIAA-CREF Money Market Fund Fund Information and Unaudited Holdings as of December 31, 2016 Weighted Average Maturity: 46.05 days Weighted Average Life: 86.16 days
More information2019 Health Plan Product Offering
UnitedHealthcare Multi-Choice allows you to purchase one health plan package with multiple benefit design options to meet a variety of health care and financial needs. Your employees can choose the option
More informationDEBT SCHEDULES. Total $1,300,000,000
American Electric Power, Inc Interest Maturity CUSIP / PPN* Amount Senior Notes, Series G 2.150% 11/13/2020 025537AH4 $500,000,000 Senior Notes, Series H 3.200% 11/13/2027 025537AJ0 $500,000,000 Senior
More informationANNEX. to the Commission decision on the reimbursement of personnel costs of beneficiaries of the Connecting Europe Facility
EUROPEAN COMMISSION Brussels, 3.2.2016 C(2016) 478 final ANNEX 1 ANNEX to the Commission decision on the reimbursement of personnel costs of beneficiaries of the Connecting Europe Facility [ ] EN EN ANNEX
More informationTO : Approved Participants February 5, 2003 Registered Options Principals Options Traders NEW EQUITY OPTION CLASSES
TO : Approved Participants February 5, 2003 Registered Options Principals Options Traders NEW EQUITY OPTION CLASSES Bourse de Montréal Inc. (the Bourse) and Canadian Derivatives Clearing Corporation (CDCC)
More informationPublic Cash Flow Statements
Public Cash Flow Statements 2014-2015 NACUBO Intermediate Accounting Learning Objectives Identify the GAAP guidance for the preparation of the cash flow statement List the components of the statement Describe
More informationCLARK COUNTY WATER RECLAMATION DISTRICT
CLARK COUNTY WATER RECLAMATION DISTRICT $47,170,000 GENERAL OBLIGATION REFUNDING BONDS, SERIES 2003 $55,000,000 GENERAL OBLIGATION WATER RECLAMATION BONDS, SERIES 2007 $115,825,000 GENERAL OBLIGATION WATER
More informationMassachusetts Large Group (51+) UnitedHealthcare Plans
2018-2019 Large Group (51+) Plans Please be advised that this guide is for informational purposes only. Premium rates and/or product forms inclu herein have been filed and are subject to approval by regulators.
More informationPAYER SPECIFICATION SHEET. June 1, Bin #:
June 1, 2009 PAYER SPECIFICATION SHEET Bin #: States: National Destination: Integrated Prescription Management Accepting: Claim Adjudication, Reversals Fmat: Version 5.1 1. Segment And Requirements By
More informationCLARK COUNTY WATER RECLAMATION DISTRICT Clark County, Nevada
CLARK COUNTY WATER RECLAMATION DISTRICT Clark County, Nevada $55,000,000 GENERAL OBLIGATION WATER RECLAMATION BONDS, SERIES 2007 DATED: NOVEMBER 13, 2007 BASE CUSIP : 181070 $135,000,000 GENERAL OBLIGATION
More informationDENAIR FOR. Lester Road Denair, CA Prepared by: Roseville, CA 95661
DENAIR UNIFIED SCHOOL DISTRICT ANNUAL REPORT FOR FISCAL YEAR ENDED JUNE, 30, 2014 Dated January 26, 2015 Prepared at the direction of and on behalf of: Denair Unified School District 3460 Lester Road Denair,
More informationSuperStream Alternative File Format (SAFF)
SuperStream Alternative File Format (SAFF) Supplementary information for creating contributions data - Combined First State Super accumulation and defined benefit data This document contains additional
More informationGoldman, Sachs & Co.
Offering Circular Supplement (To Offering Circular Dated August 1, 2014) $1,202,681,599 Freddie Mac Multiclass Certificates, Series 4386 Offered Classes: REMIC Classes shown below and MACR Classes shown
More informationMODEL ANNEX 2 FOR H2020 GENERAL MGA MULTI ESTIMATED BUDGET FOR THE ACTION. Total costs subcontracting. [F.2 Costs of ] 5
i print format A4 landscape MODEL ANNEX 2 FOR H2020 GENERAL MGA MULTI ESTIMATED BUDGET FOR THE ACTION Estimated eligible 1 costs (per budget category) EU contribution Additional information B. Direct costs
More informationMEDICARE PART D PAYER SPECIFICATION SHEET
MEDICARE PART D PAYER SPECIFICATION SHEET January 1, 2006 Bin #: 610468 States: National Destination: PharmaCare / RxClaim Accepting: Claim Adjudication, Reversals Format: Version 5.1 I. VERSION 5.1 GENERAL
More informationQuestions and Answers. Fund Accounting and Support Services RFP
Questions and Answers Fund Accounting and Support Services RFP Date Question OPERS Response 4/11 Page 13 of the RFP requests flexibility to provide minimum services with or without custody of the assets.
