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CITY OFLAKEWOOD: Plan 2—MIMOLOPlan NON -AFSCME <br />OnIV Co... aior: Se': eaI ,n IPlan TYp, I'M <br />Excluded Services S Other Covered Services: <br />service Your Plan Don NOT Cover (ThIs laAa wmpkta Ilel Chwkyaur polls, or plan documartlor olhereash dad aervhes.i <br />• Acupuodwa <br />Cm'menc"u, <br />Cards chacku (CMd) <br />• Dsmu Care(Aduta <br />edasaes <br />HeM,Aids <br />• InledifR�Taeahrien! <br />Lon Tam Cme <br />None ,on., care xben traMng xAnitle the <br />U.S. <br />• Rodine Eye Care"t) <br />Rcodrs Foot C. <br />00er Cavared services (This lane...,Isle list Chwk your policy or plan document loroUar wverad services and your wals for these aervices.) <br />Emialnc Surgery Chw ficCme Pdvalo0UI,N.a, <br />N'eigkl arse Preprame <br />36 <br />