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/Subtype /Type1 /BaseFont /Helvetica /Encoding /WinAnsiEncoding >> endobj 7 0 obj << /Length 8 0 R >> stream 07-01-15 This plan is a University sponsored student health plan designed to provide comprehensive medicalcoverage for you and your eligible dependents. It is not an insurance program. This Plan includescoverage for hospital care, surgery, emergency care, prescription drugs, limited dental and more.Generally, to be eligible for reimbursement under the provisions ofthe Plan, expenses must be incurredwhile coverage is in effect. Expenses incurred before your plan coverage becomes effective or after yourplan coverage has terminated will not be covered. This plan will only provide medical coverage on anexcess basis. This means that all medical expenses must first be submitted to any other available sourceofhealth care coverage. There is no optical coverage available.ENROLLMENT: Please retum the effollment form to Risk Management as soon as possible in order togain access to the services provided.PREFERRED PROVIDER PLAN: The health plan has been developed as a PPO (Prefened Provider)plan. You may utilize services outside ofthe preferred provider structure; however it will be at reducedbenefits.PLAN YEAR: The Plan benefit year is a fiscal year and runs from July I through June 30.ELIGIBILITY: You are eligible for benefits ifyou:o Are attending Ƶ as a graduate or undergraduate; and' Are a degree track student. Students who are accepted into a degree program and registered for morethan 0 units will be charged the enrollment fee regardless ofthe number ofunits they're registeredfor.I Are a non-degree student registered fbr more than 4 units. students who are not accepted into adegree program but are registered as a non-degree student for more than 4 units will be charged theenrollment fee.However, non-degree students registered for 4 units or less will not be charsed the fee and will not beeligible to buy in to the Student Health Plan.' Were previously covered under the Plan and are on an approved leave ofabsence from your academicprogram.o IS and lP only student. Those students who are working on "ln progress" courses, and who are no1registered for any other units, will be charged the enrollment feeAdditional information regarding eligibility:' Students who drop before the deadline will not be charged nor covered. Any student who is chargedthe fee and drops all units before the last day for a full refund (generally I week after the first day-ofclasses), will receive a full refund ofthe enrollment fee and they will have no access to anyUniversity benefits. 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0 0 1 378.72 667.08 Tm <6368617267656420> Tj 1 0 0 1 414.36 667.08 Tm <74686520> Tj /F3 9.5 Tf 1 0 0 1 430.20 666.72 Tm <656E726F6C6C6D656E7420> Tj /F3 8.5 Tf 1 0 0 1 478.80 667.08 Tm <6665652E> Tj /F3 9.0 Tf 1 0 0 1 102.24 643.32 Tm <54686F736520> Tj 1 0 0 1 131.04 642.96 Tm <73747564656E747320> Tj /F3 9.5 Tf 1 0 0 1 168.48 643.32 Tm <70617274696369706174696E6720> Tj 1 0 0 1 224.28 642.60 Tm <696E20> Tj /F3 8.5 Tf 1 0 0 1 235.08 642.60 Tm <616E20> Tj /F3 10.5 Tf 1 0 0 1 247.68 642.60 Tm <6F666620> Tj /F3 9.0 Tf 1 0 0 1 262.80 642.60 Tm <63616D70757320> Tj 1 0 0 1 297.72 642.24 Tm <6F7220> Tj /F3 9.5 Tf 1 0 0 1 308.88 642.24 Tm <6F6E6C696E6520> Tj /F3 9.0 Tf 1 0 0 1 338.04 642.60 Tm <70726F6772616D20> Tj /F3 11.0 Tf 1 0 0 1 376.20 642.24 Tm <77696C6C20> Tj /F3 9.0 Tf 1 0 0 1 395.28 641.88 Tm <6E6F7420> Tj /F3 8.5 Tf 1 0 0 1 411.48 642.24 Tm <626520> Tj /F3 9.0 Tf 1 0 0 1 424.08 641.88 Tm <6368617267656420> Tj 1 0 0 1 460.08 641.88 Tm <74686520> Tj /F3 9.5 Tf 1 0 0 1 475.92 641.88 Tm <656E726F6C6C6D656E74> Tj /F3 9.0 Tf 1 0 0 1 102.96 631.44 Tm <66656520> Tj /F3 8.5 Tf 1 0 0 1 118.44 631.08 Tm <756E6C65737320> Tj /F3 9.0 Tf 1 0 0 1 146.88 631.08 Tm <74686520> Tj 1 0 0 1 163.08 631.44 Tm <70726F6772616D20> Tj /F3 10.0 Tf 1 0 0 1 200.88 630.72 Tm <7370656369666963616C6C7920> Tj /F3 9.0 Tf 1 0 0 1 252.72 630.36 Tm <72657175697265732E> Tj 0.00 Tc /F3 15.0 Tf 1 0 0 1 84.96 607.68 Tm <2E20> Tj /F3 10.0 Tf 1 0 0 1 102.24 606.24 Tm <416E20> Tj 1 0 0 1 117.72 606.24 Tm <656C696769626C6520> Tj /F3 9.0 Tf 1 0 0 1 152.28 605.88 Tm <73747564656E74277320> Tj 1 0 0 1 192.96 605.88 Tm <636F76657261676520> Tj /F3 11.0 Tf 1 0 0 1 233.64 605.52 Tm <77696C6C20> Tj /F3 9.0 Tf 1 0 0 1 252.72 605.52 Tm <6265636F726E6520> Tj /F3 9.5 Tf 1 0 0 1 288.36 605.16 Tm <65666665637469766520> Tj /F3 8.5 Tf 1 0 0 1 327.96 605.16 Tm <6F6E20> Tj /F3 9.0 Tf 1 0 0 1 340.56 605.16 Tm <74686520> Tj /F3 10.0 Tf 1 0 0 1 356.40 605.16 Tm <666972737420> Tj /F3 9.0 Tf 1 0 0 1 376.20 604.80 Tm <64617920> Tj /F3 10.0 Tf 1 0 0 1 393.84 604.80 Tm <6F66636C61737320> Tj /F3 9.5 Tf 1 0 0 1 428.76 604.80 Tm <6F7220> Tj /F3 9.0 Tf 1 0 0 1 440.28 604.80 Tm <73747564656E7420> Tj /F3 9.5 Tf 1 0 0 1 473.04 604.80 Tm <6F7269656E746174696F6E2C> Tj 1 0 0 1 101.88 594.36 Tm <77686963686576657220> Tj /F3 9.0 Tf 1 0 0 1 148.68 594.00 Tm <6F636375727320> Tj /F3 10.5 Tf 1 0 0 1 178.92 594.00 Tm <6669727374> Tj 1 0 0 1 84.96 570.60 Tm <4255592D494E20> Tj /F3 11.0 Tf 1 0 0 1 124.92 570.24 Tm <50524F564953494F4E3A20> Tj /F3 9.0 Tf 1 0 0 1 194.04 569.52 Tm <556E64657220> Tj 1 0 0 1 222.48 569.52 Tm <74686520> Tj /F3 10.0 Tf 1 0 0 1 238.32 569.52 Tm <666F6C6C6F77696E6720> Tj /F3 9.5 Tf 1 0 0 1 281.88 569.52 Tm <70726F766973696F6E7320> Tj /F3 8.0 Tf 1 0 0 1 328.68 568.80 Tm <6120> Tj /F3 9.0 Tf 1 0 0 1 335.88 569.16 Tm <73747564656E7420> Tj 1 0 0 1 369.00 568.80 Tm <6D617920> Tj /F3 9.5 Tf 1 0 0 1 389.88 568.80 Tm <6F627461696E20> Tj /F3 9.0 Tf 1 0 0 1 419.04 568.44 Tm <636F76657261676520> Tj 1 0 0 1 459.72 568.44 Tm <756E64657220> Tj /F3 9.5 Tf 1 0 0 1 486.00 568.44 Tm <7468697320> Tj 1 0 0 1 504.00 568.44 Tm <6865616C7468> Tj 1 0 0 1 84.60 558.72 Tm <706C616E20> Tj /F3 9.0 Tf 1 0 0 1 105.84 558.00 Tm <6F7220> Tj 1 0 0 1 117.00 558.00 Tm <657874656E6420> Tj 1 0 0 1 147.96 557.64 Tm <636F76657261676520> Tj 1 0 0 1 188.64 557.28 Tm <746F20> Tj /F3 8.5 Tf 1 0 0 1 199.44 557.64 Tm <6120> Tj 1 0 0 1 207.00 557.64 Tm <73706F75736520> Tj /F3 9.0 Tf 1 0 0 1 238.32 557.28 Tm <6F7220> Tj 1 0 0 1 249.48 557.28 Tm <646570656E64656E7420> Tj /F3 9.5 Tf 1 0 0 1 295.56 556.92 Tm <6368696C6472656E20> Tj /F3 8.5 Tf 1 0 0 1 333.00 556.92 Tm <6561636820> Tj /F3 10.0 Tf 1 0 0 1 354.60 557.28 Tm <717561727465722E20> Tj /F3 9.5 Tf 1 0 0 1 392.76 556.56 Tm <496E20> Tj /F3 9.0 Tf 1 0 0 1 403.92 556.56 Tm <6F7264657220> Tj /F3 9.5 Tf 1 0 0 1 428.40 556.56 Tm <746F20> Tj /F3 9.0 Tf 1 0 0 1 439.56 556.56 Tm <7265636569766520> Tj 1 0 0 1 472.68 556.56 Tm <616E7920> Tj 1 0 0 1 490.68 556.20 Tm <636F766572616763> Tj 1 0 0 1 84.60 545.76 Tm <756E64657220> Tj /F3 9.5 Tf 1 0 0 1 111.24 545.76 Tm <7468697320> Tj /F3 9.0 Tf 1 0 0 1 129.60 545.76 Tm <506C616E2C20> Tj /F3 8.0 Tf 1 0 0 1 153.72 545.40 Tm <6120> Tj /F3 9.0 Tf 1 0 0 1 160.92 545.40 Tm <73747564656E7420> Tj 1 0 0 1 194.04 545.40 Tm <6D75737420> Tj /F3 9.5 Tf 1 0 0 1 217.08 545.04 Tm <6170706C7920> Tj 1 0 0 1 243.36 545.04 Tm <666F7220> Tj /F3 9.0 Tf 1 0 0 1 258.12 544.68 Tm <636F76657261676520> Tj /F3 9.5 Tf 1 0 0 1 298.80 544.68 Tm <647572696E6720> Tj /F3 8.5 Tf 1 0 0 1 329.04 544.68 Tm <616E20> Tj /F3 9.0 Tf 1 0 0 1 341.28 544.68 Tm <6F70656E20> Tj 1 0 0 1 364.68 544.32 Tm <656E2E726F6C6C6D656E7420> Tj 1 0 0 1 413.28 544.68 Tm <706572696F642C20> Tj /F3 10.0 Tf 1 0 0 1 445.32 544.32 Tm <77697468696E20> Tj /F3 9.0 Tf 1 0 0 1 475.20 543.96 Tm <333020> Tj 1 0 0 1 488.16 543.96 Tm <6461797320> Tj /F3 11.5 Tf 1 0 0 1 510.12 543.96 Tm <6F6661> Tj /F3 8.5 Tf 1 0 0 1 84.60 533.88 Tm <73746174757320> Tj /F3 9.0 Tf 1 0 0 1 111.24 533.52 Tm <6368616E676520> Tj /F3 10.0 Tf 1 0 0 1 144.00 533.52 Tm <692E652E2877697468696E20> Tj /F3 9.0 Tf 1 0 0 1 190.08 533.16 Tm <333020> Tj 1 0 0 1 203.40 533.16 Tm <6461797320> Tj /F3 10.0 Tf 1 0 0 1 225.36 532.80 Tm <6F6620> Tj /F3 9.0 Tf 1 0 0 1 236.88 532.80 Tm <6D6172726961676520> Tj /F3 9.5 Tf 1 0 0 1 276.84 532.44 Tm <6F7220> Tj /F3 10.0 Tf 1 0 0 1 288.36 532.80 Tm <77697468696E20> Tj /F3 9.0 Tf 1 0 0 1 317.88 532.44 Tm <333020> Tj /F3 8.5 Tf 1 0 0 1 331.20 532.44 Tm <6461797320> Tj /F3 10.5 Tf 1 0 0 1 352.80 532.44 Tm <6F6674686520> Tj /F3 9.5 Tf 1 0 0 1 380.16 532.08 Tm <626972746820> Tj /F3 11.0 Tf 1 0 0 1 402.48 532.08 Tm <6F666120> Tj /F3 9.0 Tf 1 0 0 1 421.56 532.08 Tm <6E6577626F726E20> Tj /F3 10.0 Tf 1 0 0 1 460.80 532.08 Tm <6368696C642920> Tj /F3 8.5 Tf 1 0 0 1 488.16 532.08 Tm <616E6420> Tj /F3 9.0 Tf 1 0 0 1 505.80 532.44 Tm <706179> Tj 1 0 0 1 84.24 521.64 Tm <74686520> Tj 1 0 0 1 100.44 521.64 Tm <617070726F70726961746520> Tj /F3 11.5 Tf 1 0 0 1 150.84 521.64 Tm <7172617475647920> Tj /F3 9.0 Tf 1 0 0 1 193.68 520.92 Tm <73747564656E7420> Tj /F3 9.5 Tf 1 0 0 1 226.80 520.92 Tm <636F6E747269627574696F6E20> Tj /F3 8.0 Tf 1 0 0 1 280.80 520.20 Tm <617320> Tj /F3 9.5 Tf 1 0 0 1 292.32 520.56 Tm <6F75746C696E656420> Tj 1 0 0 1 329.40 520.20 Tm <62656C6F773A> Tj /F3 7.0 Tf 1 0 0 1 102.96 497.52 Tm <4920> Tj /F3 15.0 Tf 1 0 0 1 107.28 497.16 Tm <2E20> Tj /F3 9.0 Tf 1 0 0 1 119.16 497.16 Tm <53706F7573652F446570656E64656E7420> Tj /F3 9.5 Tf 1 0 0 1 200.88 496.80 Tm <4368696C6472656E20> Tj /F3 13.5 Tf 1 0 0 1 240.12 494.28 Tm <2D20> Tj /F3 10.0 Tf 1 0 0 1 248.76 496.44 Tm <496620> Tj /F3 9.5 Tf 1 0 0 1 257.76 496.80 Tm <796F7520> Tj /F3 8.5 Tf 1 0 0 1 276.48 496.08 Tm <61726520> Tj 1 0 0 1 291.96 496.08 Tm <6120> Tj /F3 9.0 Tf 1 0 0 1 299.52 496.08 Tm <73747564656E7420> Tj 1 0 0 1 332.28 496.08 Tm <636F766572656420> Tj 1 0 0 1 368.28 495.72 Tm <756E64657220> Tj /F3 9.5 Tf 1 0 0 1 394.92 495.72 Tm <7468697320> Tj /F3 9.0 Tf 1 0 0 1 412.92 496.08 Tm <706C616E2C20> Tj /F3 9.5 Tf 1 0 0 1 436.32 496.08 Tm <796F7520> Tj /F3 9.0 Tf 1 0 0 1 455.04 495.72 Tm <6D617920> Tj 1 0 0 1 475.56 495.36 Tm <657874656E6420> Tj 1 0 0 1 506.52 495.36 Tm <6865616C7468> Tj 1 0 0 1 118.80 485.64 Tm <706C616E20> Tj 1 0 0 1 139.68 484.92 Tm <636F76657261676520> Tj 1 0 0 1 180.36 484.56 Tm <746F20> Tj /F3 9.5 Tf 1 0 0 1 191.16 485.28 Tm <796F757220> Tj /F3 8.5 Tf 1 0 0 1 213.48 484.56 Tm <73706F75736520> Tj /F3 9.5 Tf 1 0 0 1 244.80 484.20 Tm <6F7220> Tj /F3 9.0 Tf 1 0 0 1 256.32 484.20 Tm <646570656E64656E7420> Tj /F3 9.5 Tf 1 0 0 1 302.40 483.84 Tm <6368696C6472656E2E> Tj /F3 15.0 Tf 1 0 0 1 101.52 473.40 Tm <322E20> Tj /F3 9.0 Tf 1 0 0 1 118.80 473.04 Tm <4C6561766520> Tj /F3 9.5 Tf 1 0 0 1 147.24 473.04 Tm <6F66416273656E636520> Tj /F3 10.0 Tf 1 0 0 1 197.64 473.40 Tm <284C4F412920> Tj /F3 14.0 Tf 1 0 0 1 228.60 469.80 Tm <2D20> Tj /F3 10.0 Tf 1 0 0 1 237.60 472.32 Tm <496620> Tj /F3 9.5 Tf 1 0 0 1 246.60 472.68 Tm <796F7520> Tj /F3 8.5 Tf 1 0 0 1 264.96 471.96 Tm <61726520> Tj /F3 8.0 Tf 1 0 0 1 280.80 471.96 Tm <6120> Tj /F3 9.0 Tf 1 0 0 1 288.00 471.96 Tm <73747564656E7420> Tj /F3 9.5 Tf 1 0 0 1 320.76 471.96 Tm <77686F20> Tj /F3 8.5 Tf 1 0 0 1 341.64 471.96 Tm <68617320> Tj 1 0 0 1 358.56 471.60 Tm <6265656E20> Tj /F3 9.0 Tf 1 0 0 1 381.24 471.60 Tm <636F766572656420> Tj 1 0 0 1 416.88 471.60 Tm <756E64657220> Tj 1 0 0 1 443.52 471.24 Tm <74686520> Tj 1 0 0 1 459.72 471.60 Tm <506C616E20> Tj 1 0 0 1 480.96 471.24 Tm <757020> Tj /F3 10.0 Tf 1 0 0 1 493.92 471.24 Tm <756E74696C20> Tj /F3 9.0 Tf 1 0 0 1 515.52 471.24 Tm <746865> Tj /F3 