High and Standard Option Overview

This Plan offers both a High and Standard Option. Both benefit packages are described in Section 5. Make sure that you review the benefits that are available under the option in which you are enrolled.

The High and Standard Option Section 5 is divided into subsections. Please read Important things you should keep in mind at the beginning of the subsections. Also read the General exclusions in Section 6, they apply to the benefits in the following subsections. To obtain claim forms, claims filing advice, or more information about High and Standard Option benefits, contact us at 1-800/638-6589 (TDD, use 301/984-4155) or at our Web site at www.SambaPlans.com.

Both options provide comprehensive coverage for a vast majority of your health care needs. Please review the easy-to-read benefit design lay-out in Section 5 for a comparison between the High and Standard Options. Call us at 1-800/638-6589 or 301/984-1440 (for TDD, use 301/984-4155) for answers to any benefit questions.


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