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City of Lakewood: Plan 1 Coverage Period: OU011201 i -I M112017 <br />Summary of Benefits and Coverage: What This Plan Covers SWhetit Costa Ceveragefm: stngkariamlyl Plan Type: PPO <br />Your Grievance and Appeals Rights: <br />r,ht haves ecnglatnt«eree. you ran <br />anea the <br />Ihm atre00,510r M. Yenm yo.plan,Wd41. epahle to anoealor 6`aa� Fm.9,Ad ankInivr <br />ryhls, this EtM oM) or x. &A wn oxt cL be LJ.an al P00.5Wi5BI. Yen may akoca:tad ha 0.parhnent d Lakx's Emplales 6enef4s BesvMy Adnvnistra5on <br />at E�S.dd4 EBSA (3T13) a xw.v.ds1 gwlebsaArealNrefttm. <br />Does this Coverage Provide Minimum Essential Coverage? <br />The AffordableCare M requiesmustpcoftete have healhaare mvemge hatq dfiasas'mm'unum essential mrerms' This plan arpolieydoea provl& minimum <br />ssserdal...a" <br />Does this Coverage Meet the Minimum Value Standard? <br />The Affordable Care Act esbb,'M. a seem. .1. elandanf of here%of alrealN pan. Tba am.m valuestandmla W.4jacivanal value), l heath.1. <br />does meet the minima. value standard for thebenefils it provtdes, <br />33 <br />