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CITY OF LAKSWOOD Plan 2 — MMO LOPlan NON - AFSCME <br />Onty Ovmrago, far: Plan Type-, PPE. <br />• Co -payments are fixed dollar am-ounts (for example., $15) you, -pay for doves health car., usuallywhen you vec.eive the seroice- <br />f t <br />Co-insurance is ymrshare of the C-05tSr of a Coveredsenfice, caledlated as a percent of the allowed am -cunt or he serfice. For example, if the plan <br />allowed amount for an ovemight hospftal stay is $000, yg5 r �coj�neura�nce- payment of 10% would be $100. This may -change 'if youhaverft met your <br />deductible. <br />The amount tl�Le plan pays for covered serdiGeS is based. onffie _41.19we --d-network provide charges more than.t.hj�,.ja <br />_A amount If an out <br />gm .24n you may Dave to pay the difference. For example, 'if an out -of -network hospitat charges $1,500 for an overnight stay and the allowed amount is <br />$1,000, you may have to pay the $500 difference. (This is called balance billing.) <br />Is This plan may encourage you to use by eh mging you lower deduefibles. co -payments and co-insurance amounts.. <br />............. <br />up <br />...... .................................. w to a 9C-da� <br />Vskrs up tD a W-day <br />................................................. <br />.................. ........................................ <br />CITY O,F LA-KEW00:0 Plan 2 — MMO: LO Plan NON - AFSCME. <br />v <br />Coverage fir, Single f-,,r --nType: PPO <br />On. I <br />33 <br />