More informationPart D Request Claim Billing/Claim Rebill Test Data
Part D Request Test Data Transaction Header Transaction Header Segment Paid Claim Resubmit Duplicate Clinical Prior Auth Rejected Reversal 1Ø1-A1 BIN Number M 603286 603286 603286 603286 603286 1Ø2-A2
More informationCatamaran 2441 Warrenville Rd. Suite 610 Lisle, IL PAYER SPECIFICATION SHEET. Non-Medicare Part D. Plan Information
Catamaran 2441 Warrenville Rd. Suite 610 Lisle, IL 60532 PAYER SPECIFICATION SHEET Non-Medicare Part D Plan Infmation Payer Name: Catamaran Date: 12/20/11 Plan Name: Catamaran (This payer sheet represents
More informationCongo RDC Towers S.A. (TowerCo) Audit report on the annual financial statements Financial Year closing on 31st December Date 3 rd July 2015
Congo RDC Towers S.A. (TowerCo) Audit report on the annual financial statements Financial Year closing on 31st December 214 Date 3 rd July 215 EY Building a better working world Congo RDC Towers S.A. «TowerCo»
More information$53,975,000 IMPERIAL COUNTY LOCAL TRANSPORTATION AUTHORITY SALES TAX REVENUE BONDS (LIMITED TAX BONDS)
NEW ISSUE BOOK-ENTRY ONLY S&P Ratings: Series 2012A: A+ Series 2012B: A+ Series 2012C: A+ Series 2012D: A+ Series 2012E: A+ See RATINGS herein In the opinion of Fulbright & Jaworski L.L.P., Los Angeles,
More informationTariff Revisions to Accommodate California Department of Water Resources (DWR) Bond-Related Costs
December 4, 2002 Advice 2315-E (Pacific Gas and Electric Company ID U 39 E) Public Utilities Commission of the State of California Subject: Tariff Revisions to Accommodate California Department of Water
More informationPennsylvania PROMISe Companion Guide
Pennsylvania PROMISe Companion Guide NCPDP Version D.0 September 2010 Version 1.0 This page is left intentionally blank September 2010 Table of Contents Overview... 1 Revisions to the Companion Guide...
More informationBelow are the current active months, active strike prices, and their codes for FINISAR CORPORATION (NEW)
CBOE Research Circular #RS09-555 DATE: December 4, 2009 TO: Members RE: New Listings On 12/7/2009 the CBOE will begin trading options on the following equity securities. CBOE will trade in all existing
More information$36 for Jiffy Lube Signature Service Oil Change, Tire Rotation, and Rain-X Original Glass Treatment (Up to $73.97 Value)
46718 YM $36.00 18263478 46719 UB $38.00 38955279 46720 ZQ $36.00 92273608 46721 WZ 46722 UH $65.50 30346621 46723 EY 46724 EI $36.00 44813245 46725 RL $62.00 42073012 46726 CH $39.60 82839249 46727 YD
More informationSXC Health Solutions, Inc.
