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HomeMy WebLinkAboutFlorida Municipal Insurance Trust - RFP/006/18/CH Response - 2018 05 09/,I mk • womlk OIRIGUMAL r r Pill .wi Florida L eague of Cities, Inc. Florida Municipal hiiisurance Trust TABLE OF CON T'E a Letter of Transmittal Experience and Advantages Tab A Hometown Health, BenTek, UHC and Delta Dental Tab C Licenses, Biography and References Tab D Rates, Summaries and Required Forms Tab E May 11, 2018 Casey Howard HR & Risk Administrator City of Winter Springs 1126 East State Road 434 Winter Springs Florida 32708 Re: Request for Proposals: RFP/006/18/CH Group Health Insurance Plans/Services Dear Ms. Howard: In 1977, the Florida League of Cities established its insurance program at the urging of city officials, as they were unable to find affordable coverage. Today, the FMIT has grown to be one of the largest public entity programs in the United States, and is recognized for its outstanding service, broad forms of coverage with competitive pricing and value added services built by and for cities. The Trust has superior financial strength, highlighted by $475 million in assets, $195 million in surplus and approximately 600 members. The Florida League of Cities is your association. We have established our programs in response to the needs and requests of our membership. Providing these services has saved our cities money over the past 40 years. In addition to the cost savings, our proposal will show the significant improvement in services that have been implemented at the specific request of cities/members like the City of Winter Springs. These include: ➢ Insurance coverage provided by the League in partnership with United Healthcare without the additional fees associated with other fully insured programs. ➢ Hometown Health is a customized wellness initiative designed by and for cities exclusively. This is provided at no additional cost. ➢ Hometown Health screenings for your employees are fully funded by the League as part of your program. No additional cost. ➢ Hometown Health incentive awards for your employees are fully funded by the League as part of your participation. No additional cost. ➢ On -site services and health coaching provided by the League for your employees. No additional cost. ➢ Automated online enrollment and billing services provided at no additional cost. ➢ Claims administration provided directly by the League with claims management support by United Healthcare. ➢ League staff provides direct support on claims management — we know you by name. ➢ League plans are reviewed and fully compliant with the Affordable Care Act. ➢ The League is providing newsletters to members as well as quarterly webinars to inform City staff on the implementation and impacts of the Affordable Care Act. No additional cost. ➢ Regional workshops are continually held for member cities for personalized training on the Affordable Care Act. No additional cost. ADVOCATEyour Your WAMOHOPM _NSURAN(f TRAP"T',", These services are provided currently to members like the City of Winter Springs by League staff — your Association. Florida Statute 112.08 (2)(a) specifically authorizes your City to participate in the Florida League of Cities program. This was designed to assist municipalities in providing quality benefits at the lowest possible cost. The League has been able to grow and succeed through the support and input from our membership. The services have grown at the request of our members. We have succeeded by providing the highest quality product and services while providing great value. Thank you for your consideration Sincerely, Lindsey Larson Account Executive Florida League of Cities, Inc. 125 East Colonial Drive Orlando FL 32801 Phone: (920) 606-9716 Fax: (407) 425-9378 Email: ��au-so,nCei.),f�c.i.t�,@,s,.,cor.n Your your ADVOCATE I PARTNER Insurance Services As Administrator for the Florida Municipal Insurance Trust, the League has a longstanding commitment to superiority for its membership. ➢ Underwriting and Policy Services — Customized program are offered to address the changing needs and exposures of public entities. Policy pricing, processing and issuance are handled internally. ➢ Claims Management — Oversight of all claims administration is performed by Florida League of Cities staff. ➢ Member Services — Licensed league account executives are readily available to review, advise and place coverage with no added consulting fees or commissions. ➢ Enrollment and Billing — A comprehensive portal is provided to each Member prior to policy inception. ➢ Hometown Health —A Municipal specific health promotions program tailored to fit your specific wellness needs. * The following disclosure is made in accordance with Florida law: The Florida League of Cities serves solely as the sponsor and administrator of the self-insurance programs provided by the Florida Municipal Insurance Trust. The Florida Municipal Insurance Trust exists as an independently governed, separate legal entity under Florida law. your RESOURCE your 1your ADVOCATE PARTNER Health Insurance As Administrator for the Florida Municipal Insurance Trust, the League has a longstanding commitment to superior services for our members. We offer a wide variety of products and services that add value to our membership's insurance investment. How does your insurer compare? ➢ Pooling — Your cost = claims + overhead. The pooled buying power of the FMIT allows for lower overhead resulting in a long term lower cost provider with cost saving advantages not realized in the standard insurance market. ➢ Complete Benefits Package — Comprehensive benefits products designed specifically by municipal members for municipal members. ➢ Affordable Care Act Compliance — Hands on assistance in aiding members with maintaining compliance and providing updates on the changing health care industry. )o, United Healthcare — Direct partnership with the FMIT provides the broadest network and strongest discounts to lower claims costs. ➢ On-line Enrollment and Billing Service — Free, full service enrollment and billing suite to improve efficiency and reduce administrative burdens on your staff. ➢ No Commissions or Broker Fees — Services provided by Florida League of Cities employees that work solely on the Member's behalf lowering costs. ➢ A Carrier who knows you by Name — Service provided by Florida League of Cities employees that know you as a Member. Every League employee has a member first approach. ➢ COBRA Administration — Full service for all lines carried through the FMIT. ➢ Medicare Plan Administration — Segregates Medicare participant claims costs from the active employees to reduce impact on the ACTIVE EMPLOYEE RATES. yotcr RESOURCE ROAI� 71 T M�N�i I III nFq 1 giop e �[490k�dkk ��kJ'V�tl�4�b�B, Employee Health Promotion / Wellness Program As Administrator for the Florida Municipal Insurance Trust, the League has a longstanding commitment to superior services for our members. We offer a wide variety of products and services that add value to our membership's insurance investment. How does your insurer compare? ➢ Health Coach — Personal health coach assigned to each employee. ➢ Fully Funded Health Screenings — The Florida League of Cities funds health screening events held at your local government for no cost to you or your employees. ➢ Fully Funded Incentive Program — The Florida League of Cities funds your incentive program to attain proven results by funding the employee gift card bonus program at no additional cost to your local government. ➢ Custom Health Promotion/Wellness Website — Hometown Health website designed by and for municipalities exclusively. ➢ Continued outreach from the Florida League of Cities Wellness Coordinator — A Florida League of Cities staff member with a Master of Public Health assists in implementing your wellness program. ➢ Workplace Wellness Planner —Manual for your wellness program customized to your specific needs. ➢ Hometown Health Award — The pinnacle of wellness programming throughout the state of Florida. This recognition program is aimed at rewarding local government who have demonstrated success. ➢ Financial support from Florida League of Cities —Asa HIPAA compliant program (as required by the Affordable Care Act) the League helps reduce total program costs. your RESOURCE ADVOCATE PARTNER your your qpp _4 XV1, NO - A, A*r AN, Nggg eaWi FREE.' E,mploye�e Wellness P f,/" rA­ Hometown Health is an employee health promotion prograrn for municipalities that have group health insurance with the Florida Municipal Insurance Trust. The program was developed by the Florida League of Cities to help cities contain or reduce health care costs. 