Other Coverages
	1st $500 Outpatient
	Prescription Drug
	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!

You may select from two optional maternity benefits:

1. A $2,000 maximum benefit, which is not subject to the deductible.
2. No maximum benefit and is subject to the deductible and coinsurance.
   

The maternity benefits will cover, but are not limited to:

• Normal pregnancy
• Complications of pregnancy
• Miscarriage
• Therapeutic and elective abortions.

Maternity benefits are available, provided the requirement of no less than 270 days of Medical Mutual coverage before delivery date applies.