SXC Health Solutions, Inc. 2441 Warrenville Rd. Suite 610 Lisle, IL 60532 PAYOR SPECIFICATION SHEET Year 2008 Bin #: 610593*National, 011883 (TeamstersRx), 012882 (Kroger Prescription Plans), 610174 (Scriptrax)
More informationRULE 15c2-12 FILING COVER SHEET
RULE 15c2-12 FILING COVER SHEET This cover sheet is sent with all submissions to the Municipal Securities Rulemaking Board (the Nationally Recognized Municipal Securities Information Repository) and any
More informationEQUITIES DIRECTIVES. 26 January 2018
EQUITIES DIRECTIVES 26 January 2018 JSE Limited Reg No: 2005/022939/06 Member of the World Federation of Exchanges JSE Limited I 2014 VERSION CONTROL Equities Directives 22 August 2005 As amended by Date
More informationEnvisionRxOptions Request For Pricing D.Ø Payer Sheet
EnvisionRxptions Request For Pricing D.Ø heet General Information Name: ENVIIN/RX PTIN Revision Date: 4/4/2016 Plan Name/Group Name: GAN020, GAN025, GAN030, GAN035, GAN060, RFP005, RFP010, RFP015, RFP025,
More informationNOTICE TO FLOOD INSURANCE STUDY USERS
VOLUM ME 2 OF 4 WAYN NE CO OUNTY Y, MICH HIGAN (ALL JUR RISDICTIONS) Community C Community Community Name N Number Community Na C ame N Number Allen Park k, City of 260217 * Grosse Poin nte Woods, 260231
More informationSmall Business Enrollment Spreadsheet Guide
Small Business Enrollment Spreadsheet Guide June 2018 Table of contents Introduction... 2 How the Enrollment Spreadsheet enrollment works and benefits of use... 2 When may the Enrollment Spreadsheet be
More informationWith effect from 29 March Intermediary Product Guide.
With effect from 29 March 2018. Intermediary Guide. What s inside... Introducing our product range effective from 29 March 2018. Up to 95% LTV What's inside? Page 2 year fixed Movers and first time buyers
More informationLocal Government pension Scheme End of Year Return 2016/2017
Local Government pension Scheme End of Year Return 2016/2017 This document will guide you through completing the End of Year spreadsheet that must be returned to the Dorset County Pension Fund at the end
More informationEnvisionRxOptions Part D D.Ø Payer Sheet
EnvisionRxptions Part D D.Ø heet GENERAL INFRMATIN Name: ENVIIN/RX PTIN Revision Date: 12/12/2017 Plan Name/Group Name: AmWIN- QHP BIN: Ø14848 PCN: MEDD BIN: Ø15185 PCN: Plan Name/Group Name: AmWINRx (Effective
More informationNCPDP VERSION 5.Ø REJECT CODES FOR TELECOMMUNICATION STANDARD
NCPDP VERSION 5.Ø REJECT CODES FOR TELECOMMUNICATION STANDARD Reject Code Explanation Field Number Possibly In Error ØØ ("M/I" Means Missing/Invalid) Ø1 M/I Bin 1Ø1 Ø2 M/I Version Number 1Ø2 Ø3 M/I Transaction
More informationExelon Corporation NYSE: EXC. Investment Thesis
Student Investment Fund Stock Report Analysts: Kevin Nincehelser, David Packard Recommendation: BUY Market Cap: $28.98 billion Current Price: $44.58 Sector: Utilities Dividend Yield: 4.7% 12 month target
More informationNOVA SCOTIA MUNICIPAL FINANCE CORPORATION
Financial Statements of NOVA SCOTIA MUNICIPAL FINANCE CORPORATION INDEPENDENT AUDITORS' REPORT To the Directors of Nova Scotia Municipal Finance Corporation We have audited the accompanying financial statements
More informationCount and Percent - Full-time Faculty NCA Self-Study Faculty Survey Spring 2008
A1. Are you full-time faculty or part-time faculty (includes adjuncts)? Full-time A2. What is your tenure status? Tenured t tenured, but on tenure track t tenured, and not on tenure track A3. What is your
More informationEffective March 16, 2015
Alberta Pricing and Schedule A Effective: March Code FG Resident Sportfishing $ 28.00 $ 29.40 $ 2.75 AA Resident Antelope Archery Draw $ 59.95 $ 62.95 $ 2.75 AC NRA Wildlife Certificate $ 68.22 $ 71.63
More informationCITY OF WICHITA, KANSAS
OFFICIAL STATEMENT NEW ISSUES Book-Entry Only RATINGS: See RATINGS herein In the opinion of Kutak Rock LLP, Kansas City, Missouri, Bond Counsel, under existing laws, regulations, rulings and judicial decisions
More informationPlan Information. Billing (B1), Reversal (B2), and Rebilling (B3) Transaction Data Elements (M Mandatory, R Required, RW Required When)
