1 Administration Application – Faxes
Network Type: PPO (Preferred Provider Organization). No referral required. Precertification Vendor: HTH Healthcare: 888-323-1461 Drug Vendor: Express Scripts: 855-889-7708 COVERED SERVICE/PLAN CATEGORY IN-NETWORK OUT-OF-NETWORK GENERAL INFORMATION Deductible. Employee only - $1,500 . Family - $3,000 Employee only - $1,500 ................
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