The General Agency

Sic Description::

SIC - Description

Number of EE's:

EE #

State:

State

Zip:

Zip

Major Medical Deductible::

Medical Ded

Major Medical Out-of Pocket:::

OOP

Family Max:

in fam max

In-patient benefit Maximum:

In pt max

In-patient deductible:

In pt ded

Waive in patient deductible?

Waive in ded

Out-patient benefit type:

Out Type

Out-patient benefit max:

Out Ben Max

Out-patient benefit deductible:

Out bene ded

Emergency room deductible:

out Er ded

Waive ER deductible for accident:

waive er ded