NetCard Systems P.O. Box 4517 Centennial, CO 80112 PAYER SPECIFICATION SHEET Segment and Field Requirements by Transaction Type Plan Information Payer Name: NetCard Systems Date: 03/15/16 Plan Name: NetCard
More information$36 for Jiffy Lube Signature Service Oil Change, Tire Rotation, and Rain-X Original Glass Treatment (Up to $73.97 Value)
64116 SN 64117 PX $101.49 30160318 64118 XS $40.50 89691909 64119 VJ $119.97 29848570 64120 ZY $36.00 15724529 64121 GE 64122 JA $36.00 11830723 64123 QL $35.00 48299371 64124 OJ 64125 FT $271.98 92968619
More informationPayer Sheet. Commercial Primary
Payer Sheet Commercial Primary Table of Contents HIGHLIGHTS Updates, Changes & Reminders... 3 PART 1: GENERAL INFORMATION... 4 Pharmacy Help Desk Information... 4 PART 2: BILLING TRANSACTION / SEGMENTS
More informationCERTIFICATE OF ACCURACY
CERTIFICATE OF ACCURACY It is hereby declared that the translation of the enclosed document, from French to English language has been translated by a qualified translator and is, to the best of our knowledge
More information1. CONTRACT ID CODE PAGE OF PAGES AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT U 1 2
1. CONTRACT ID CODE OF S AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT U 1 2 2. 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable) 17-Dec-2015 1300540532 N/A 6. ISSUED
More informationWith effect from 1 November Intermediary Product Guide.
With effect from 1 November 2018. Intermediary Guide. What s inside... Introducing our product range effective from 1 November 2018. Up to 95% LTV What's inside? Page 2 year fixed Movers and first time
More informationDMMS TECHNICAL INSTRUCTION MANUAL
Payment Systems & Business Technology Domestic Money Monitoring System DMMS TECHNICAL INSTRUCTION MANUAL DMMS Instruction Manual. Ver004 Page 1 Identifier: Revision: Effective Date: Last Update Date: DMMS.001
More information2013 Proposed Non-Ad Valorem Recap
BL BELMONT LAKES CDD $ 4,200.00 42 42 $ 176,400.00 0 0 42 42 1 BROWARD COUNTY GARBAGE - 1 $ 270.00 182 190 $ 51,300.00 0 0 182 190 4 BROWARD COUNTY GARBAGE - 4 $ 270.00 653 858 $ 231,660.00 2 0 655 858
More informationList of contents of draft legislation
of draft legislation Part A Purpose and application AA 1 AA 2 AA 3 Purpose of Act Interpretation Definitions Part B Core provisions BA Purpose BA 1 Purpose BB Income tax and resulting obligations BB 1
More informationAetna Savings Plus Plan Guide
Aetna Savings Plus Plan Guide For businesses with 2-50 eligible employees in the Chicagoland area Aetna Avenue Your Destination for Small Business Solutions Health Insurance plans are offered and/or underwritten
More informationPayer Sheet. Commercial Other Payer Amount Paid
Payer Sheet Commercial Other Payer Amount Paid Table of Contents HIGHLIGHTS Updates, Changes & Reminders... 3 PART 1: GENERAL INFORMATION... 4 Pharmacy Help Desk Information... 4 PART 2: BILLING TRANSACTION
More informationTable 2A-2: FY Budget Letter MFP Transfer Amount (Monthly Amount) September 2017
Total MFP Distribution Amount +/-Audit Adjs. - State Cost Allocations to Other Public s Office of Juvenile Justice Local Revenue Representation Due Monthly to Other Public s Recovery District Type 3B s
More informationAFE ADVISORS INVESTMENT. Defining a Global Fiduciary Standard of Excellence. SELF-ASSESSMENT of FIDUCIARY EXCELLENCE for U.S.
SELF-ASSESSMENT of FIDUCIARY EXCELLENCE for INVESTMENT ADVISORS AFE Defining a Global Fiduciary Standard of Excellence For professionals who provide investment advice, including financial advisors, broker-consultants,
More informationTO : Approved Participants May 27, 2002 Registered Options Principals Options Traders Sales Managers NEW EQUITY OPTION CLASSES
TO : Approved Participants May 27, Registered Options Principals Options Traders Sales Managers NEW EQUITY OPTION CLASSES Bourse de Montréal Inc. and Canadian Derivatives Clearing Corporation (CDCC) hereby
More informationAmendment No. 1 to SCHEDULE TO. Filing Party: Hospitality Investors Trust, Inc.
