adessa, anthony a, b & c exp 6-4-16.pdf
TRANSCRIPT
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Antheill.+ rv1ernbeJ Name: SANDRA A ADESSA Member ID: XDL567 A63087
Contract Code: T160 Ellective Date: 08/01/2009 BIN: 610053 Plan: 040
PPO 3500 HSA-Competible Plan
$3,500 Deductible- Single t7,000 Deductible Family Deductible applies to all services
07/7.J/09
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Anthem. om/a
c, . .,,,.r.-r !, . ..: 1-800-333.0912 Membs: Possc:ion UM of 1flts ccwd PtM'.
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