9.5 Tf 1 0 0 1 118.44 461.16 Tm <74696D6520> Tj /F3 9.0 Tf 1 0 0 1 140.04 460.80 Tm <7468617420> Tj /F3 9.5 Tf 1 0 0 1 158.76 461.16 Tm <796F7520> Tj /F3 9.0 Tf 1 0 0 1 177.48 460.80 Tm <6C6561766520> Tj 1 0 0 1 202.32 460.44 Tm <7363686F6F6C20> Tj 1 0 0 1 232.56 460.44 Tm <6F6E20> Tj 1 0 0 1 245.52 460.08 Tm <616E20> Tj 1 0 0 1 258.48 460.08 Tm <617070726F76656420> Tj 1 0 0 1 300.60 460.08 Tm <6C6561766520> Tj /F3 9.5 Tf 1 0 0 1 325.08 459.72 Tm <6F66616273656E636520> Tj /F3 10.0 Tf 1 0 0 1 372.24 460.08 Tm <284C4F41292C20> Tj /F3 9.5 Tf 1 0 0 1 406.44 459.72 Tm <796F7520> Tj /F3 9.0 Tf 1 0 0 1 424.80 459.36 Tm <6D617920> Tj 1 0 0 1 445.68 459.36 Tm <657874656E6420> Tj /F3 9.5 Tf 1 0 0 1 476.28 459.72 Tm <796F7572> Tj /F3 9.0 Tf 1 0 0 1 118.44 448.92 Tm <636F76657261676520> Tj 1 0 0 1 159.48 448.56 Tm <756E64657220> Tj 1 0 0 1 186.12 448.56 Tm <74686520> Tj 1 0 0 1 201.96 448.20 Tm <506C616E20> Tj /F3 9.5 Tf 1 0 0 1 223.20 448.20 Tm <666F7220> Tj /F3 9.0 Tf 1 0 0 1 237.96 447.84 Tm <74686520> Tj 1 0 0 1 253.80 448.20 Tm <6C656E67746820> Tj /F3 10.5 Tf 1 0 0 1 282.60 447.48 Tm <6F6674686520> Tj /F3 9.0 Tf 1 0 0 1 309.60 447.48 Tm <617070726F76656420> Tj /F3 10.0 Tf 1 0 0 1 351.36 447.48 Tm <4C4F412C20> Tj /F3 9.0 Tf 1 0 0 1 378.36 447.48 Tm <757020> Tj /F3 9.5 Tf 1 0 0 1 391.32 447.12 Tm <746F20> Tj /F3 8.5 Tf 1 0 0 1 402.48 447.12 Tm <6120> Tj /F3 9.5 Tf 1 0 0 1 410.04 447.12 Tm <6D6178696D756D20> Tj /F3 9.0 Tf 1 0 0 1 455.04 447.12 Tm <657874656E73696F6E20> Tj /F3 10.5 Tf 1 0 0 1 498.24 446.76 Tm <6F666F6E65> Tj /F3 9.5 Tf 1 0 0 1 118.44 437.04 Tm <796561662E> Tj /F3 15.0 Tf 1 0 0 1 101.16 424.44 Tm <332E20> Tj /F3 9.5 Tf 1 0 0 1 118.44 424.08 Tm <436F6E74696E756174696F6E20> Tj /F3 9.0 Tf 1 0 0 1 176.40 424.08 Tm <436F76657261676520> Tj /F3 12.5 Tf 1 0 0 1 219.24 421.20 Tm <2D20> Tj /F3 10.5 Tf 1 0 0 1 227.52 423.72 Tm <496620> Tj /F3 9.5 Tf 1 0 0 1 236.88 424.08 Tm <796F7520> Tj /F3 9.0 Tf 1 0 0 1 255.60 423.36 Tm <6861766520> Tj /F3 8.5 Tf 1 0 0 1 278.28 423.36 Tm <6265656E20> Tj /F3 9.0 Tf 1 0 0 1 300.60 423.00 Tm <636F766572656420> Tj 1 0 0 1 336.96 423.00 Tm <756E64657220> Tj /F3 9.5 Tf 1 0 0 1 363.24 423.00 Tm <7468697320> Tj /F3 9.0 Tf 1 0 0 1 381.24 423.00 Tm <506C616E20> Tj /F3 8.5 Tf 1 0 0 1 402.84 422.64 Tm <616E6420> Tj /F3 9.0 Tf 1 0 0 1 420.48 422.64 Tm <6E6F20> Tj /F3 9.5 Tf 1 0 0 1 433.80 422.64 Tm <6C6F6E67657220> Tj /F3 8.5 Tf 1 0 0 1 463.32 422.64 Tm <6D65657420> Tj /F3 9.5 Tf 1 0 0 1 486.00 422.64 Tm <746865> Tj /F3 10.5 Tf 1 0 0 1 118.44 412.20 Tm <656C69676962696C69747920> Tj /F3 9.0 Tf 1 0 0 1 162.36 412.20 Tm <726571756972656D656E74732C20> Tj /F3 10.5 Tf 1 0 0 1 222.48 412.20 Tm <28666F7220> Tj /F3 9.5 Tf 1 0 0 1 242.28 411.48 Tm <6578616D706C652C20> Tj /F3 11.0 Tf 1 0 0 1 285.12 411.48 Tm <696620> Tj /F3 9.5 Tf 1 0 0 1 294.12 411.48 Tm <796F7520> Tj /F3 10.0 Tf 1 0 0 1 312.84 411.12 Tm <7765728020> Tj /F3 9.5 Tf 1 0 0 1 337.68 411.12 Tm <6E6F7420> Tj /F3 10.0 Tf 1 0 0 1 354.60 411.12 Tm <617474656E64696E6720> Tj /F3 8.5 Tf 1 0 0 1 400.32 410.76 Tm <636C617373657320> Tj /F3 10.5 Tf 1 0 0 1 432.72 410.76 Tm <647572696E6720> Tj /F3 9.5 Tf 1 0 0 1 465.84 410.40 Tm <616E7920> Tj /F3 10.5 Tf 1 0 0 1 484.92 410.76 Tm <717561727465722C> Tj 1 0 0 1 118.44 400.32 Tm <696E636C7564696E6720> Tj /F3 10.0 Tf 1 0 0 1 163.80 399.96 Tm <53756D6D65722D796F7520> Tj 1 0 0 1 224.28 399.60 Tm <776F756C6420> Tj /F3 9.0 Tf 1 0 0 1 254.88 399.60 Tm <6E65656420> Tj /F3 10.0 Tf 1 0 0 1 278.64 398.88 Tm <746F20> Tj 1 0 0 1 290.16 399.24 Tm <6275792D696E2920> Tj /F3 9.5 Tf 1 0 0 1 325.44 399.24 Tm <796F7520> Tj /F3 8.5 Tf 1 0 0 1 343.80 398.88 Tm <616E6420> Tj /F3 9.5 Tf 1 0 0 1 361.44 399.24 Tm <796F757220> Tj /F3 10.0 Tf 1 0 0 1 383.76 398.52 Tm <656C696769626C6520> Tj /F3 8.5 Tf 1 0 0 1 418.32 398.52 Tm <646570656E64656E747320> Tj /F3 9.0 Tf 1 0 0 1 468.00 398.52 Tm <6D617920> Tj /F3 9.5 Tf 1 0 0 1 488.88 398.16 Tm <636F6E74696E7565> Tj 1 0 0 1 118.08 388.80 Tm <796F757220> Tj /F3 9.0 Tf 1 0 0 1 140.40 388.08 Tm <636F76657261676520> Tj /F3 9.5 Tf 1 0 0 1 181.44 388.08 Tm <666F7220> Tj /F3 9.0 Tf 1 0 0 1 195.84 387.72 Tm <757020> Tj /F3 9.5 Tf 1 0 0 1 209.16 387.72 Tm <746F20> Tj /F3 8.5 Tf 1 0 0 1 220.32 387.72 Tm <6F6E6520> Tj /F3 7.5 Tf 1 0 0 1 237.96 388.08 Tm <2820> Tj /F3 6.0 Tf 1 0 0 1 243.00 387.36 Tm <4920> Tj /F3 9.0 Tf 1 0 0 1 246.96 385.56 Tm <2920> Tj 1 0 0 1 253.08 387.72 Tm <7175617274657220> Tj /F3 9.5 Tf 1 0 0 1 285.48 387.00 Tm <7468726F75676820> Tj 1 0 0 1 320.76 387.00 Tm <7468697320> Tj 1 0 0 1 338.76 387.00 Tm <6275792D696E20> Tj 1 0 0 1 368.64 387.00 Tm <70726F766973696F6E2E> Tj 1 0 0 1 100.80 364.68 Tm <54686520> Tj 1 0 0 1 120.96 364.32 Tm <6F70656E20> Tj /F3 10.0 Tf 1 0 0 1 145.44 363.96 Tm <656E726F6C6C6D656E7420> Tj 1 0 0 1 197.64 364.32 Tm <706572696F6420> Tj /F3 11.0 Tf 1 0 0 1 229.32 363.60 Tm <666F7220> Tj /F3 10.0 Tf 1 0 0 1 245.88 363.24 Tm <656C696769626C6520> Tj /F3 9.5 Tf 1 0 0 1 280.44 362.88 Tm <73747564656E747320> Tj 1 0 0 1 320.76 362.88 Tm <616E6420> Tj 1 0 0 1 340.20 362.88 Tm <646570656E64656E747320> Tj /F3 9.0 Tf 1 0 0 1 393.84 362.52 Tm <697320> Tj /F3 9.5 Tf 1 0 0 1 403.56 362.52 Tm <74686520> Tj 1 0 0 1 420.48 362.16 Tm <6C61737420> Tj /F3 9.0 Tf 1 0 0 1 438.48 362.52 Tm <74776F20> Tj /F3 8.5 Tf 1 0 0 1 456.12 362.16 Tm <762C65656B7320> Tj /F3 10.0 Tf 1 0 0 1 483.84 362.16 Tm <6F6665616368> Tj /F3 9.5 Tf 1 0 0 1 100.44 352.44 Tm <63616C656E64617220> Tj /F3 10.5 Tf 1 0 0 1 140.76 352.44 Tm <717561727465722720> Tj 1 0 0 1 180.72 352.08 Tm <4275792D696E20> Tj /F3 9.5 Tf 1 0 0 1 213.84 351.72 Tm <636F76657261676520> Tj /F3 11.5 Tf 1 0 0 1 255.96 351.36 Tm <77696C6C20> Tj /F3 9.0 Tf 1 0 