1--lornetown Health is easily incorporated into a workplace with hands-on assistance from Florida League of Cities wellness coordinators. They will assist your city every step of the way and provide all the materials needed to develop and run a successful wellness program. Participating cities receive training, pro- gram planning, financial support, and onsite screenings and flu shots at no cost to them or their employees. The Florida League of Cities partners with WebMD Health Services to provide a full suite of health and wellness products and services that support our goal of creating a healthier workforce for our members. Hometown Health rewards participants for completing a variety of healthy activities. The program includes two required "gateway" activities (Health Assessment and a health screening) and multiple options to earn a $100 gift card. The screening helps detect conditions and risk factors early, making them easier and less expensive to treat. Then, Hometown Health participants can complete a variety of activities designed to help them achieve a healthier lifestyle, Options include: Free Telephonic Health Coaching: One-on-one phone calls with a certi- fied health coach to achieve goals such as smoking cessation, weight loss, get- ting better sleep or managing stress. Digital Health Assistant: This online tool helps participants set and meet their health goals over a period of 28 days. Goals include smoking cessation, weight loss, healthy eating and stress management. Cumulative steps target: Participants can sync their Fitbit with Hometown Health to automatically record their daily steps. Health Challenges: Twice a year, Home- town Health offers challenges to en- courage healthy behaviors. -your your your RESOURCE *ADVOCATE PARTNER N Ol C d m m O C 01 N C 67 N � C Q ® a N a M N N N N C M C N C C N C C ,O. •O. .O. ,O.O C_ .a. +O+ 0 a0+ O a O Q O 3 N 7 N O la iC.. 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In 45 0 CS cn —a- 0c E417 0 0 0 CL CD < > w < o w u 0 0 m CL o m -0 0 IS o E LL M W 0 E 0) —x 0 0) c CD m o rn 7E 0 a) E mo 0 a) Co 0 0 (D 0 E M (D 0 E 0 4 q m U) w 0 0 0 01 0 0 G> 0 E W oE w P a) u 0CJ >0, cDQlb CL 0 o E E �o 0 m �6- 0 Onmline Enrollinent arid., Powered by BenTek E On-line Benefits Management System E User-friendly Administrator Enrollment Website E Electronic Billing and Payment Tracking E Customized Eligibility and Enrollment Reporting E Health Care Reform Compliance E Online Administrative Guides and Comprehensive Training Videos OPTIO�,,,J�""IAL FEATURES E Payroll and Personnel Auditing E 24/7 Employee Self -Service Website E Employee Administered Online Enrollment Software E Annual Open Enrollment Employee Portal Welcome AdvantageHometown Health At UnitedHealthcare, we recognize that health problems can have a tremendous impact on your life - both at work and outside of work. So we are pleased to offer you a new health plan that features a special support team with our "nurse in the family" approach, and various health services and resources at your fingertips when you need them. :; ii I z any tJrn v'^ You may contact the nurse team at any time if you have questions about: Your health and prescription benefits • A new diagnosis • Finding a primary care physician • A medical claim Simply call 1-844-518-8079 for help with any questions related to your health plan benefits. We are here for you. Receive support f€ onn experienced nurses Your new health plan from UnitedHealthcare includes a team of experienced nurses who offer support to you or your caregiver if you have a health condition that requires complex care, or if you recently received care at a hospital. If you plan to be hospitalized in the near future, a nurse may call you to discuss your upcoming procedure and give you information about what to expect when you go to the hospital. Following your hospitalization, the same nurse will follow up with you to support you during your recovery. If you suffered injuries from an accident or were diagnosed with a complex condition such as cancer or chronic kidney disease, a nurse may call you to discuss your needs and provide support to help you receive the care you need. If you are managing a chronic condition such as diabetes, asthma or coronary artery disease, our nurse team may contact you to help identify recommendations that supplement or support your care. ,f�ob If you are expecting a new baby, a nurse may reach out to you with information on managing your maternity experience. We understand the importance of relationships in health care. That's why each time you or someone in your family needs support, you will have the same nurse - or a "nurse in the family." If your nurse is not available, other nurses can help you too. Expbre avaiiab'e h(:,;a]-1.-', sedu ces and resources at your fingertips In addition to experienced nurses, your new health plan offers various resources to use whenever you need them. Simply visit the Health & Wellness tab and other areas on myuhc.come to find information and services available to you - at your convenience. The material provided through this program is for your information only. It is provided as part of your health plan. It should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. This program is not a substitute for your doctor's care. Program nurses and coaches cannot diagnose problems or suggest treatment. Your personal health information is kept private based on your plan's privacy policy ru:, jr,an� , o o"rvti;ls d hy cxr by e qh Ivrita r el hcmn In LNR2� i + ('r'rrrrrLr ai l; x a in?: Mfily; tear HIhNri.trMbvese,rces1,^,srnudbyldioed,Inc rrrt8^iiaffiBtA T');0Id Uvon HoaIt6 r a,,n Srorwes, l i, R'irUJ 3 r s"ram„".tJiff J"I W Uri .. ...0 . � UnitedHe�dfficare No Text Get stay ted you for bE-.'�ng a Lfii,,Jtede,,Al"m3are rneirnbeir, W(Uinderstand that rnanac ng heafth [,)ar'i 'Denefits and cointroHlhrig cos E:1'1N be cornp�!Hcated, That's wl)y we c)ffer a rrmmi-rer we[,Dsrte arad a ded�atec,,J tearrs maciy 't4D II,rep yoii.,r IJHICJE'.'n�,,Iand your rcoveragE.), treatrnenil optJons ancl 1-nore, hope this guide helps imake your heaI[th caire experience easleir. Coett us if you need help. Get started,. [InI tedIft.Amwe' 911-87726-04 . . ........... . .... . .................. ... . . . . ... ....... . ...... ....... . ...... . . . . . . .. . EMPLOYEE SMITH Samoa W,1h Fb SPOUSE SMITH CHILDI SLUTH CHILD2 SMRTH CHILD3 SMITH WQi!dHN-)Whffor0 jPkm Nlwe� LWO E-trj Example only. Your costs may vary. How to'llind youi- con,i�Iplete plain detalis. ID ar�,d g�,oup nunrtbeir Use these when registering on myuhc.com or calling with questions. Your cost for a covered service (usually due at your appointment). L*,,w iA t# my&!!