As filed with the Securities and Exchange Commission on May 24, 2018 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 Amendment No. 1 to SCHEDULE TO TENDER OFFER STATEMENT UNDER
More information(Non-legislative acts) REGULATIONS
21.11.2013 Official Journal of the European Union L 312/1 II (Non-legislative acts) REGULATIONS COMMISSION REGULATION (EU) No 1174/2013 of 20 November 2013 amending Regulation (EC) No 1126/2008 adopting
More informationOTHER TRANSACTIONS SUPPORTED Payer: Please list each transaction supported with the segments, fields, and pertinent information on each transaction.
NCPDP VERSION D CLAIM BILLING/CLAIM REBILL REQUEST CLAIM BILLING/CLAIM REBILL PAYER SHEET ** Start of Request (B1/B3) Payer Sheet ** GENERAL INFORMATION Payer Name: San Francisco Health Plan Date: 04/16/2013
More informationOTHER TRANSACTIONS SUPPORTED Payer: Please list each transaction supported with the segments, fields, and pertinent information on each transaction.
NCPDP VERSION D CLAIM BILLING/CLAIM REBILL REQUEST CLAIM BILLING/CLAIM REBILL PAYER SHEET ** Start of Request (B1/B3) Payer Sheet ** GENERAL INFORMATION Payer Name: University of North Carolina Health
More informationCODES FOR PHARMACY ONLINE CLAIMS PROCESSING
S FOR PHARMACY ONLINE CLAIMS PROCESSING The following is a list of error and warning codes that may appear when processing claims on the online system. The error codes are bolded. CODE AA AB AI AR CB CD
More informationOON Indiv OOPM. OON Fam OOPM. INN Fam OOPM. PCP Copay. Virtual Visits
Split s - Heritage Plus Per Type Type Rx s QS-7 AM-JX Platinum 20/100% N/A N/A $2,000 $6,000 100% 70% $2,000 $6,000 $10,000 $20,000 N/A $20 $40 $100 $200 100% $250 $650 N/A $800 N/A Emb Sep N 247A QS-8
More informationA. To maintain a balanced District budget in FY 2011, subordinate executive branch agencies shall abide by the following restrictions:
GOVERNMENT OF THE DISTRICT OF COLUMBIA ADMINISTRATIVE ISSUANCE SYSTEM SUBJECT: Allocation of Spending (FY 2011) Mayor s Order 2010-160 October 4, 2010 ORIGINATING AGENCY: Office of the City Administrator
More informationCommittee on Payments and Market Infrastructures
Committee on Payments and Market Infrastructures Outline of the new structure of statistical tables Statistics on payments and financial market infrastructures in the CPMI countries (Red Book statistics)
More information1. NCPDP VERSION D.0 CLAIM BILLING 1.1 REQUEST CLAIM BILLING
1. NCPDP VERSION D.0 CLAIM BILLING 1.1 REQUEST CLAIM BILLING GENERAL INFORMATION Payer Name: American Health Care Date: January 2016 Plan Name/Group Name: SEE APPENDI BIN: SEE APPENDI PCN: SEE APPENDI
More informationFile No. SR-NASD Amendments to Rules Governing Member Communications with the Public
May 17, 2000 Katherine A. England Assistant Director Division of Market Regulation Securities and Exchange Commission 450 Fifth Street, N.W. Washington, D.C. 20549 Re: File No. SR-NASD-00-12 Amendments
More informationUnitedHealthcare Insurance Company
California Large Group Annual Aggregate Rate Data Report Form Version 3, September 7, 2017 (File through SERFF as a PDF or excel. If you enter data on a Word version of this document, convert to PDF before
More informationPrescription Item Report Glossary for Appliance Contractors
Prescription Item Report Glossary for Appliance Contractors A OCS Code The code (beginning F) allocated by NHSBSA which is a unique identifier for an appliance contractor. B Dispensing Month The month
More informationOTHER TRANSACTIONS SUPPORTED Payer: Please list each transaction supported with the segments, fields, and pertinent information on each transaction.
NCPDP VERSION D CLAIM BILLING/CLAIM REBILL REQUEST CLAIM BILLING/CLAIM REBILL PAYER SHEET ** Start of Request (B1/B3) Payer Sheet ** GENERAL INFORMATION Payer Name: Community Health Choices Date: 09/21/2017
More informationOTHER TRANSACTIONS SUPPORTED Payer: Please list each transaction supported with the segments, fields, and pertinent information on each transaction.