0 1 275.76 351.00 Tm <626520> Tj /F3 9.5 Tf 1 0 0 1 288.72 351.00 Tm <65666665637469766520> Tj /F3 10.5 Tf 1 0 0 1 328.68 351.00 Tm <66726F6D20> Tj 1 0 0 1 353.52 350.64 Tm <4A616E7561727920> Tj /F3 12.0 Tf 1 0 0 1 394.56 350.64 Tm <4920> Tj /F3 10.0 Tf 1 0 0 1 401.76 350.28 Tm <746F20> Tj /F3 10.5 Tf 1 0 0 1 413.28 350.28 Tm <4D6172636820> Tj /F3 9.0 Tf 1 0 0 1 446.04 350.28 Tm <33312C20> Tj /F3 11.5 Tf 1 0 0 1 461.88 350.28 Tm <417072696C20> Tj /F3 12.0 Tf 1 0 0 1 489.24 350.28 Tm <4920> Tj /F3 9.5 Tf 1 0 0 1 496.44 349.92 Tm <746F20> Tj 1 0 0 1 507.60 349.92 Tm <4A756E65> Tj 1 0 0 1 100.44 340.20 Tm <33302720> Tj /F3 10.5 Tf 1 0 0 1 116.28 340.20 Tm <4A756C7920> Tj /F3 8.5 Tf 1 0 0 1 138.96 339.84 Tm <3120> Tj /F3 10.0 Tf 1 0 0 1 146.52 339.84 Tm <746F20> Tj /F3 9.5 Tf 1 0 0 1 158.40 339.84 Tm <53657074656D62657220> Tj /F3 9.0 Tf 1 0 0 1 209.16 339.48 Tm <333020> Tj /F3 9.5 Tf 1 0 0 1 222.48 339.12 Tm <616E6420> Tj /F3 10.0 Tf 1 0 0 1 242.28 339.12 Tm <4F63746F62657220> Tj /F3 8.0 Tf 1 0 0 1 282.24 338.76 Tm <3120> Tj /F3 10.0 Tf 1 0 0 1 289.44 338.76 Tm <746F20> Tj /F3 9.5 Tf 1 0 0 1 301.32 338.76 Tm <446563656D62657220> Tj /F3 11.0 Tf 1 0 0 1 349.20 338.40 Tm <33312E20> Tj /F3 10.0 Tf 1 0 0 1 368.28 338.40 Tm <546865726520> Tj /F3 8.5 Tf 1 0 0 1 398.88 338.04 Tm <61726520> Tj /F3 9.5 Tf 1 0 0 1 414.72 338.04 Tm <6E6F20> Tj 1 0 0 1 428.40 338.04 Tm <696E766F6963657320> Tj 1 0 0 1 466.20 338.04 Tm <6F7220> Tj 1 0 0 1 478.08 337.68 Tm <72656D696E64657273> Tj /F3 9.0 Tf 1 0 0 1 100.44 327.96 Tm <73656E7420> Tj /F3 10.0 Tf 1 0 0 1 121.32 327.96 Tm <746F20> Tj /F3 9.5 Tf 1 0 0 1 132.84 327.96 Tm <73747564656E747320> Tj /F3 10.0 Tf 1 0 0 1 172.44 327.60 Tm <6C79686F20> Tj /F3 9.5 Tf 1 0 0 1 194.76 327.60 Tm <61726520> Tj /F3 10.0 Tf 1 0 0 1 212.04 327.24 Tm <627579696E6720> Tj /F3 10.5 Tf 1 0 0 1 245.52 327.24 Tm <696E20> Tj /F3 10.0 Tf 1 0 0 1 257.04 326.88 Tm <746F20> Tj /F3 9.5 Tf 1 0 0 1 268.56 326.88 Tm <74686520> Tj /F3 10.5 Tf 1 0 0 1 285.12 326.88 Tm <5049616E2E20> Tj /F3 9.5 Tf 1 0 0 1 313.56 326.52 Tm <54686520> Tj /F3 10.0 Tf 1 0 0 1 333.72 326.52 Tm <4465706172746D656E7420> Tj 1 0 0 1 390.96 326.16 Tm <6F6620> Tj 1 0 0 1 402.48 326.16 Tm <5269736B20> Tj 1 0 0 1 425.52 326.16 Tm <4D616E6167656D656E7420> Tj 1 0 0 1 487.44 325.80 Tm <63616E6E6F74> Tj /F3 9.5 Tf 1 0 0 1 100.44 316.08 Tm <61646420> Tj /F3 10.0 Tf 1 0 0 1 120.24 316.08 Tm <53747564656E7420> Tj 1 0 0 1 158.04 315.72 Tm <4865616C746820> Tj /F3 9.5 Tf 1 0 0 1 191.16 315.36 Tm <506C616E20> Tj /F3 8.5 Tf 1 0 0 1 214.20 315.36 Tm <6665657320> Tj /F3 10.0 Tf 1 0 0 1 234.00 315.00 Tm <746F20> Tj /F3 10.5 Tf 1 0 0 1 245.52 315.36 Tm <796F757220> Tj /F3 10.0 Tf 1 0 0 1 269.28 315.00 Tm <73747564656E7420> Tj 1 0 0 1 305.28 314.64 Tm <6163636F756E742E20> Tj /F3 11.5 Tf 1 0 0 1 348.12 314.28 Tm <416C6C20> Tj /F3 9.5 Tf 1 0 0 1 364.68 314.64 Tm <7061796D806E747320> Tj /F3 10.0 Tf 1 0 0 1 410.40 313.92 Tm <6D75737420> Tj /F3 9.0 Tf 1 0 0 1 435.60 313.92 Tm <626520> Tj /F3 9.5 Tf 1 0 0 1 448.56 313.92 Tm <6D61646520> Tj 1 0 0 1 475.92 313.56 Tm <627920> Tj 1 0 0 1 489.60 313.56 Tm <636880636B2C> Tj 1 0 0 1 100.44 303.84 Tm <6D6F6E657920> Tj /F3 10.0 Tf 1 0 0 1 132.84 303.48 Tm <6F726465722C20> Tj 1 0 0 1 163.44 303.48 Tm <6F7220> Tj /F3 10.5 Tf 1 0 0 1 176.04 303.12 Tm <63726564697420> Tj /F3 10.0 Tf 1 0 0 1 205.20 303.12 Tm <6361726420> Tj /F3 11.0 Tf 1 0 0 1 227.88 303.12 Tm <7769746820> Tj /F3 9.5 Tf 1 0 0 1 250.92 302.76 Tm <74686520> Tj /F3 10.0 Tf 1 0 0 1 267.48 302.76 Tm <5669736120> Tj 1 0 0 1 290.16 302.40 Tm <6F7220> Tj /F3 10.5 Tf 1 0 0 1 302.76 302.40 Tm <4D61737465724361726420> Tj /F3 9.5 Tf 1 0 0 1 361.08 302.04 Tm <6C6F676F20> Tj 1 0 0 1 382.68 302.04 Tm <627920> Tj /F3 10.0 Tf 1 0 0 1 396.36 301.68 Tm <63616C6C696E6720> Tj /F3 9.5 Tf 1 0 0 1 428.76 302.04 Tm <283930392920> Tj /F3 10.5 Tf 1 0 0 1 454.32 301.68 Tm <3635662D343031302E20> Tj 1 0 0 1 502.56 301.32 Tm <41> Tj /F3 10.0 Tf 1 0 0 1 100.44 291.96 Tm <6E6577626F726E20> Tj 1 0 0 1 142.92 291.60 Tm <6368696C6420> Tj 1 0 0 1 167.76 291.24 Tm <6D75737420> Tj /F3 9.5 Tf 1 0 0 1 192.96 290.88 Tm <616C736F20> Tj /F3 9.0 Tf 1 0 0 1 213.48 290.88 Tm <626520> Tj /F3 10.0 Tf 1 0 0 1 226.44 290.88 Tm <656E726F6C6C656420> Tj 1 0 0 1 266.04 290.52 Tm <696E20> Tj /F3 9.5 Tf 1 0 0 1 277.20 290.16 Tm <74686520> Tj 1 0 0 1 294.12 290.52 Tm <706C616E20> Tj /F3 11.0 Tf 1 0 0 1 316.08 290.16 Tm <77697468696E20> Tj /F3 9.0 Tf 1 0 0 1 347.76 289.80 Tm <333020> Tj 1 0 0 1 361.08 289.80 Tm <6461797320> Tj /F3 10.0 Tf 1 0 0 1 384.12 289.80 Tm <6F6620> Tj /F3 11.0 Tf 1 0 0 1 395.64 289.80 Tm <626972746820> Tj /F3 10.0 Tf 1 0 0 1 421.20 289.44 Tm <6F7220> Tj 1 0 0 1 433.80 289.44 Tm <61646F7074696F6E20> Tj /F3 10.5 Tf 1 0 0 1 476.28 289.44 Tm <696E20> Tj /F3 10.0 Tf 1 0 0 1 487.80 289.08 Tm <6F7264657220> Tj 1 0 0 1 515.16 289.08 Tm <746F> Tj /F3 9.5 Tf 1 0 0 1 100.44 279.72 Tm <7265636569766520> Tj 1 0 0 1 134.64 279.36 Tm <616E7920> Tj 1 0 0 1 153.72 279.00 Tm <636F76657261676520> Tj /F3 10.0 Tf 1 0 0 1 196.56 279.00 Tm <756E64657220> Tj 1 0 0 1 225.72 278.64 Tm <7468697320> Tj /F3 11.0 Tf 1 0 0 1 245.16 279.00 Tm <706C616E2E20> Tj /F3 10.0 Tf 1 0 0 1 272.88 278.28 Tm <546865726520> Tj /F3 9.0 Tf 1 0 0 1 302.40 278.28 Tm <697320> Tj /F3 9.5 Tf 1 0 0 1 312.12 277.92 Tm <6E6F20> Tj /F3 10.0 Tf 1 0 0 1 325.80 277.92 Tm <6175746F6D6174696320> Tj 1 0 0 1 373.68 277.56 Tm <6F7220> Tj /F3 10.5 Tf 1 0 0 1 386.28 277.56 Tm <74656D706F7261727920> Tj /F3 9.5 Tf 1 0 0 1 437.04 277.20 Tm <636F76657261676520> Tj /F3 10.0 Tf 1 0 0 1 479.52 277.56 Tm <70726F7669646564> Tj /F3 10.5 Tf 1 0 0 1 100.08 267.84 Tm <666F7220> Tj /F3 9.5 Tf 1 0 0 1 116.28 