%c.c%m t* %ee X92.11D,, #!IZA riderp—, 2MeAd.MeAts, re4,uirev� notices and welcome materials. You can also request printed copies at no charge by calling the member number on your ID card. Get started Regilster for rnyuhc.corri! Gell,', 24/7 or­fdirP,,e access to yotiir hea!fi',­,�, plam, Set up your myuhc.com account today. It's a personalized website that helps you access and manage your health plan and health information. Use it to: • Find network doctors and facilities. • Check your coverage and claims status. • Review preventive care services. • Print a temporary ID card. • Receive two award -winning monthly enewsletters: Healthy Mind Healthy BodyO and Benefit Awareness News. Set tocli"Iay, o 1. Go to myuhc.com. 2. Click on Register Now. You'll need your ID card or your Social Security number and date of birth. 3. Follow the step-by-step instructions. D 3 Download ttie UnitedHe6fthcaDDT e Hea!t[�AMe' mobile app. o,,r,#),Ahe­go a,cces,s,,, GD HealthWe puts your health plan at your fingertips. Download it for free today to use the myuhc.com features listed above. Plus, view your digital ID card, find nearby care and more. Wr,itclh shirt irideos about: • Getting started with your plan. • Using your benefits. • Avoiding cost surprises. If you need care. mol Filind a network pir"'ovider, How do you find onel 1 to cmercd yar,fiyse��ylocaflon andmyuti.comnpft other pilions, like qualificaboins. You cain get addiflonai trifoinnation about doctors, understand ycxjr covorage and iearin which services Imay r(:,q,Jire approvai, . .... .... .. Take advantage of network, care. Network docAors, rnentall health professon6ls, hospitals, ck-Ocs and iabor,--Aortes charge 6scounted rates, which typGina liy saves you trioney, Even ffyour Iplan afllows yoiu to receive care oritside of' youir inetwork, be aware that it oar Ad COSt YOU rnore. .......... . fa', Choose with confidence. 1-he Unitoad�i--iealth Prernliurnl'l 1prograalrm evaklates doctors 41 17 pirernklIrrl spec4lfies Which repiresent 48 SLAb-speciafties Iusing quality arld cost efficiency standards. it was created to Iheip r"nembers make rnore iinfoirnned and persoinahy appiropriate cho'Bcesfor th61r rrtedicW care. Find a Unitedlleaith Flreirnkmn piroviderat rnyulic,com, With sorne plans, your out-of-pocket costs may Ibe less When YOU Use LkiftedFleafth Pirefflklrllu Care Physicians. Check YOLAr health 1piaann docurnents for detaHs, J �Need hospital care? Talk tO YOUr doctoir first to deteirrnhie which hospital can ima.ei youir rnedical orstirgicai needs, You our YOLAr doctor meaty linen required to notify UnitedFlealthcaire biefore you're acknitted. Chocrse a i,,irlrnary cmv ph,piclain (F)IOPI), Akhough your Ipiaarn may not reciurrie you to choose a PCP, it's a-.i good idea to have one rnalin doctor with in-depth knowIledge of your Iheaatth to hMp gutrle you on the best 1paath of care, Find one at mytiltic.com or cafl the tori-fir(,.,e rnea)bev nuinnber on your IIID card, Sclht-Wi,ile your pireventive care scirn rndruhrigs,, Most United HeMthcare Ipla ins 1pay 100 Ipercent of the cost of cevtarn preventive care seiMces millffi as networlk provider. Olh&* your heafth plan docurrients Moir detaflls. Visit uiicprevq.3iritivec�mi-(a,coirrm to find age- aind gender-appirophate preventive care recornimendafloins foir evevyorhcoveired uindeir YOUr pran, [f you, 0 ( All Kru")''itivviihere �to go,,,),, With many options for getting care, how do you choose? This chart may help you understand where to go for what - and how you can save money. 244'wootgr 14 urse PHrr,mry Cav'e�, M'ryslkciar"� You can speak with a registered nurse 24/7. Call the phone number on your ID card to get started. A Virtual Visit lets you see a doctor using the camera on your smartphone, tablet or computer. YOU can even get a prescription sent to your local pharmacy, all in 30 minutes or less. Selecting a PCP to help manage your care may help save you both time and money. Your primary doctor may provide preventive carp, treat more chronic conditions, access your health records, manage your, medications and refer you to a specialist, if needed. • Choosing appropriate medical care • Finding a doctor or hospital • Understanding'treatment options • Supporting a healthier lifestyle • Answering medication questions • Allergies • Bladder infections • Bronchitis • Cough/colds • Diarrhea • Fever • Pinkeye • Rashes • Seasonal flu • Sinus problems • Sore throat • Stomachaches • Checkups • Preventive services • Minor skin conditions • Vaccinations • General health management • No additional cost to you. • Call 24/7. 24-hour nurse is for informational purposes only. - Often requires a copayment and/or coinsurance. Services may not be available in all states or for all groups. See back page of this guide or go to myuhc.com to learn more about Virtual Visits. • Often requires R copayment and/or coinsurance. • Normally requires an appointment, • Usually little wait time with scheduled appointment. Not all services may be, included in your health plan. Please refer to your health plan documents. Cost and time information represent averages only and are not tied to a specific condition, level of coverage or treatment. Your out-of-pocket costs will vary based on plan design. Check your plan documents for specific coverage details. M 0 if yci,,j) rieed, care �0 n� ve� In I e rt C 0"'i" Visit aconvenience ~ Common infections ~ Often requires acopaymmnt CammClinUc care clinic when (such amahepthroat) and/or coinsurance similar io you can't see your ° Minor skin conditions office visit, doctor and your (Such aepoison ivy) " Walk-in patients are welcome health issue isn't , Vaccinations with noappointments necessary, ~�~=� urgent. Those clinics , Pregnancy tests but wait bmy *aoun«a� oeo�enin�oeo. ^ Minor injuries ° saeohea Urgent Care Urgent care ieusually ° Sprains ° Often requires acnpnymem ideal when you need ° Strains and/or coinsurance that may be care quickly, but it's »ntanemenJencY ^ 8moUcu�rha1maynead h|�horthananoffio�vio� � °Walk-in afew stinchea patients are welcome, but (and your doctor isn't ° Minor waiting periods may belonger ea available). Urgent rana patients with more urgent needs centers treat issues that , Minor infections will betreated first, amn'tlife+hmatoning, ° Minor broken bones The ERisfor life- ~ Heavy bleeding ° Often requires ahigher Rmmmm(ER) threatening orvery " Large open wounds copoymentand/or coinsurance. serious conditions that ° Sudden ohangeinv�ion ° Open 24/7,but waiting periods require immeUi�ooam. , Chest pain may bolonger because patients This i»also when t» with life -threatening emergencies ~~~�~ oe|l81l oryour local ° Sudden weakness »r will be. treated first, emergency number. trouble talking ° |fyou're inatrue medical ° Major burns emergency, arid you goW ^ Spinal injuries anetwork oroutuf-network ° Severe head injury emergency room for care, ° Breathing diffinu|ty the same oopaymantand coinsurance levels will apply. ~ Major broken bones However, you may pay higher ouuzf-uooketcosts ifyou go/oon nu4of-netwwrkemergency room. Ftl-fcflri�g car4,,,,,,,, w1l Tani you ameƒk avcAjing, Call the member phone number on your ID card to find providers near you, and to learn if any restrictions apply. sliUK c,'Jedding where to go'? Call the toll -free member phone number on your ID card (TTY 711). Not all services may be induced myour health clan. Please refer to your health ;flandocuments, Cost arid time information represent averages only and are riot tied to a specific condition, level of coverage or treatment. 00011[1011010%% N 400 f Nuns Q3, i�e ) ��j 4: � MY %11. 1 ,:."Ite costs, Know your costs before getting care. You can estimate and compare fees for an upcoming treatment or procedure on myuhc.com. Your estimate shows out-of-pocket expenses based on your plan and current benefit status. * United Healthcare Internal Claims Analysis, 2015, eo 000"Am % r P re a, re YC) L"! 