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piCoverage Ferlo:d., .01101J2017 - TV73112017 <br />ty of Lakewood -. Plan I <br />Summary of Benefits and Coverage: What This Plan Covers & What it Costs Coverage for..- Sin-gle or Family) Nan- Type. PPCI <br />Your Grievance and Appeals Rights: <br />if you have a complaint or are dissatis-fiedwit h. a derial of coverage for claims under your plan: you may be able to appeal aT file a gai-ey-a For q ues=Ins about your <br />n e- r" U 6 fy Ad r ri i r t. i s tr a fib. n <br />V -n the plar at 8,00-540.2582- You may also c m-dact. t - Department Lab®res Emplace Be oafits S <br />I_q -his no . ce:, you. can conta& <br />hts:, t -tire, or assmta <br />at 866A44-FE-B-85A (3273) orwwiv.:dolqo%-44ebsalbolt hreform_ <br />Doee. this Coverage Provide Minimum'Essential Coveragel <br />The offHaileCare Act requires ina-sit pm*,e to have heafth cam cuve,-,age that q%offies as 'min-i mum essential coverage." This plan or policy does provide minimam. <br />essential wveraga. <br />Does: this Coverage Meet the. Minimum Value Standard? <br />The IWbr-dable tare Act establishes a ininim. um value standard of benefits of health plan. Tbe. �.mini mr.wnii-alue standard- is 60% tactisHal value). This: health cuverage <br />does meet the minimum value standard for the benefits it provides, <br />31 <br />