This document provides a Summary of Benefits and Coverage (SBC) for a UnitedHealthcare plan, detailing coverage options, costs, and limitations for the coverage period from November 1, 2016, to October 31, 2017. It includes information on deductibles, out-of-pocket limits, network providers, and specific coverage for medical events such as office visits, tests, surgeries, and prescription drugs. The document also outlines rights to continue coverage, grievance and appeals rights, and language access services.
documents/EFTA00316273.pdf
{}