| Document Date: 2014-03-11 09:48:55
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Company PET / Procedures Education Laboratory / / Country United States / / Currency USD / / Facility clinic Services You May Need In-Network / / IndustryTerm vision services / health outpatient services / term in-network / use disorder inpatient services / medical transportation / retail pharmacy / inpatient services / room services / lab services / excluded services / covered services / use disorder substance abuse outpatient services / / MedicalCondition Infertility / accidental injury / Substance use disorder / diabetes / injury / illness / / MedicalTreatment immunization / Cosmetic surgery / immunizations / Chiropractic / Acupuncture / surgery / Bariatric surgery / respiratory therapy / / Organization U.S. Department of Health and Human Services / Blue Cross and Blue Shield Association / Medicare / / / Position Nurse / network optometrist / specialist / General / Chiropractor / cost estimator / Physician / surgeon / / ProvinceOrState Iowa / / Technology x-ray / / URL www.wellmark.com / www.cciio.cms.gov / /
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State of Iowa Retiree Blue Advantage® Coverage Period: [removed] – [removed]Coverage for: Single & Family | Plan Type: HMO Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a summ