WebbSimply Blue HRA PPO Platinum $5000 $5,000 $10,000 30% N/A N/A $6,350 $12,700 $2,500 $5,000 $30/$50/$60/$150 $20/$60/50%/20%/25% Simply Blue HSA Simply Blue HSA … WebbSimply Blue PPO Gold $1500 Coverage Period: Beginning on or after 01/01/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual …

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