11 V I IIILG 4 .0,ol What to bring: - Your health plan ID card and one form of picture ID, such as a driver's license. - A list of medications you're taking, 0 Records from previous visits. a Questions you want to ask your doctor. Ne�ed UnitedHealthcare Insurance Company on behalf of itself and its affiliates does not discriminate on the basis of race, color, national origin, age, disability, or sex in its health programs or activities. To request a document in another format or to get assistance free of charge, please call the toll -free member phone number listed on your health plan ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m. ET. If you believe that we have failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by mail or email: United Healthcare Civil Rights Grievance P.O. Box 30608 Salt Lake City, UT 84130 If you need help filing a grievance, please call the toll -free member phone number listed on Your health plan ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m. ET. You can also file a complaint directly with the U.S. Dept. of Health and Human Services online, by phone or mail: • Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Complaint forms are available at www.hhs.gov/ocr/off ice/file/indox.htmi. • Phone: Toll -free 800368-1019, 8OG-537-7697 (TDD) • Mail: U.S. Dept. of Health and Human Services 200 Independence Avenue, SW Room 509F HHH Building Washington, D.C. 20201 ,"I"ii.lp yfoxgeeie/.....jo"oucvcar. e, rir Know how clain'Pis are paid. lfflmrt� YOU see a netw(,Yr* doc,tor': . .. .. .. . . . . . . . . . Claims are submitted for you and You may be asked to pay some or all of the bill before you leave. United Healthcare will process the claim to: • Determine whether the claim was for eligible preventive care, so it can be paid 100 percent. • Make sure it's an eligible expense under your plan, • Make sure the service is charged at the discounted network rate. %AltiervyroU see ain If your plan allows visits to out -of -network providers, you may be asked to pay some or all of the bill before you leave. • If the doctor doesn't submit your claim, you'll be responsible for doing it. • Find medical claim forms and instructions on myuhc.com. • Remember, discounted rates don't apply to out -of -network doctors so you may pay more. IN 1PONNNINEEMSOM MHOWN MA W)ffill � � N9011)(111 N NO) SOINJAM11 ERB OF lif] W111108111 I I I I I I I I I I I I I 11131 if I l Follow your claims from start to finish, and track payments you've made to health care providers in one place. You can also pay your bills online with the Make Payment feature at myuhc.com, ��), ro b e r'tj ij wi it, Gh ,,f), � c ll a u f ? Information about the appeals and grievances process can be found in the Claims & Accounts tab on myuhc.com. You can also call the toll -free member number on your ID card, TTY 711, ill U�V Y), U �rii a e rs A I i nti -Eand' vour 0)) "0 Iffiealth sta:`I�`,,:,,ements. avftf)) We'll send you health statements when you or one of your covered dependents use your health plan. You can see all claims processed for that period, plus your network and out -of -network balance and deductible information. Z-111W IM, 0gaNbvea Dry Winter Skin Member ID 012345678 Statement Period 11n7116.01 M 2117 W". waalfi& —d. mn y pt.* -..g fm — N."W— VAA. -- - "y feel qX4, i1 mob &0 ca uW dry Ak� uhappftl Ups end Hares Mack To amd ­fl Pr(kfwfw fA­ 01— wc d'int, It. V 11r4. fth .,V. w.t. _t.,w A tw, mcka"s oftm mid un rV balm bid m" smW. A h­W&ov w Wh6p by 9dding Avisturt W tho m in yww hwo H W" V*d thw {te* VW sr''ffi cwl,­ 0, bWS,Wf}lk5I8M,'fl YO. O.W, ModlUl daIMS Whom 03MOnU may be -Mad ft= VW: Medical claims where payments may be needed from you; Cbai.q woc.&scd berween I Itl 7116 1 o 0 1 /1 V1 7 Pay your Applied To provId"r(s) when Deductible I ",bill you' I VOS11 6 — I., BRADLEY w.,Wnd by TEST PROVIDEN 8R.1; S303ba pq,,,9, S%36-62 .... .. . ......... i ...... . . . . ............ . F_ 00 9­b� 0.— .1., w 0. M.6.1 CW. D.W11 ­fi.. .1 W. d.­� th. E01-11- 0 64.$IM Mm� 1�tow to ,ball .,Oir'frijiO, iri'. I'VI( R,) Your unique number that protects your Social Security number. Your health plan statement during a specific time, yo�,u), may o,�,mn.",., The amount you need to pay your health care provider if you didn't pay at the time of services, and the portion that's applied to your deductible. If you're dissatisfied with the handling of a claim processing issue by UnitedHealthcare or any other experience with United Healthcare, you may file a complaint verbally by calling the toll -free member number on your ID card, or in writing through the Medical Appeals and Grievances information on myuhc.com, RWMs and mspmmUMes Rights and responsibilities. You hame the Hght to: Soc, Vc,,,atcd msppc;1and dignRy by &..tteplw,I dHealuPisar';ara Ira r.3nm irk, n eboNo "e k dco;h:>rs amKiRw hmMwme pdmGyd& dor Greab'nenis, desUs ,ind pro" a,dwos yu,r tnccive" Soo Nofl, o uf Flaivacy Pmct'ices in your benefit pbn docume.mts 9ar a de„icrlp6cn of Nvv Uni�dHeafflwve p'wotexls yow pni-sooI N,,,nW) infrhmnation Vo�oe concems aLosA Rw ague mA owe Wnr rHw�eive, Re,y ccn npaink,, mW mWeb nm=v*q Wor hodM p Am and Hw c m e pRMdwi toycw, RE�cek,,�fimcfly hc,!spnr s�e,; loyour "xvc(arns • Cancfldly di�;CtOS VVN) YOUr dcctofloe ,,:gpnplate, and medcaly necessary op10ns, for your cn wbwn nqwGns of ccxof ur bonefit covonaqe • Access dodu's, @toalfl-i czve pnn)fes6ict iais ,end troaRJ-1 Uwe WdMins, FAWlMe M dml(ms Mod ymmum wWqxxv doc�toarRJ c0iet kaa raft)"tr t we, pioolI ssr -fls, * f4m%ze anJ mdm mmmma &ohm mqwkQ Me crgarflz,afior i's pfAoJe& * Receive, irJomialicIn nbot L)nited ieWfficarc, ow r,cnkcs, netwok doclow Is m W hmM "mm pKmNs w6 Be N Awn md QuUt, at id mlusp ko, offiy aWedm= KM nod l Bare coverage cJecjsocons and cUrmt ammMq mMen aXAa9k. an Advunu, Dire cliiie toi desJgnate lt)e kdrol of cwre3 you irvdsif� ta re'ce;ve shmldyl,m b,come to-intle to oxpmss ya-a winhcrs, Wxm,," responsAl'Alitles: Know ; md confim i yout- bonoRs befom receivina,p ireutrieN, • ContLictran npprrq rh !No honakh cam prodkomMmA you have a medical rleed ocancem • Shm pwHD = ioaWi Cam, • Flay any necxossr)vy cWjvmM W Me hIe you mcp�ve tMWnM,C • JscI mry-,o,'ptcy ruimservices cmly fcx h tjujlcs and ffiat, hn t e judginI,k oas reasnrl,aje pensclln, mql iwrc ltllholed+ afi-, freatu'lent Uo avod j,",.,"apanJyto ife or PleaMl Flcrvidc irflorn "Wicn , x�.odp,� I Bar yoa a Fnflox,v ��ie �tqreeoHqmn kAnsKu am; quhAms of doctoom anl Nmaffli car. ,, prdossicmaks. 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Pohr df,,,mande�, A rtader a un int-,o pr6yappekz &e rmm6i,o do tcicpN,,mc sans ftais figuntM sur ve�,Ve card." iTaffik,, du do sah m do mm M re XtuWz my b to mho M PM3 71 1 Vbs stm to dva A Qkn,r-ajuda e lnfawv@f,�kr wri sp.o i dforna 8 sew cu�k�s, sow ldw iffn RguH para o n0rnero fk- Melone gmkuito clue, cccsta nocwiuo dc 10 do sour pB,qno he sao.Ac, presstono O.TTY711 yAa&powo ,Jo uzyskania bczr,,>Ui inform ao$ poi nocy we v, asnym jqzyku. Ro i dugi p O d hEVPt,9k Y1V MMEl ury0eszcztjny rva denyfikaf:,�yjrpj pLou i vvci�n0.'17"(71 1 Se katom das f ,ecbt, kc8leNcior! i &ik,, und hfixn),a5,)ncn n hmx,',-',pooche ;,u cdiAnm. 1ftn eirxn anzufmden rufai So odic: gob6honfreio %mmywh her QaKwwvAhwwg1mQs mHni Alkm Sh dh R I FY -C tl I- j� �R JZ fftQ -4-,, L QPQ I M T N k 1 bt0 A AR t zf f V 0) If K t F`dZgEgafVtLV6;4 .p )p6 A 'V— j.) .p. ., z Ll 4 'j&q1j, �PL 1.