NCPDP VERSION D CLAIM BILLING/CLAIM REBILL REQUEST CLAIM BILLING/CLAIM REBILL PAYER SHEET ** Start of Request (B1/B3) Payer Sheet ** GENERAL INFORMATION Payer Name: AmeriHealth Caritas Louisiana Date:
More informationGap Analysis for NCPDP D.0 Billing
Gap Analysis for NCPDP D.0 Billing Version 1.0 April 2010 p This information is provided by Emdeon for education and awareness use only. While Emdeon believes that all the information in this document
More informationIncome Tax Bill. Government Bill. Explanatory note. General policy statement
Bill Government Bill Explanatory note General policy statement This bill is the third stage of a project to rewrite New Zealand s income tax legislation. The objective of the rewrite project is to make
More informationMaywood Chemical Company Superfund Site ADMINISTRATIVE RECORD. Operable Unit 2 - Groundwater. Document Number GW-006
Formerly Utled Stes Remedal Acton Program (FUSRAP) Maywood Chemcal Company Superfund Ste ADMNSTRATV RCORD Operable Unt - Groundwater Document Number GW-6 Maywood R Data nventory for Groundwater, Surface
More informationPayer Sheet. Medicaid Primary Billing & Medicaid as Secondary Payer Billing Other Payer Amount Paid (OPAP)
Payer Sheet Medicaid Primary Billing & Medicaid as Secondary Payer Billing Other Payer Amount Paid (OPAP) Table of Contents HIGHLIGHTS Updates, Changes & Reminders... 3 PART 1: GENERAL INFORMATION... 4
More informationChoice Portfolio Guide
Commercial Groups of 51 100 Health Net 51 100 Choice Portfolio Guide Innovative sales opportunities tailored for success Effective January 1, 2015 Karen Boyd, Health Net We translate expertise into innovation.
More informationStudent Loan Backed Reporting Mixed Deal - FFELP Monthly/Quarterly Distribution Report. Notes/Bonds - Group I (FFELP)
Student Loan Backed Reporting Mixed Deal - FFELP Notes/Bonds - Group I (FFELP) Class CUSIP IRS Status Rate(a) Auction Status Original Balance Beg Princ Bal Interest Accrual Principal Paid End Princ Bal
More informationCayucos Elementary School District
Cayucos Elementary School District Continuing Disclosure Filing For the Period Ending June 30, 2014 Prepared by Cayucos Elementary School District 301 Cayucos Drive Cayucos, CA 93430 Table of Contents
More informationMARKET ANNOUNCEMENT. Monthly Trading Report for ASX and SFE Markets
MARKET ANNOUNCEMENT 5 September 2006 Monthly Trading Report for ASX and SFE Markets Please see attached monthly trading information for August 2006 for ASX and SFE Markets. For further information on ASX
More informationBond Rating Reports Covering Fiscal Year 2012
Bond Rating Reports Covering Fiscal Year 2012 Submitted as part of the MTA 2012 Annual Report Pursuant to New York State Public Authorities Law Section 2800(1)(a)(2)(iv) Bond Rating as of March 29, 2013
More informationU S E R S G U I D E F O R P R O G R A M M E M A N A G E M E N T B U D G E T T O OL
CONTENTS U S E R S G U I D E F O R P R O G R A M M E M A N A G E M E N T B U D G E T T O OL P M B V8.6 ( E X C E L T O O L V E R S I O N 8. 6 ) O C T O B E R 215 1. Quick Reference Guide...2 1.1. What
More informationTHIS COVER PAGE CONTAINS CERTAIN INFORMATION FOR REFERENCE ONLY. IT IS NOT A SUMMARY OF THIS ISSUE. INVESTORS
NEW ISSUE BOOK-ENTRY ONLY RATINGS: S&P: AA FITCH: AA See the caption RATINGS In the opinion of Stradling Yocca Carlson & Rauth, a Professional Corporation, Bond Counsel, under existing statutes, regulations,
More informationLocal Government Pension Scheme End of Year Return 2015/2016
