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City of Lakewood : Plan 1 Cnveira�!lelileiritx[ 01/01/20117 112/V1/201 7 <br /> Summary oflBenefils and Coverage: What This Plan Covers&What it Casts Coverage for: Single,or Family I Plan Type: PPO <br /> Your Grievance and Appeals Rights:: <br /> If you have a complaint or are dissatisfied with a denial of coverage for chains under your pilon,you may Iae able to 22pig or,file a grievance. For questons about your <br /> rights,this notice,or aas&ance,you car contact:the plan at 800.540.2583. You may afro contact the Department of Labor's Employee Benefits Security Admini5tradon <br /> at 86,6.444.EBSA(3273) <br /> Does this Coverage Provide Mininnum Essenitilall Coverage? <br /> The Affordable Care Act requires most jpeopUe to have health cam•coverage that qualifiesas,"minimunn esseintial coverage."This plan or policy does.provide minimum <br /> essential coverage. <br /> Does this Coverage Meet the IMINimum Value Standard? <br /> The Affordable Care Act estkishes a mirimum value standard of benefits of a health ptlan.The mininnurn value MandaTd os 60%(acPuarial value).Tho health coverage <br /> does meet the minimum,value standard For the beinefilts!it Iprovidles. <br /> 34 <br />