� ;.AU,�, u,. I TY /'I I . JLa tj -,,- J—:*— A fl ,I ol 1 ifl o cl p ottnrc, iht 0o :i h nfc H nr iulctn ie,,M tua h r q-p w r Po,r. dc:Nedere m cliiana fl mtnao tede4onhcci verde sndicaV,) sifla Uja tessem id,,,,)nbfk-,,qfiva del piano =Mo o pmh b 0, Dlsp)oc0ivJ pa non udo,,-�nti,/TTY� 71 l T -litedlieWtbearo' A When you don't feel well, or your child is sick, the last thing you want to do is leave the comfort of home to sit in a waiting room. Now, you don't have to. Use virtual visits when: A virtual visit lets you see and talk to a doctor from your mobile device or computer * Your doctor is not available without an appointment. Most visits take about 10-15 minutes and doctors can write a You become ill while traveling a prescription*, if needed, that you can pick up at your local pharmacy. And, it's part of your health benefits. - You are considering visiting a hospital emergency room for a non -emergency Conditions cariirrjonIII y treate dthroijugh a virtual visit health condition Doctors can diagnose and treat a wide range of non -emergency medical Not good far': conditions, including: * Bladder infection/ - Diarrhea Rash Anything requiring an exam or test Urinary tract infection - Fever Sinus problems Complex or chronic conditions * Bronchitis - Migraine/headaches * Sore throat Injuries requiring bandaging or * Cold/flu - Pinkeye e Stomach ache sprains/ broken bones Access fireual Asits Log in to myuhc.com® and choose from provider sites where you can register for a virtual visit. After registering and requesting a visit you will pay your portion of the service costs according to your medical plan, and then you will enter a virtual waiting room. During your visit you will be able to talk to a doctor about your health concerns, symptoms and treatment options. learn,, n ftion','. 1�1,ogirvto * Prescription services may not be available in all states. Access to virtual visits and prescription services may not be available in all states or for all groups. Go to rnyuhc. coin for (Trots information about availability of virtual visits and prescription services. Always refer to your plan documents for your specific coverage. Virtual visits are not an insurance product, health care provider or a health plan. Virtual visits are an Internet based service provided by contracted UnftedHeafthcare providers that allow members to select and interact with independent physicians and other health care providers. It is the member's responsibility to select health care professionals. Care decisions are between the consumer and physician. Virtual visits are not intended to address emergency or life -threatening medical conditions and should not be used in those circumstances. Services may not be available at all times or in all locations. Members have cost share responsibility and all claims are adjudicated according to the terms of the members benefit plan. Payment for virtual visa services does not cover pharmacy charges; members must pay for prescriptions (if any) separately. Insurance coverage provided by or through Unitedl-lealtlicare Insurance Company or as affiliates. Administrative services provided by United HealthGare Services, Inc. or their affiliates. MT-1027900.0 6/16 C 2016 United HeafthCare Services, Inc. 16-2211 IM16667 „pfV' S IIX>✓�pOl���nd Y ���I ( �� �� '�U�U ��ua'yd (�'�@�s.u/e�G�g a��/�4ma "�'quuaaxmrlle��'�Mr¢uvauun%u, uminr Delta Dental PPOsm PPO O Visit a dentist in the PPOI network to maximize your savings.2 These dentists have agreed to reduced fees, and you won't get charged more than your expected share of the bi11.3 Find a PPO dentist at deltadentalins.com.4 Set aii7i +.SIndkrij g accoji,,grrrt Get information about your plan anytime, anywhere by signing up for an Online Services account at deltadentalins.com. This free service, available once your coverage kicks in, lets you check benefits and eligibility information, find a network dentist and more. <� II i,"v i Il Dn� i i u I! t wrY I E1'� You don't need a Delta Dental ID card when you visit the dentist. Just provide your name, birth date and enrollee ID or social security number. If your family members are covered under your Save with aI .r` X � jl�.rcuunl "u e}m$mrutr'� dR vnd'lll r''��� wne I.. ... ��E III Cr� plan, they will need your information. Prefer to take a paper or electronic ID card with you? Simply sign in to Online Services, where you can view or print your card with the click of a button. &4,1, ”, uaP P ''2 a ge If you're covered under two plans, ask your dental office to include information about both plans with your claim, and we'll handle the rest. of Did you start on a dental treatment plan before your PPO coverage kicked in? Generally, multi- stage procedures are only covered under your current plan if treatment began after your plan's effective date of coverage.5 You can find this date by logging in to Online Services. III lI Um lI ' Visit deltadentalins.com/welcome. f(`raa�mumiluy,� t/ tl�l� (k `I�1//1���� �MNBhY(il��'�II ' In Texas, Delta Dental Insurance Company offers a Dental Provider Organization (DPO) plan. 'You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-PPO dentist. Network dentists are paid contracted fees. 3You are responsible for any applicable deductibles, coinsurance, amounts over plan maximums and charges for non -covered services. We recommend verifying before each appointment that your dentist is a PPO dentist. s Applies only to procedures covered under your plan. If you began treatment prior to your effective date of coverage, you or your prior carrier is responsible for any osts. Group- and state -specific exceptions may apply. Enrollees currently undergoing active orthodontic treatment may be eligible to continue treatment under elta Dental PPO. Review your Evidence of Coverage, Summary Plan Description or Group Dental Service Contract for specific details about your plan. LEGAL NOTICES: Access federal and state legal notices related to your plan at deltadentalins.com/about/legal/index-enrollee.htmi. Copyright 2016 Delta Dental. All rights reserved. I-il...,,,-,PPO 496083E. (rev. 5/16) J� e e ��a '�'�� n'�ranmuoAG" ��i"miu,mr. I`�Wannmaut i -roh�,�aavminm2!!� DeltaCare° USA provided by D_- Dental benefits made easy! When you enroll in a DeltaCare USA, plan, you'll choose a primary care dentist from our network of carefully screened, private practice dentists. You must visit your primary care dentist to receive benefits.z • No restrictions on pre-existing conditions (except work in progress) • Access to specialty care and out -of -area emergency care A partner in oral health Your DeltaCare USA plan encourages regular dental care with an extensive list of covered services to help you stay healthy. Budget -friendly costs With your DeltaCare USA plan, there are no surprises. You'll know your copayments, and your out-of-pocket costs are clearly defined before treatment begins. • No deductibles or maximums3 for covered services • Pay only your copayment (if any) at the time of treatment Convenient services We make it easy for you — there are no claim forms to complete, and no plan ID card is required to receive treatment. • Access plan information online • Low or no copayments for services like • Change your primary care dentist by phone or cleanings and exams online Delta Dental Insurance Company provides benefits as a Prepaid Limited Health Services Organization as described in Chapter 636 of the Florida Statutes. LEGAL NOTICES: Access federal and state legal notices related to your plan: deltadentalins.com/about/legal/index-enrollee.htmi DeltaCare USA is underwritten in these states by these entities: AL — Alpha Dental of Alabama, Inc.; AZ — Alpha Dental of Arizona, Inc.; CA — Delta Dental of California; AR, CO, IA, MA, MI, MN, NE, OR, RI, SC, WA, WI — Dentegra Insurance Company; DC, DE, FL, GA, KS, TN, WV — Delta Dental Insurance Company; HI, ID, IL, IN, KY, MD, MO, NJ, OH, TX — Alpha Dental Programs, Inc.; NV — Alpha Dental of Nevada, Inc.; UT — Alpha Dental of otah, Inc.; NM — Alpha Dental of New Mexico, Inc.; NY — Delta Dental of New York, Inc.; PA — Delta Dental of ennsylvania; VA — Delta Dental of Virginia. Delta Dental Insurance Company acts as the DeltaCare USA administrator in all these states. These companies are financially responsible for their own products. x Verify that the dentist is your selected DeltaCare USA primary care dentist before each appointment. Plans with an Accidental Injury Rider have a $1600 annual maximum for accidental injury. Consult your Evidence/Certificate of Coverage. 