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NetworkNetwork <br />50%20%50%20%50% <br />50%20%50%20%50%50%20%50%20%50%20%50%20%50%20%50%20%50%20%50%afterdeductible50%20%50%20%50%$4050%20%50%20%50% <br />NetworkNonNetworkNon <br />NetworkInNetworkIn <br />applied <br />Pharmacy: <br />Copay <br />NetworkNon <br />NetworkNon <br />$120 <br />$60 <br />Network <br />$30$60 <br />Brand: <br />Brand: <br />Brand:Brand: <br />$10$20 <br />Network <br />Generic:Generic: <br />PreferredIn <br />Preferred <br />after <br />PreferredPreferred <br />30% <br />Use <br />Non <br />Non <br />Network: <br />Must <br />Non <br />NetworkInNetworkIn <br />Plan <br />50% <br />NetworkNonNetworkNon <br />Medical <br />100% <br />then <br />ded. <br />days, <br />ded. <br />after <br />$100, <br />Abuse$40 <br />20% <br />after <br />5 <br />20% <br />visit <br />max <br />FACILITIESIn <br />SERVICESIn <br />then <br />$150/day, <br />per <br />20% <br />Home <br />RX <br />Therapy; <br />Abuse) <br />Rehabilitation <br />AETNA <br />Substance <br />Occ. <br />use <br />Therapy <br />MntlHlth/Subsmust <br />and <br />Term <br />Physical <br />HOSPITAL/SURGICAL <br />Yr <br />supply, <br />Facility <br />yrYr <br />Manipulationsupply <br />Health <br />Surgery <br />Coveragedays/Cal. <br />Care <br />visits/cal.visits/cal. <br />Short <br />visits <br />PHARMACY <br />Convalescent <br />Mental <br />HealthSpeech, <br />Current dayday <br />OutpatientOutpatientOutpatient Order <br />ağǣΑЊЋЉ <br />Inpatient <br />1003090 <br />Delivery <br />6020 <br />OTHER <br />Spinal <br />Retail <br />Home <br />(Incl.toto <br />Mail <br />Incl. <br />MaxMaxMax <br />UpUp <br /> <br />