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City of Lakewood : Plan 2 Coverage Period: 0110112014- 1273112014 <br />Summary of Benefits and Coverage: What This Plan Covers x What it costa Coverage for: Single or Family I Plan Type: PPO <br />Questions: Call 800.540.2583 or visit us at MedMutual.com/SBC. P,g, 3 of g <br />If you aren't clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossary 501935963 <br />at MedMutual.cemlSBC or call 800.540.2583 to request a copy. BEN 133 IP6399M 13 -OW25 <br />City of Lakewood : Plan 2 Coverage Period: OV0112 014 - 1213x2014 <br />Summary of Benefits and Coverage: What This Plan Covers B What it Costa Coverage for: Single or Family I Plan Type: PPO <br />36 <br />