10 114 111 ., I We keep you smiling deltadentaIins.com/enrollees SCFLSTD Administered by Delta Dental Insurance Company HL_DCU_FL48N_V17_W_EN_2.14.17_LTR Answers to frequently asked questions about your DeltaCare USA plan GETTING STARTED 1. How do I enroll in a DeltaCare USA plan? Simply complete the enrollment process as directed by your benefits administrator. Be sure to select a primary care network dentist for yourself or your dependents, and indicate this dentist and the name of your group when you enroll. 2. How do I get started using my DeltaCare USA plan? Once we process your enrollment, we'll mail you welcome materials that will include: The name, address and phone number of your selected primary care dentist: Simply call the dental facility to make an appointment. Important note: In order to receive benefits under your plan, you must visit your primary care network dentist for all services. If you require treatment from a specialist, your primary care dentist will coordinate a referral for you. You can change your primary care dentist by contacting us. • Your Evidence/Certificate of Coverage (plan booklet): This useful document provides a thorough description of how to use your benefits, including covered services, copayments and any limitations and exclusions of your plan. • An ID card: This card is for your records only — you do not need to present it in order to receive treatment. 4. How much will my dental treatments cost? How do I pay? With your DeltaCare USA plan, some services are covered at no cost, while others have a copayment (amount you pay) for certain services. To find out how much a treatment will cost, refer to the "Description of Benefits and Copayments" in this brochure for a list of covered services and copayments. It's a good idea to bring your Evidence/Certificate of Coverage to your appointment in case you need to discuss your copayment for a service with your dentist. If you have any questions about the charges for a service, please contact our Customer Service department. If you receive treatment that requires a copayment, simply pay the dental facility at the time of service. CHOOSING A DENTIST S. How do I select my primary care dentist? When you enroll, you must select a primary care dentist from the DeltaCare USA network. To search for a dentist, use the "Find a Dentist" tool at deltadentalins.com and select DeltaCare USA as your network. If you do not select a dentist when you enroll, we will choose one for you. 6. Does everyone in my family have to choose the same primary care dentist? Your family members can visit the same primary care network dentist, but you do not have to. You may collectively select a maximum of three different primary care network dentists.z 3. How long will it take to get an appointment with my primary care dentist? 7. Can I change my primary care dentist? Two to four weeks' is a reasonable amount of time Yes. You can request to change your primary care to wait for a routine, non -urgent appointment. If dentist at any time. Simply visit our website and log you require a specific time, you may need to wait on to your Online Services account or call or write longer. Most DeltaCare USA dentists are in private to Customer Service. Change requests received by group practices, which generally offer greater the 2111 of the month will become effective the first appointment availability and extended office hours. day of the following month. ' In TX, three weeks is a reasonable amount of time to wait for a routine, non -urgent appointment. In TX, there is no limit. Each eligible family member may select his or her own primary care network dentist. 8. My dentist says she is a Delta Dental dentist, but she isn't listed in the DeltaCare USA directory. Can I still visit her for services? No. You must visit your selected primary care network dentist to receive benefits under this plan. Delta Dental has many networks, and participation may vary — not all Delta Dental dentists are DeltaCare USA dentists. 9. What should I do if I need to see a specialist? If you require specialty dental care — such as oral surgery, endodontics, periodontics or pediatric dentistry — contact your primary care dentist to request a referral. Specialty dental services not performed by your selected primary care dentist must be authorized by us. You are responsible for any applicable copayments. GENERAL PLAN INFORMATION 10. If I'm traveling, is emergency treatment covered under my plan? You and your eligible dependents have out -of -area coverage for dental emergencies when you are more than 35 miles3 from your primary care dentist. Your out -of -area emergency benefit (typically limited to $100 per enrollee3 every 12 months4) is for services to relieve pain until you can return to your primary care network dentist. Standard plan limitations, exclusions and copayments may apply. 11. Can I access my plan online? Yes. Visit deltadentalins.com/enrollees to create a free, secure Online Services account. On our website, you can access your plan benefits and ID card, select (or change) your primary care dentist — and more. 12. Does my plan cover pre-existing conditions? What about treatments that are in progress? Treatment for pre-existing conditions (except work in progress5), including missing or extracted teeth, is covered under your plan. Treatment in progress includes services such as preparations for crowns or root canals, or impressions for dentures. If you started treatment before your plan's effective date, you and your prior dental carrier are responsible for any costs. Some DeltaCare USA plans may cover in - progress orthodontic treatment. 13. Does my plan cover teeth whitening? Yes. External bleaching is a benefit under your DeltaCare USA plan. Review your plan booklet for more information and talk to your dentist about your options. 14. Does my plan cover tooth -colored fillings and crowns? Yes. Porcelain and other tooth -colored materials are included in this plan. 15. What if I have additional questions about my plan? Please contact us for additional support. Our Customer Service agents can answer benefits questions as well as help you change your primary care dentist or arrange for urgent care referrals. See the back page of this brochure for our contact information. 3 In TX, there is no limit on the number of miles or on the dollar amount per emergency. 