Other Coverages Prescription Drug Maternity Care Life Insurance Critical Illness Three Simple Steps.. 1. Open and print the Individual Application 2. Fill everything out and remember to sign and date the form. 3. Fax it back to GBA at 614-410-0999 Start NOW! Coverage for the first $500 of outpatient care - Will cover the first $500 of outpatient care provided in the network for each person, each policy year. (NOTE: Copay still applies) Services to which the benefit will be applied include: Well child care services Routine office visits Outpatient diagnostic services Routine Pap test Covered Immunizations Routine testing (excludes Routine Mammogram) Medically Necessary office visits
Three Simple Steps..
1. Open and print the Individual Application
2. Fill everything out and remember to sign and date the form.
3. Fax it back to GBA at 614-410-0999
Start NOW!
Coverage for the first $500 of outpatient care -
Services to which the benefit will be applied include:
