Laserfiche WebLink
CITY OF LAKEWOOD: Ptah 2 — WO LO Plan NON-AFSCh1E <br />Only C ne rm: 8:ne --LiF—Liv IPIan irpe: Cw <br />Excluded Services &Other Covered Services: <br />W.Your Plan Does NOT C., (This IenYacomplaM1 Ii,L Chttkyour polirywplan dwumenifor o0ereaduded eervkea4 <br />• Aco uooM <br />• CosmLtic SUR¢y <br />OmlN checkiry (CMldl <br />OmlelC.fArun <br />• Gl.. <br />I:eairp Aids <br />• InletiMyirealmmt <br />t«g-i«m Care <br />NonemnpsncY cam xlrm ha;einp«dside lM <br />U.S <br />• RMine EyeCarelMMl1 <br />Rwk�re FM Cue <br />tlher Cov<red SeMm tlM1lalanLwmpleM1 ilst CM1ttk yourpolicyorpM1n documenikroNerwvertd servlus mdtourcwM1 (orlheaw<rviaal <br />• Smialnc 3ugry CkmpAC Cme PirvaaOury Nusi�g <br />• WepM (m9Prolmns <br />YourRlghtsto Continue Coverage: <br />If Yw Iwe cwor uN«ure pfan IW,tlep«,drtt upon 6se cimumsla0ces, Fedu-d a State lmrs mgro, epIXeca«e uA mlo you to keep heMlh oo,mo,. Am7 <br />su A,Msmlha WWI in duraimem.1mqufto wlapaf 8P,,ai.m.wruch ml to spmfia,Wu, IheWem;Med a Nos I., <br />t F kmilatiwum Yuv neMs locmt..,uopa may ako;tf/. <br />Fw mwa WwmekwmYavdf@sis focmlimre<ovenge,conlxl Ilreplan al &%1.1d2I460. Yw may Msocwlml yeuslale imumcedspadmenl, ll:e O5. Ospaiment of <br />LaW, Empbyee Bms.Sts 6xunykVrcrxslnlim � BE6.V31.JT12«wxw.tld 5ov1e0sa wIM U 9. Dey�lm'71 of N¢�IM1 alN N,enm 9evees et OT! N! 2tYd %615ww <br />xwwechoma.Bw- <br />YourGrlevanee andAppeais Rights: <br />dyw hma a wlwanl wam c aatisnadxuhaceMal cra:waM f« Md,� waervo« d� ran mar I» aMa Is,e�l«ne a gnaw_. E«uuesliwe ama ro« <br />ireMs, Iffs 1c�,wasistarca,ywcasco.'AxLllregan al8Lb 2YL.1JW <br />Language Access Services B00232.7400 <br />O INt o^s �J.Z Jh:aa t ll� - Im DC _ <br />ei <br />IIt"rersn rLa.,w,34e trJ5 tersa_�s.hii Mr,w,aq} i,y;ta;;,esena <br />M Lici14x1 S,'i'Jnrattl'J IJ t(-0I i4¢-tars{ <br />30 <br />