Local Government Pension Scheme End of Year Return 2015/2016 This document will guide you through completing the End of Year spreadsheet that must be returned to the Dorset County Pension Fund at the end
More informationAMO Trade Acceptance Service
Attachment 4 A Trade Acceptance Service Business & Technical Overview Version: Draft 0.5 Publication date: Thursday, 28 January 2010 Property of: Australian Clearing House Pty Limited and ASX Settlement
More informationNCPDP VERSION 5.1 REQUEST PAYER SHEET
NCPDP VERSION 5.1 REQUEST PAYER SHEET Payer Name: WellPoint Pharmacy Revised Date: 12/11/2005 Management Processor: WellPoint Pharmacy Switch: All Management Effective as of: 1/1/2006 Version/Release #:
More informationCERTIFICATE OF ACCURACY
CERTIFICATE OF ACCURACY It is hereby declared that the translation of the enclosed document, from French to English language has been translated by a qualified translator and is, to the best of our knowledge
More informationInformation Note 36/2016 of 14 March CADE SYSTEM FEES
Information Note 36/2016 of 14 March CADE SYSTEM FEES Tax ID No.: A-82.695.677 - Companies Register of Madrid, Volume 15611, Book 0, Sheet 5, Page nº M-262.818, Entry 1 The purpose of this Information
More informationAGGREGATE MATURITY SCHEDULE
NEW ISSUE BOOK-ENTRY ONLY RATINGS: Moody s: Aaa Standard & Poor s: AAA FitchRatings: AAA (See RATINGS herein.) In the opinions of Squire, Sanders & Dempsey L.L.P., San Francisco, California, and of The
More informationTITLE 26 INTERNAL REVENUE CODE. May 21, 1970, 84 Stat. 241; Pub. L , title XIX, 1906(b)(13)(A), Oct. 4, 1976, 90 Stat
6416 Page 3248 May 21, 1970, 84 Stat. 241; Pub. L. 94 455, title XIX, 1906(b)(13)(A), Oct. 4, 1976, 90 Stat. 1834.) AMENDMENTS 1976 Subsecs. (a), (b). Pub. L. 94 455 struck out or his delegate after Secretary
More informationManager, Tax Operations, Members Services Unit LOCATION: CH/L3 EXTENSION: 2433 DATE: 14 November 2002 REFERENCE: MSU/CAA/Y2913 SUBJECT:
Market Bulletin One Lime Street London EC3M 7HA FROM: Manager, Tax Operations, Members Services Unit LOCATION: CH/L3 EXTENSION: 2433 DATE: 14 November 2002 REFERENCE: MSU/CAA/Y2913 SUBJECT: 2001 CANADIAN
More informationMQ Gateway Trust (ARSN ) Interim report - for the half-year ended 31 December 2008
(ARSN 123 784 930) Interim report - for the half-year ended MQ Portfolio Management Limited ACN 092 552 611 (Responsible Entity of MQ Gateway Trust ("Trust" ARSN 123 784 930) is a wholly owned subsidiary
More informationMonthly Data and Contribution Submissions Employer Guide
West Midlands Pension Fund Monthly Data and Contribution Submissions Employer Guide Contents 1 Key principles of monthly data and contribution submissions 2 Data requirements a) Personal data b) Financial
More informationMAINE GENERAL ASSISTANCE NCPDP VERSION D.Ø PAYER SHEET
MAINE GENERAL ASSISTANCE NCPDP VERSION D.Ø PAYER SHEET REQUEST CLAIM BILLING/CLAIM REBILL ** Start of Request (B1/B3) Payer Sheet ** GENERAL INFORMATION Payer Name: Maine General Assistance Date: June
More informationMortgage Bankers Financial Reporting Form
Mortgage Bankers Financial Reporting Form Fannie Mae Form 1002 / Freddie Mac Form 1055 Ginnie Mae Form HUD 11750 Reporting Period: Second Quarter 2016 Data for the Period Ending: This form was generated
More informationFORMULAS FOR THE NUMBER OF BINOMIAL COEFFICIENTS DIVISIBLE BY A FIXED POWER OF A PRIME
PROCEEDINGS OF THE AMERICAN MATHEMATICAL SOCIETY Volume 37, Number 2, February 1973 FORMULAS FOR THE NUMBER OF BINOMIAL COEFFICIENTS DIVISIBLE BY A FIXED POWER OF A PRIME F. T. HOWARD Abstract. Define
More information