Please note that the information presented on the following pages is only a summary of the benefits provided. Some services require prior authorization. Check with your health plan or refer to your Certificate of Insurance for more information. All services covered by your health plan are fully described in your Certificate of Insurance. For exact terms and conditions of the health care benefits, provisions, exclusions and limitations of each plan, please refer to your Certificate of Insurance. The plan's Certificate of Insurance, if different from the benefits described here, will apply.

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