267.84 Tm <616E7920> Tj 1 0 0 1 135.36 267.48 Tm <646570656E64656E74732C20> Tj /F3 10.0 Tf 1 0 0 1 191.88 267.12 Tm <696E636C7564696E6720> Tj /F3 9.5 Tf 1 0 0 1 236.52 266.76 Tm <61646F7074656420> Tj /F3 10.0 Tf 1 0 0 1 275.76 266.40 Tm <6F7220> Tj /F3 9.5 Tf 1 0 0 1 288.36 266.40 Tm <6E657276626F726E20> Tj /F3 10.0 Tf 1 0 0 1 330.48 266.04 Tm <6368696C6472656E2E> Tj 0.00 Tc /F3 9.5 Tf 1 0 0 1 82.80 244.08 Tm <457874656E73696F6E2F436F6E74696E756174696F6E20> Tj /F3 9.0 Tf 1 0 0 1 185.76 243.00 Tm <436F7665726167652D> Tj 1 0 0 1 98.64 231.84 Tm <53747564656E74> Tj 1 0 0 1 98.28 219.96 Tm <706C757320> Tj 1 0 0 1 118.44 219.24 Tm <6F6E6520> Tj /F3 10.5 Tf 1 0 0 1 136.44 219.24 Tm <6F6674686520> Tj /F3 9.0 Tf 1 0 0 1 163.44 218.88 Tm <616D6F756E747320> Tj /F3 9.5 Tf 1 0 0 1 201.60 218.52 Tm <62656C6F7720> Tj /F3 10.0 Tf 1 0 0 1 230.40 218.52 Tm <666F7220> Tj /F3 8.5 Tf 1 0 0 1 245.52 218.16 Tm <646570656E64656E7473> Tj /F3 9.0 Tf 1 0 0 1 99.72 207.36 Tm <4F6E6520> Tj 1 0 0 1 119.88 207.36 Tm <646570656E64656E7420> Tj 1 0 0 1 165.96 207.36 Tm <2873706F75736520> Tj /F3 9.5 Tf 1 0 0 1 200.88 206.64 Tm <6F7220> Tj /F3 10.0 Tf 1 0 0 1 212.40 206.28 Tm <6368696C642920> Tj 1 0 0 1 239.76 206.28 Tm <6F6620> Tj /F3 8.0 Tf 1 0 0 1 251.28 205.92 Tm <6120> Tj /F3 9.0 Tf 1 0 0 1 258.48 205.92 Tm <636F766572656420> Tj 1 0 0 1 294.48 205.56 Tm <73747564656E74> Tj /F3 10.0 Tf 1 0 0 1 99.36 195.48 Tm <54776F20> Tj /F3 9.0 Tf 1 0 0 1 121.68 195.12 Tm <6F7220> Tj 1 0 0 1 132.84 195.12 Tm <6D6F726520> Tj 1 0 0 1 157.32 194.76 Tm <646570656E64656E7473> Tj 0.00 Tc 1 0 0 1 358.92 228.96 Tm <243530302E303020> Tj 1 0 0 1 395.64 229.68 Tm <70657220> Tj 1 0 0 1 411.84 229.68 Tm <71756172746572> Tj /F3 15.0 Tf 1 0 0 1 358.56 204.84 Tm <2420> Tj /F3 9.0 Tf 1 0 0 1 372.24 205.20 Tm <3533302E303020> Tj 1 0 0 1 403.56 205.56 Tm <70657220> Tj 1 0 0 1 419.76 205.20 Tm <71756172746572> Tj /F3 7.0 Tf 1 0 0 1 358.56 192.60 Tm <2420> Tj /F3 9.0 Tf 1 0 0 1 365.04 193.32 Tm <312C3036302E303020> Tj 1 0 0 1 403.56 193.32 Tm <70657220> Tj 1 0 0 1 419.76 193.32 Tm <71756172746572> Tj 0.00 Tc /F3 10.5 Tf 1 0 0 1 81.72 171.72 Tm <505245534352495054494F4E20> Tj /F3 10.0 Tf 1 0 0 1 164.52 171.00 Tm <4452554720> Tj /F3 10.5 Tf 1 0 0 1 198.36 170.28 Tm <434F5645524147453A20> Tj /F3 9.0 Tf 1 0 0 1 265.32 169.56 Tm <4561636820> Tj /F3 9.5 Tf 1 0 0 1 289.08 169.56 Tm <656E726F6C6C656420> Tj /F3 9.0 Tf 1 0 0 1 326.52 169.20 Tm <73747564656E7420> Tj /F3 11.0 Tf 1 0 0 1 359.28 168.84 Tm <77696C6C20> Tj /F3 8.5 Tf 1 0 0 1 378.36 168.84 Tm <626520> Tj /F3 9.5 Tf 1 0 0 1 390.96 169.20 Tm <676976656E20> Tj /F3 8.0 Tf 1 0 0 1 417.24 168.48 Tm <6120> Tj /F3 9.5 Tf 1 0 0 1 424.44 168.48 Tm <4356532F436172656D61726B20> Tj 1 0 0 1 492.12 168.12 Tm <4865616C7468> Tj /F3 10.0 Tf 1 0 0 1 81.72 159.48 Tm <6361726520> Tj 1 0 0 1 104.76 159.48 Tm <4964656E74696669636174696F6E20> Tj 1 0 0 1 164.16 158.76 Tm <636172642C20> Tj /F3 9.5 Tf 1 0 0 1 190.08 158.40 Tm <776869636820> Tj /F3 9.0 Tf 1 0 0 1 218.52 158.04 Tm <63616E20> Tj /F3 8.5 Tf 1 0 0 1 236.16 158.04 Tm <626520> Tj 1 0 0 1 248.40 157.68 Tm <7573656420> Tj /F3 9.0 Tf 1 0 0 1 270.36 157.68 Tm <617420> Tj 1 0 0 1 280.80 157.68 Tm <616E7920> Tj /F3 9.5 Tf 1 0 0 1 298.44 158.04 Tm <70617274696369706174696E6720> Tj /F3 9.0 Tf 1 0 0 1 354.24 157.32 Tm <706861726D61637920> Tj /F3 9.5 Tf 1 0 0 1 398.52 156.60 Tm <646973706C6179696E6720> Tj /F3 9.0 Tf 1 0 0 1 444.96 156.60 Tm <74686520> Tj /F3 10.5 Tf 1 0 0 1 460.80 156.24 Tm <6376732F636172656D61726B> Tj /F3 10.0 Tf 1 0 0 1 81.72 147.60 Tm <646563616C2E20> Tj /F3 9.0 Tf 1 0 0 1 111.96 147.24 Tm <54686520> Tj 1 0 0 1 131.04 146.88 Tm <636F737420> Tj /F3 10.5 Tf 1 0 0 1 150.84 146.88 Tm <6F6674686520> Tj /F3 9.5 Tf 1 0 0 1 177.84 146.88 Tm <707265736372697074696F6E20> Tj /F3 11.0 Tf 1 0 0 1 230.76 146.16 Tm <77696C6C20> Tj /F3 9.0 Tf 1 0 0 1 249.84 145.80 Tm <626520> Tj /F3 10.0 Tf 1 0 0 1 262.80 145.80 Tm <62696C6C656420> Tj /F3 9.5 Tf 1 0 0 1 289.44 145.44 Tm <6469726563746C7920> Tj /F3 9.0 Tf 1 0 0 1 324.00 145.44 Tm <746F20> Tj 1 0 0 1 334.80 145.08 Tm <74686520> Tj 1 0 0 1 350.64 145.08 Tm <506C616E20> Tj 1 0 0 1 371.88 145.08 Tm <616674657220> Tj 1 0 0 1 393.48 144.72 Tm <74686520> Tj 1 0 0 1 409.32 144.72 Tm <73747564656E7420> Tj 1 0 0 1 442.44 145.08 Tm <7061797320> Tj /F3 8.0 Tf 1 0 0 1 464.40 144.36 Tm <6120> Tj /F3 9.0 Tf 1 0 0 1 471.60 144.36 Tm <636F2D7061796D656E742E> Tj /F3 9.5 Tf 1 0 0 1 81.72 135.72 Tm <507265736372697074696F6E7320> Tj /F3 10.0 Tf 1 0 0 1 139.68 135.00 Tm <66696C6C656420> Tj /F3 9.5 Tf 1 0 0 1 164.16 135.00 Tm <7468726F75676820> Tj /F3 10.0 Tf 1 0 0 1 199.80 134.28 Tm <6356532F636172656D61726B20> Tj /F3 11.0 Tf 1 0 0 1 267.84 133.92 Tm <77696C6C20> Tj /F3 8.5 Tf 1 0 0 1 286.92 133.56 Tm <626520> Tj /F3 10.0 Tf 1 0 0 1 299.52 133.56 Tm <6C696D6974656420> Tj /F3 9.5 Tf 1 0 0 1 331.56 133.20 Tm <746F20> Tj /F3 8.0 Tf 1 0 0 1 342.72 133.20 Tm <6120> Tj /F3 9.5 Tf 1 0 0 1 349.92 133.20 Tm <6D6178696D756D20> Tj /F3 11.0 Tf 1 0 0 1 395.28 132.84 Tm <6F666120> Tj /F3 8.5 Tf 1 0 0 1 414.00 132.84 Tm <334F2D64617920> Tj /F3 9.5 Tf 1 0 0 1 446.04 132.48 Tm <737570706C792E20> Tj /F3 9.0 Tf 1 0 0 1 479.52 132.48 Tm <54686520> Tj 1 0 0 1 498.60 132.12 Tm <636F2D> Tj 1 0 0 1 81.36 124.20 Tm <7061796D656E7420> Tj 1 0 0 1 120.60 123.12 Tm <616D6F756E747320> Tj /F3 11.0 Tf 1 0 0 1 159.12 123.12 Tm <77696C6C20> Tj /F3 8.5 Tf 1 0 0 1 178.20 122.76 Tm <626520> Tj /F3 9.0 Tf 1 0 0 1 190.80 122.04 Tm <2431352E303020> Tj /F3 9.5 Tf 1 0 0 1 222.84 122.40 Tm <666F7220> Tj /F3 9.0 Tf 1 0 0 1 237.24 122.76 Tm <67656E6572696320> Tj 1 0 0 1 271.08 121.68 Tm <647275677320> Tj 1 0 0 1 297.00 121.68 Tm <616E6420> Tj 1 0 0 1 315.00 120.96 Tm <2433302E303020> Tj /F3 10.0 Tf 1 0 0 1 346.68 121.32 Tm <666F7220> Tj /F3 9.0 Tf 1 0 0 1 361.80 121.32 Tm <6272616E6420> Tj /F3 8.5 Tf 1 0 0 1 388.44 120.96 Tm <6E616D652B20> Tj /F3 9.0 Tf 1 0 0 1 419.04 120.96 Tm <64727567732C20> Tj /F3 9.5 Tf 1 0 0 1 447.84 120.60 Tm <776869636820> Tj /F3 8.0 Tf 1 0 0 1 476.28 120.60 Tm <617265> Tj /F3 9.0 Tf 1 0 0 1 81.36 111.60 Tm <64697370656E73656420> Tj 1 0 0 1 125.64 110.88 Tm <617420> Tj /F3 9.5 Tf 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/Length 15 0 R >> stream ƵAHSC employees who are "full time benefit eligible" will not be charged the fee. The fee willnot apply regardless ofwhether employees are using the education benefit or not. Spouses ofemployees who are using the employee education benefit will be charged the enrollment fee.Those students participating in an off campus or online program will not be charged the enrollmentfee unless the program specifically requires. . An eligible student's coverage will becorne effective on the first day ofclass or student orientation,whichever occurs firstBUY-IN PROVISION: Under the following provisions a student may obtain coverage under this healthplan or extend coverage to a spouse or dependent children each quarter. In order to receive any coveragcunder this Plan, a student must apply for coverage during an open en.rollment period, within 30 days ofastatus change i.e.(within 30 days of marriage or within 30 days ofthe birth ofa newborn child) and paythe appropriate qratudy student contribution as outlined below:I . Spouse/Dependent Children - If you are a student covered under this plan, you may extend healthplan coverage to your spouse or dependent children.2. Leave ofAbsence (LOA) - If you are a student who has been covered under the Plan up until thetime that you leave school on an approved leave ofabsence (LOA), you may extend yourcoverage under the Plan for the length ofthe approved LOA, up to a maximum extension ofoneyeaf.3. Continuation Coverage - If you have been covered under this Plan and no longer meet theeligibility requirements, (for example, if you wer not attending classes during any quarter,including Summer-you would need to buy-in) you and your eligible dependents may continueyour coverage for up to one ( I ) quarter through this buy-in provision.The open enrollment period for eligible students and dependents is the last two v,eeks ofeachcalendar quarter' Buy-in coverage will be effective from January I to March 31, April I to June30' July 1 to September 30 and October 1 to December 31. There are no invoices or reminderssent to students lyho are buying in to the PIan. The Department of Risk Management cannotadd Student Health Plan fees to your student account. All paymnts must be made by chck,money order, or credit card with the Visa or MasterCard logo by calling (909) 65f-4010. Anewborn child must also be enrolled in the plan within 30 days of birth or adoption in order toreceive any coverage under this plan. There is no automatic or temporary coverage providedfor any dependents, including adopted or nervborn children. Extension/Continuation Coverage-Studentplus one ofthe amounts below for dependentsOne dependent (spouse or child) of a covered studentTwo or more dependents $500.00 per quarter$ 530.00 per quarter$ 1,060.00 per quarter PRESCRIPTION DRUG COVERAGE: Each enrolled student will be given a CVS/Caremark Healthcare Identification card, which can be used at any participating pharmacy displaying the cvs/caremarkdecal. The cost ofthe prescription will be billed directly to the Plan after the student pays a co-payment.Prescriptions filled through cVS/caremark will be limited to a maximum ofa 3O-day supply. The co-payment amounts will be $15.00 for generic drugs and $30.00 for brand name+ drugs, which aredispensed at our preferred pharmacies: the ƵMC pharmacy, the Faculty professional pharmacy(located in the Faculty Medical offices), rhe Ƶ Meridian pharmacy, the Ƶ Highland SpringiPharmacy, the ƵMC Murrieta Physicians office Bldg pharmacy and the Ƶ community pharmacy. endstream endobj 15 0 obj 3554 endobj 16 0 obj << /Length 27 >> stream % CANON_PFINF_TYPE0_TEXTON endstream endobj 17 0 obj << /Length 45 >> stream q 605.52 0 0 789.12 0.00 0.00 cm /Obj12 Do Q endstream endobj 18 0 obj << /Type /Page /MediaBox [ 0 0 605.52 789.12 ] /Parent 3 0 R /Resources << /Font << /F3 6 0 R >> /XObject << /Obj12 12 0 R >> /Subtype 14 0 R /ProcSet [ /PDF /Text /ImageB /ImageC /ImageI ] >> /Contents [ 16 0 R 17 0 R 13 0 R ] >> endobj 3 0 obj << /Kids [ 11 0 R 18 0 R ] /Count 2 /Type /Pages >> endobj xref 0 1 0000000000 65535 f 3 1 0000142340 00000 n 12 7 0000060832 00000 n 0000108144 00000 n 0000138280 00000 n 0000141890 00000 n 0000141912 00000 n 0000141990 00000 n 0000142086 00000 n trailer << /Size 19 /Info 1 0 R /Root 2 0 R /Prev 60435 /ID [<10e5b1f5a8d4f08349b7ea54b043e70f><10e5b1f5a8d4f08349b7ea54b043e70f>] >> startxref 142412 %%EOF 19 0 obj << /Type /XObject /Subtype /Image /Name /Obj19 /Width 1679 /Height 2192 /BitsPerComponent 1 /ColorSpace /DeviceGray /Filter /CCITTFaxDecode /DecodeParms << /K -1 /Columns 1679 >> /Length 25184 >> stream WXr3vU+aH4ZGl(S(^Fd+ֈ;JGaL #>G#0 "'9@?]Om4n B&_wrM곺д;>O[3=:ׯH}&;SX [A"xFٙȐŮ\ϑ lVaٯ-G\6f= $ħHhBѣ Fv &ihCGvXF\Z3w[ ACGwZ;gwG?).4Ol&o6]eAnɻIpĨMMD}'e8uLqI%g. çIޚQI'wIMӾh{֓|pnit_Z uz WL/vo ~\/vn{H=k~p_q K]㭱_} 4kKo}ִ1I}Eotp? 