Adessa, Anthony A, B & C Exp 6-4-16.pdf

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Transcript of Adessa, Anthony A, B & C Exp 6-4-16.pdf

  • Antheill.+ rv1ernbeJ Name: SANDRA A ADESSA Member ID: XDL567 A63087

    Contract Code: T160 Ellective Date: 08/01/2009 BIN: 610053 Plan: 040

    PPO 3500 HSA-Competible Plan

    $3,500 Deductible- Single t7,000 Deductible Family Deductible applies to all services

    07/7.J/09

    '

    Anthem. om/a

    c, . .,,,.r.-r !, . ..: 1-800-333.0912 Membs: Possc:ion UM of 1flts ccwd PtM'.

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