Insurance Coverage Summary Sample

This document is about a summary of benefits and coverage for a PPO health insurance plan. It provides details on the plan's deductibles, copayments, coinsurance, out-of-pocket limits, and the services covered. The document highlights the differences in costs for using in-network versus out-of-network providers, as well as lists the services that are not covered by the plan. It gives examples of how the plan might cover the costs for a normal delivery and managing type 2 diabetes.