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Tj /F3 9.5 Tf 1 0 0 1 127.80 583.20 Tm <7468726F75676820> Tj /F3 9.0 Tf 1 0 0 1 163.44 583.20 Tm <74686520> Tj 1 0 0 1 178.92 583.20 Tm <4465706172746D656E7420> Tj /F3 10.0 Tf 1 0 0 1 231.48 583.20 Tm <6F6620> Tj /F3 9.5 Tf 1 0 0 1 243.36 582.84 Tm <5269736B20> Tj 1 0 0 1 265.32 582.84 Tm <4D616E6167656D656E742E20> Tj /F3 9.0 Tf 1 0 0 1 327.96 582.84 Tm <54686520> Tj 1 0 0 1 346.68 582.84 Tm <747970657320> Tj /F3 9.5 Tf 1 0 0 1 371.88 582.84 Tm <6F66736572766963657320> Tj /F3 9.0 Tf 1 0 0 1 419.76 582.84 Tm <7468617420> Tj /F3 9.5 Tf 1 0 0 1 438.48 582.48 Tm <7265717569726520> Tj /F3 10.0 Tf 1 0 0 1 471.24 583.20 Tm <7072696F72> Tj /F3 9.5 Tf 1 0 0 1 83.52 571.68 Tm <617574686F72697A6174696F6E20> Tj /F3 8.5 Tf 1 0 0 1 141.84 571.32 Tm <61726520> Tj /F3 8.0 Tf 1 0 0 1 157.68 570.96 Tm <617320> Tj /F3 10.0 Tf 1 0 0 1 169.20 571.32 Tm <666F6C6C6F77733A> Tj /F3 15.0 Tf 1 0 0 1 83.52 547.92 Tm <2E20> Tj /F3 11.0 Tf 1 0 0 1 96.12 546.48 Tm <416C6C20> Tj /F3 9.5 Tf 1 0 0 1 112.32 546.48 Tm <686F73706974616C20> Tj /F3 9.0 Tf 1 0 0 1 148.68 546.12 Tm <61646D697373696F6E73> Tj /F3 13.5 Tf 1 0 0 1 91.44 534.96 Tm <2E20> Tj /F3 9.0 Tf 1 0 0 1 99.36 533.52 Tm <5363686564756C656420> Tj 1 0 0 1 145.44 533.52 Tm <61646D697373696F6E7320> Tj 1 0 0 1 195.12 533.16 Tm <6D75737420> Tj /F3 8.5 Tf 1 0 0 1 218.52 533.16 Tm <626520> Tj /F3 9.0 Tf 1 0 0 1 231.12 533.16 Tm <617574686F72697A656420> Tj /F3 9.5 Tf 1 0 0 1 278.28 533.16 Tm <7072696F7220> Tj 1 0 0 1 300.96 532.80 Tm <746F20> Tj /F3 9.0 Tf 1 0 0 1 312.12 532.80 Tm <656E7472616E636520> Tj 1 0 0 1 350.28 532.80 Tm <746F20> Tj 1 0 0 1 361.08 532.80 Tm <74686520> Tj /F3 9.5 Tf 1 0 0 1 376.92 532.80 Tm <686F73706974616C2E> Tj /F3 12.5 Tf 1 0 0 1 91.44 522.00 Tm <2E20> Tj /F3 9.5 Tf 1 0 0 1 99.00 520.56 Tm <466F7220> Tj /F3 9.0 Tf 1 0 0 1 116.28 520.56 Tm <656D657267656E637920> Tj 1 0 0 1 165.24 520.56 Tm <61646D697373696F6E732C20> Tj /F3 10.0 Tf 1 0 0 1 217.44 520.20 Tm <6E6F74696669636174696F6E20> Tj /F3 9.0 Tf 1 0 0 1 268.92 519.84 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name* drugs. Prescriptions not filled bythe Cvs/Caremark system will not be covered under the Plan.*This is the co-payment when a name brand is purchased due to no generic being available, however ifastudent chooses a name brand over a generic drug, the student will be responsible for the generic co-payment plus any difference in cost between the two medications.UTILIZATION RE\rlEW: All services that require pre-admission review or prior authorization musl beprocessed through the Department of Risk Management. The types ofservices that require priorauthorization are as follows:. All hospital admissions. Scheduled admissions must be authorized prior to entrance to the hospital.. For emergency admissions, notification must be within 48 hours or the next business day.o All outpatient surgerieso Home health services, skilled nursing facilities. Orthotics and purchase or rental of durable medical equipmentPlease refer to the Plan Document for a complete description of required authorizations. Participants inthis Plan must follow the pre-admission review process in order to receive full hospitalization benefits.IF A PARTICIPANT DOES NOT FOLLOW THE PRE-ADMISSION REVIEW PROCESS.HOSPITALIZATION BENEFITS WILL BE REDUCED BY 5O%.SUMMARY: This is a summary of the coverage available under the Ƶ Student Health Plan. In orderto fully understand your Plan benefits you will need to obtain a Ƶ Student Health Plan Document,which will describe all ofthe Plan coverage, limitations, and exclusions. We are also enclosing aSchedule of Benefits for your reference. 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<323525> Tj /F3 6.5 Tf 1 0 0 1 484.92 432.36 Tm <35302E2F6F> Tj /F3 8.0 Tf 1 0 0 1 484.92 420.12 Tm <353025> Tj 1 0 0 1 484.92 408.24 Tm <353025> Tj 1 0 0 1 482.40 396.36 Tm <37303025> Tj 1 0 0 1 482.40 384.12 Tm <37303025> Tj 1 0 0 1 484.20 371.16 Tm <353430> Tj /F3 7.5 Tf 1 0 0 1 468.72 360.36 Tm <4E6F20> Tj 1 0 0 1 481.32 360.00 Tm <436F766572616765> Tj /F3 8.0 Tf 1 0 0 1 483.84 347.04 Tm <733430> Tj 1 0 0 1 468.36 335.88 Tm <4E6F20> Tj /F3 7.5 Tf 1 0 0 1 481.32 335.88 Tm <436F766572616765> Tj 0.00 Tc /F3 8.5 Tf 1 0 0 1 66.96 326.16 Tm <496E70617469656E7420> Tj /F3 8.0 Tf 1 0 0 1 104.04 325.80 Tm <53657276696365352F5375726765727920> Tj /F3 9.0 Tf 1 0 0 1 170.64 328.32 Tm <2A> Tj /F3 8.0 Tf 1 0 0 1 66.96 313.92 Tm <486F73706974616C53657276696365733A> Tj /F3 8.5 Tf 1 0 0 1 66.60 301.32 Tm <4F757470617469656E7420> Tj /F3 8.0 Tf 1 0 0 1 109.80 301.32 Tm <5375726765727920> Tj 1 0 0 1 141.12 300.96 Tm <466163696C69747920> Tj /F3 7.5 Tf 1 0 0 1 168.84 300.96 Tm <4368617267657369> Tj /F3 8.5 Tf 1 0 0 1 66.96 289.44 Tm <4D617465726E69747920> Tj /F3 7.5 Tf 1 0 0 1 106.20 289.08 Tm <4361726520> Tj 1 0 0 1 125.28 289.44 Tm <2D20> Tj /F3 8.5 Tf 1 0 0 1 130.32 289.08 Tm <6C6E70617469656E7420> Tj /F3 7.5 Tf 1 0 0 1 166.32 288.72 Tm <5365727669636573> Tj /F3 8.0 Tf 1 0 0 1 66.60 277.20 Tm <50726F66657373696F6E616C20> Tj /F3 7.0 Tf 1 0 0 1 114.48 277.20 Tm <4665657320> Tj /F3 8.0 Tf 1 0 0 1 133.20 277.56 Tm <2D20> Tj /F3 8.5 Tf 1 0 0 1 138.60 276.84 Tm <496E70617469656E74> Tj /F3 8.0 Tf 1 0 0 1 66.60 265.32 Tm <50726F66657373696F6E616C20> Tj /F3 7.0 Tf 1 0 0 1 114.48 265.32 Tm <4665657320> Tj /F3 7.5 Tf 1 0 0 1 133.20 265.32 Tm <2D20> Tj /F3 8.5 Tf 1 0 0 1 138.24 264.96 Tm <4F757470617469656E7420> Tj /F3 8.0 Tf 1 0 0 1 181.44 264.60 Tm <53757267657279> Tj 1 0 0 1 66.24 253.08 Tm <536B696C6C656420> Tj 1 0 0 1 92.88 253.08 Tm <4E757273696E6720> Tj 1 0 0 1 123.84 253.08 Tm <466163696C69747920> Tj 1 0 0 1 151.56 253.08 Tm <2D20> Tj /F3 7.5 Tf 1 0 0 1 156.96 252.72 Tm <333020> Tj /F3 8.0 Tf 1 0 0 1 168.12 252.72 Tm <64617920> Tj /F3 9.0 Tf 1 0 0 1 183.96 252.72 Tm <6C696D6974> Tj 0.00 Tc /F3 7.0 Tf 1 0 0 1 392.40 312.12 Tm <37306F796F> Tj /F3 8.0 Tf 1 0 0 1 392.40 299.88 Tm <31303025> Tj 1 0 0 1 392.40 287.64 Tm <37303025> Tj 1 0 0 1 392.40 275.40 Tm <37303025> Tj 1 0 0 1 392.04 263.52 Tm <31303025> Tj 1 0 0 1 392.04 251.28 Tm <6C6F6F766F> Tj 0.00 Tc 1 0 0 1 484.20 311.76 Tm <323525> Tj 1 0 0 1 484.20 299.52 Tm <323525> Tj 1 0 0 1 484.20 287.28 Tm <323525> Tj /F3 7.5 Tf 1 0 0 1 483.84 275.40 Tm <323525> Tj /F3 8.0 Tf 1 0 0 1 483.84 263.16 Tm <353025> Tj 1 0 0 1 481.68 250.92 Tm <726F6F25> Tj 0.00 Tc /F3 8.5 Tf 1 0 0 1 66.60 241.20 Tm <507265736372697074696F6E20> Tj /F3 8.0 Tf 1 0 0 1 114.84 240.84 Tm <4472756773> Tj 1 0 0 1 66.60 229.32 Tm <52657461696C20> Tj /F3 7.5 Tf 1 0 0 1 89.64 229.68 Tm <28757020> Tj /F3 9.0 Tf 1 0 0 1 103.68 228.96 Tm <746F20> Tj /F3 8.0 Tf 1 0 0 1 114.12 228.96 Tm <33312D64617920> Tj 1 0 0 1 141.84 228.60 Tm <737570706C7929> Tj 1 0 0 1 74.16 217.08 Tm <47656E65726963> Tj /F3 6.5 Tf 1 0 0 1 74.52 205.20 Tm <42726120> Tj /F3 7.5 Tf 1 0 0 1 87.48 204.84 Tm <6E64> Tj 0.00 Tc /F3 7.0 Tf 1 0 0 1 369.00 239.40 Tm <4C4C554820> Tj /F3 8.0 Tf 1 0 0 1 390.60 239.40 Tm <506861726D6163696573> Tj 0.00 Tc /F3 8.5 Tf 1 0 0 1 456.84 239.04 Tm <4F7468657220> Tj /F3 8.0 Tf 1 0 0 1 481.32 239.04 Tm <506861726D6163696573> Tj /F3 7.5 Tf 1 0 0 1 482.76 201.96 Tm <53346F> Tj 0.00 Tc /F3 8.5 Tf 1 0 0 1 66.24 192.96 Tm <44656E74616C536572766963657320> Tj /F3 7.5 Tf 1 0 0 1 126.72 193.32 Tm <2D20> Tj /F3 8.0 Tf 1 0 0 1 131.76 191.52 Tm <3535303020> Tj 1 0 0 1 153.00 193.32 Tm <706C616E20> Tj /F3 8.5 Tf 1 0 0 1 171.36 193.32 Tm <7965617220> Tj 1 0 0 1 190.80 192.24 Tm <6D6178696D756D> Tj /F3 8.0 Tf 1 0 0 1 65.88 181.08 Tm <50726576656E7469766520> Tj 1 0 0 1 108.36 180.72 Tm <436F76657261676520> Tj 1 0 0 1 145.80 180.72 Tm <696E636C756465737420> Tj 1 0 0 1 180.72 180.36 Tm <616E6E75616C20> Tj 1 0 0 1 208.44 180.00 Tm <6578616D2C20> Tj /F3 7.5 Tf 1 0 0 1 233.28 180.00 Tm <6E656365737361727920> Tj /F3 8.0 Tf 1 0 0 1 271.80 179.64 Tm <782D726179732C20> Tj /F3 7.5 Tf 1 0 0 1 298.80 179.28 Tm <6261736963> Tj /F3 8.5 Tf 1 0 0 1 65.52 168.84 Tm <746565746820> Tj /F3 8.0 Tf 1 0 0 1 88.20 168.48 Tm <636C65616E696E6720> Tj /F3 8.5 Tf 1 0 0 1 121.68 169.20 Tm <2832782F7972292C20> Tj 1 0 0 1 151.56 168.84 Tm <70657269646F6E74616C20> Tj 1 0 0 1 192.24 168.12 Tm <6865616C746820> Tj /F3 7.5 Tf 1 0 0 1 218.16 167.76 Tm <6173736573736D656E742C> Tj 1 0 0 1 65.88 156.96 Tm <426173696320> Tj 1 0 0 1 87.12 156.96 Tm <436F76657261676520> Tj /F3 8.0 Tf 1 0 0 1 124.20 156.60 Tm <696E636C756465736920> Tj 1 0 0 1 159.84 156.24 Tm <4E6F6E2D737572676963616C20> Tj 1 0 0 1 208.80 155.88 Tm <65787472616374696F6E732C20> Tj /F3 9.0 Tf 1 0 0 1 254.88 156.24 Tm <70756C706F746F6D792F726F6F74> Tj /F3 8.0 Tf 1 0 0 1 65.52 144.72 Tm <63616E616C2C20> Tj 1 0 0 1 89.64 144.72 Tm <616D616C67616D20> Tj 1 0 0 1 126.00 144.36 Tm <66696C6C696E67732C20> Tj 1 0 0 1 154.44 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73.08 Tm <726573756C7420> Tj /F3 7.5 Tf 1 0 0 1 160.20 72.72 Tm <696E20> Tj 1 0 0 1 168.84 72.72 Tm <35302520> Tj /F3 8.5 Tf 1 0 0 1 187.20 72.72 Tm <726564756374696F6E20> Tj 1 0 0 1 225.36 72.36 Tm <6F6620> Tj /F3 8.0 Tf 1 0 0 1 235.44 72.00 Tm <62656E65666974732E> Tj ET endstream endobj 28 0 obj << /Length 29 0 R >> stream Loma [inda University Student Health PlanPlan Benefits71712075 Coverage for Services Coverage at Non-at ƵMC & BMC preferred providers Out-of-pocket Maximum Co-paymentCo-payments for out-of-network services, any co-payments for prescriptiondrugs, medical supplies, rental or purchase of medical equipment,orthotics/prosthetics, wheelchairs, and any additional co-pavments forfailure to obtain pre-admission authorization are not included in the out-of,pocket maximum, In addition these services are not subject to the maximumout-of-Docket limit. ln Network53,000 per individual/S6,000 Family Out ot Network No Limit Outpatient ServicesIn Network Office Visit Co-paymentlOut of Network Office VisitlLab Services, X-ray & Diagnostic TestinS:Maternity Care - Outpatient VisitsOutpatient Emergency Room VisitUrgent Care VisitHome Care Services - 30 visit limit *Hospice Services *Professional CounselingPhysical/Occupational/Speech Therapy *Orthotics/Prosthetics - S1,000 limit *O/P MedicalSupplie5 *Rental or Purchase of Durable Medical Equipment - up to 90 days *Ambulance - Emergency Transport - S10,000 limitRepatriation Expenses - 510,000 limit *Vision ExamsOpticalMaterialsHearing Care - Audiometricians/Hearing SpecialistsHearing Aids s40700%s400S100 Co-payments40700%700%s10s4080%ao%80vo700v"700%s40No CoveraBes40No Coverage 50%so%50%25%25%25%700%so%25%50./o50%50%700%700%540No Coverages40No Coverage Inpatient Service5/Surgery *HospitalServices:Outpatient Surgery Facility ChargesiMaternity Care - lnpatient ServicesProfessional Fees - InpatientProfessional Fees - Outpatient SurgerySkilled Nursing Facility - 30 day limit 70oyo100%700%700%100%loovo 25%25%25%25%50%roo% Prescription DrugsRetail (up to 31-day supply)GenericBra nd ƵH Pharmacies Other PharmaciesS4o DentalServices - 5500 plan year maximumPreventive Coverage includest annual exam, necessary x-rays, basicteeth cleaning (2x/yr), peridontal health assessment,Basic Coverage includesi Non-surgical extractions, pulpotomy/rootcanal, amalgam fillings, & stainless steelcrowns SOD Dentistry Clinic Other Dentists700% No CoveragefOO% No Coverage700% No CoverageT000/6 No Coverage Quanerly 8uy-in ProvisionsExtension/Continuation Coverage - student onlyOne Dependent (spouse or child) of a covered studentTwo or more Dependent of a covered student Ssoo51,060 *Prior Authori2ation Required. 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