4 Exceptions may apply. Refer to your Evidence/Certificate of Coverage. s In TX, there is no exception for work in progress for covered DeltaCare USA benefits. Useful information Check out our SmileWay' Wellness program Find oral health resources, including a risk self - assessment tool, quizzes, articles, videos and a subscription to Grin!, our free dental wellness e-magazine, at mysmileway.com. Find a network dentist near you Use our convenient "Find a Dentist" tool and select DeltaCare USA as your network. • Find a dentist near your home or office • Narrow your search by location, specialty, languages spoken — and more Sign up for an online account Use your mobile device or desktop to sign up for a free, secure Online Services account. • Review your plan benefits • Access your ID card Underwritten by: Delta Dental Insurance Company 1130 Sanctuary Parkway Alpharetta, GA 30009 Contact us Need help? Let us know. Online: Visit deltadentalins.com/about/contact/ contactUs_ddic.html and choose the "DeltaCare USA Customer Service" form. Write to: Delta Dental Insurance Company 1130 Sanctuary Parkway Alpharetta, GA 30009 Call toll -free: 800-422-4234 Customer Service agents are available Monday through Friday, 8 a.m. to 9 p.m., Eastern time. Or, use our automated phone system, available 24/7. Administered by: Delta Dental Insurance Company 1130 Sanctuary Parkway Alpharetta, GA 30009 NOTE: This is only a brief summary of your plan. This brochure is not intended to replace your legally required plan booklet. The Group Dental Service Contract determines the exact terms and conditions of your coverage. Please refer to the "Description of Benefits and Copayments" and "Limitations and Exclusions of Benefits" in this brochure for a complete list of covered procedures, copayments, plan limitations and exclusions. You may also consult your Evidence/Certificate of Coverage, which will be mailed to you upon enrollment. If you wish to review an Evidence/Certificate of Coverage prior to enrollment, you may request a copy by calling Customer Service at 800-422-4234. Copyright 2016 Delta Dental. A.II rights reserved. HL.__DCU._SHELL_EN #92056M (rev. '7/I6 �Iam�ouaar�ra�y�M t pN�N{�p�INMyI��i' �[�ryg,ONtllldi�mAYaNhNp WIUNAIl1�^' !µ° �,,,N�"p„„�yn�.Al@IIIINIIgIll�rrj�fl�i {! " "�U��i1WI@m�ll.�� ,gO�IpJmlgl'�7!11 gAiuNUA�IP(y� �0 rfl6;��� ,�p,PlW�0�Y0BtiP�11�� uvn �Y� �pW'�'NPN,�IIb a^4ku"U�mv'MreXtiIV �ppronFlp 11� 'ry �1� 1 �NNA1\YPN I\VN � NtlIII �IkNNtth l �w I�IIAhntl 1W' ��u�R�Y,( ""�BII�Mai.tl NkNm�gm9,aVla QWi 14Bi� " OyIPtPORBl4' @N"IVilnl Want information about your dental plan? Take advantage of our web and mobile resources to: - check your eligibility • look up coverage details DliiQl�InIlnllillilillldlllliiiihl��o��littt�ttn��5��t��� • check claims Whether you're on a computer, tablet or smartphone, you can access all the information you need at your fingertips. 1. Visit the website 2. Access the mobile -optimized site 3. Use the free app vwmrn b wupmfl� �iuo7J^Wn p ed�,��mu�m�I�, � 9i¢s" �!�ma� �1ui�v i i M�IIYAi � We keep you smiling" es.deltadentalins.com deltadentalins.com/enrollees h e c k to hi le, s it e SmIFeUlny KIR, 1. Enter deltadentalins.com/enrollees on your computer's browser. 2. Browse the features listed below. If you haven't already done so, register for Online Services. Already got an account? Log in! �IM X Online Services (register or log in): See benefits, eligibility, deductibles and maximums; check claims; view or print an ID card B. Find a dentist C. Dental Plan Support Guide D. SmileWayO Wellness site I Available to Delta Dental PPO` and Delta Dental Premier' enrollees only. 2 Some features available to PPO and Premier enrollees only. 'USA„800-422-4234 Go rn (::) b i I e I 1. Enter deltaclentalins.com on your smartphone's browser. 70 2. Click the Visit Mobile M my �r, C'm Site button. M ID at u i�,, e s: A. Find a dentist B. View your electronic ID card C. Check deductibles and maximums D. See your benefits and eligibility E. Check claims Get tlrile app2 1. Open the App Store or Google Play. 2. Search for "Delta Dental." 3. Download the free app titled Delta Dental by Delta Dental Plans Association. e t LD r, e s,,,, A. Get a cost estimate B. Find a dentist C. Check claims E) See your benefits, eligibility, deductibles and maximums lic— Use a musical timer to brush for 2 minutes [,> E 1,,") E � I l, P'D A Sri) DE[ 1,At, Delta Dental of California: 800-765-6003 Delta Dental of Delaware, Inc., Delta Dental of the District of Columbia, Delta Dental of New York, Inc., Delta Dental of Pennsylvania (and Maryland), Delta Dental of West Virginia, Inc.: 800-932-0783 Delta Dental Insurance Company (Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas, Utah): 800-521-2651 lelta Dental Premier and Delta Dental PPO are underwritten by Delta Dental Insurance Company in AL, DC, FL, GA, LA, MS, MT, NV, TX and UT and by not -for -profit ntal service companies in these states: CA - Delta Dental of California; PA, MID - Delta Dental of Pennsylvania; NY - Delta Dental of New York; DE - Delta Dental of --laware; WV - Delta Dental of West Virginia. In Texas, Delta Dental PPO is underwritten as a Dental Provider Organization (DPO) plan. These enterprise companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies that together provide dental coverage to 73 million people in the U.S. The welosite deltaclentalins.com is the home of the Delta Dental companies listed above. For other Delta Dental companies, visit the Delta Dental Plans Association website at deltaclental.com. Copyright 2016 Delta Dental, All rights reserved EF30 #96083 (rev. 6/16) Welcome to your visil'on plan, ku rx,:)st c)[A Of YoLP it& �Uhits althcar,"" Need h6lp9 VISIt iiillytilwlcvisiol°iii.col,mi. I Cy u r toyour if ee,f I It")er vv"'Axik",� for 2,1,1, �,)ccxas do ,i[)out �#,.mr A',ibn I)Ian Flave a UnitedHeafthcwe heWth plan^? yrur vi!, x a n d I piuvicicv,, mid VISbri D on yc>ur i riubk-,, vvill"i III Unkedl lealthear e liealfl,AMOI apt' Call toff-firee. I 8OD-638-3 120, 1 1"Y''71 1 clon'l N,,,vo compl-dr`r fir d arusvvers",:, caH u, rvlmdq 1hruj(411"I 8 K) ,�jIM Find out what YOLUr * '0 vision �pla,n covers. Eye Your plan includes a fully covered exam. A copay may apply. Your plan uses Spectera Eyecare Networks, a national network of eye doctors, which includes optometrists and ophthalmologists. They are located at both private practice and retail settings. Network eye doctors can help save you money. be;t ef,,i t You get contact lenses, a fitting and up to two follow-up visits. Choose from popular brands, including some that are fully covered. rV lenses for dependent children are available at no cost. e,­vff Certain providers will offer a 20% discount on additional pairs of eyeglasses, including prescription sunglasses. y to yc,',)ur ,,:,,�an Take steps to protect,your eyes. 1��qnd ai,"i eye, doctoi, un your iiietwork? Choose from local and national network providers in Spectera Eyecare Networks. Here are just some of the well-known retail locations in your network: Log in to myuhcv1sion.corif to search by provider name, specialty or location. Sdhedule your annual eye exal�lm., Regular visits to an eye doctor can help keep your eyes healthy and improve your overall health. If you get headaches, eyestrain or blurry vision, it may be time for new glasses. In some cases, medications can cause these issues, but symptoms may be a sign of a more serious problem. An eye exam can help find any underlying causes. Discover nl�mre waysto save IIby LlSiHlng ills miyuhievillolln.com. AM,w'rRICNsBm-v"r�""""''"'I _ CUMV10 WMiMRMM 00"CA& EW 3"YASS WORT' Fof Eyes "'o,wouh.. WARBY PARKER A dilated exam lets your doctor look inside your eye and check your eye health. The exam can also show early signs of illness, even before other parts of your body are affected • State that you have vision insurance with U n ited Healthcare. • Give your name and date of birth, or • Show your vision ID card so the provider can verify your benefits. Save money at more than 550 Laser Vision Network of America locations.3 Order contact lenses at online for 10% off 'Plans may vary. Check your coverage at rnyuhcvision.corn to verify benefits, Not all providers participate in all plans. Check with your provider before using your benefits. Warby Parker add,,cl to the network effective January 201 & Network location count as of October 1, 201T r "i" Prk te') e' yiawr If there aren't any network providers within 30 miles of where you live or work, you may be able to see an out -of -network provider with network benefits. Log in to rnyUlicvision.com to learn more. fl/f for),D You don't need your ID card to use your benefits, but it can help your eye doctor know how to bill for services. Access your ID card from your computer or mobile device at MYUhavision,con't. F I i I I ,I Of, Buy high -quality digital hearing aids, starting at $699 each, through hi Healthlnnovationsg The cornparry does not treat members differently because of sex, age, race, color, disability or national origin. If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to the Civil Rights Coordinator. Online: UHC_Civii_Rights@uhc.com Mail: Civil Rights Coordinator. United Healthcare Civil Rights Grievance. P.C. Box 30608 Salt Lake City, UTAH 84130 You must send the complaint within 60 days of when you found out about it. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look e at it aga in. If you need help with your complaint, please call 1-800-638-3120, TTY 711. You can also file a complaint with the U.S. Dept. of Health and Human Services. Online. https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Complaint forms are available at http://www,hhs.gov/ocr/office/ file,/inclex.Intmi. Phone: Toll -free 1-800-368-1019, 800-537-7697 (TDD) Mail: U.S. Dept. of Health and Hurnan Services, 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.G. 20201 You have the right to get help and information in your language at no cost. 1b request an interpreter, call the toll -free member phone number listed on your health plan ID card, press 0. TTY 711. Tiede derecho a recibir ayuda a inforinaci6n en su idioma sin costa. Pam solicitar un int6rprete, Ilame al n6rnero de tel6fono gratuito Para miembros que so encuentra en Sid tarjeta de identificad6n del plan de salad y presione 0. TTY 711 MA Yg�* Jj R V, WAO 7 11 Quy vi o6 quj6n dLyyc gi6p fly v5 c9p th6ng tin ba'ng ngbn ngCr c6a quy vi mien phi. De y6u 6au dul th6ng dick vi6n gi6p 0, vui lbng gQi s6 di&n thoai mien phi d6nh cho h6i vi6n Aryc n6u tr6n th6 ID crivang trinh b6o hie'rn y t6 c6a q iiy vi, b9m s6 o. TTY 711 _j 0 1 _CF__-'�52f ��l _1__1 92-5 81-21 0101 u I _�_? -=,I Lr -LICE.Ea 0 I- I D l- 121 A [ 25 -2 918 1 !il N Ad 0 'Nt L. I D) ­.`_` Oil D I TH F � _i;_r� 21 L �1­ 'Lil Ld 81010 2. TTY 711 May karapatan kang makatariggap ng tUlong at impormasyon sa iyong wilka Pang walang bayad. Upang hUrniling ng tagasalin, tawagan ang toll -free na numero ng telepono na nakalagay sa iyong ID card rig planong pangkalusugan, pinclutin ang 0. TTY 711 Bbl wmeeTe npaI30 Ha 6ecnAaTHoe nOAyqeHme nomowti m 141-10opma4vi/I Ha BaWeMq3blKe. 4To6bi noAaTb 3anpoc nepeB0A`­1WKa n031301-114're no 6ecnilaTHOMY Homepy Tefre#Ha, yKa3@HHOMY Ha o6paTHOI�i cropOHe Babi "AeHT1,11i7HKaLAW01-41-10A KapTbI W Ha>KMIATe 0.)IMI-Ims TTY 711 Par'ya i J� '­J J ldky­Jl a '_;'3WI.0 j, d-Wl q l 5y aU- Z),ktl.LVb 711 (TTY) �i Ou gen dwa you jwenn bid ak enfbmascyon nan lang natif natal CLI gratis. Pou mancle you eni rele nirnewo gratis mannn Ian ki endike sou kat ID plan sante ou, peze 0. TTY 711 Vousavez le drolt d'obt.enir gratUiternent do I'aide et des renseignements dans votre langue. Pour demander & parler a Lin interpr6te, appelez le num6ro de t6l6phone sans frais figural-ASUr votre carte d'aff ili6 du regime de sours de sante et appuyez sur la touche 0. XFS 711. Vocb tem o direlto de outer ajUda o informaq5o em seu idioma e sem custos. Para solicitar um int6rprete, ligue Para o n6mero de teleforle gratuito Clue consta no cartbo de 10 do seu plano de sa6de, pressione 0. TTY 711 Masz prawo do uzyskana bezrAatnej informacji i pomocy we w1asnym jQzyku. Po usfugi tfurnacza zaclzwoh pod bezpfatny numer urnieszczony na karcie identyfikacyjnej planu rnedycznego i wci6nij 0. TTY 711 Sie habon das Recht, kostonlose Hilfe and Informationen in flier Sprache zu erhaften. Um einen Dolmetscher anzi-ifordern, rufen Sie die geb0hrenfreie Nummer auf 1hrer Krankenversicherungskarte an and drOcken Sie die 0. TTY 711 0 = ) ®*—his -e -+j-I t tt U , I'M-= tz: 1,) >G)ID t- TTY# L)j 1.4 l c t 9 4_5,A�i TTY 711 e,*4 J-1i I-) J—L- L,-fl Hai it diritto di otterere aiuto e inforr'nazionj nella tua lingua graturtamente. Per richiedere un interprete, chianna it numoro teleiforlico Verde indicato sulla tua tessera identificativa del piano sanitario e prel lo 0. Disposifivi per non udenti/TTY: 711 The hi Healthinnovationej hearing program is provided through Unitecidealthcare, offered to existing members of certain products underwritten or provided by UnitedHeallhoare. Insurance Company or its affiliates to provide specific hearing aid discounts. This is not an Insurance nor managed care product, and fees or charges for services in excess of tho,,.,,e defined in program materials are the member's responsibility. UnitedHeafthcare cons not Gncicirse, nor guarantee hearing aid products/servk;os available through the hearing program, This program may not be available in all states or for 811 group sizes, components subject to change. This policy has exdusjons, limitations and terms under which the policy may be continued in force or discontinued. For cost.,,, and complete details or coverage, contact UnitedHealthrare Insurance Compuny, United Healthcare vision coverage provided by or through Unlodi-lealthcare Insurance Cornpiny, located in Hartford, Connecticut, UntedHpalthogre Insurance Company of New York, located in Islandia, New York, or their affiliates. The contracting entity for Spectera Eyecarp Networks is Spectera, Inc, Administrative services provided by Spectera, Inc., United Healthcare Services, Inc. or their affiliates. Plans sold in Texas use policy form nUrnbor VPOI-.06,TX or VPOLA 3.TX and associated COG form number VCOC.INT.06.TX or VCOG.CER.13. I X, plans sold in Virginia use policy form number VP0L.06.VA or VPOL..13 VA and associated GOO form number VCOC.INT.06.VA or VCOCcER.1 3.VA. ff] Facebookcorri/United!Heafthcare t3 TWItterrnorn/kivic, IM instagram.corrVUnitedHpaitricarr: C3 YouTube.rom/Unftedl-lealthcare MT-1 112492.1 11/17 (a) 20'17 United ilealliCare Sevvices, Inc. 17-6085 10 United1lealthearEll"' Vsflon insurarice Discover myuhcv"ision.com Our easy -to -use self-service member website lets you easily verify your benefits and eligibility, find answers to frequently asked questions, locate a provider, access online offers and services, print a member ID card, and much more. Members log in here New Users register here Find a, provider usi ng zip code or cityand state k% 4-1- "Highest in Customer Satisfaction with Vision Plans, Two Years in a Row" 1 0001 Find information about Get answers Find links to vision insurance and watch to common special offers educational videos about questions about and other keeping your eyes healthy. using this site services Learn all abourt YOUr vilsion benefilts and how to make the most of your plan View your Print your ID card Find providers benefit summary for you and your near you or search family for new locations Search for a network 0) Wevw Benefits Print D C'�'Parnd Find a Provider See what lens options and contacts are covered r®r, J. —!t, Save money on contacts, Lasik, and hearing aids @) Chiectlk Clahrri Berief it F�,AQ%ii Healtll & Status Mfefflriess . ........... . .. View your claim Get answers Watch videos or download history here to Frequently fliers on common vision Asked Questions and eye health topics. Questions? Call 1-800-638-3120 or visit mlyuhicvision.com. t,j'nited,11eaJthcar0,' UnitedHealthcare received the highest numerical score in the proprietary J.D. Power 2013.2014 Vision Plan Satisfaction Report", 2014 report measures opinions of consumers with vision plans, includes four plans, and is based on responses from 3,063 consumers. Proprietary study results are based on experiences and perceptions of consumers surveyed October — November 2014. Your experiences may vary. Visit www.jdpower.com UnitedHealthcare vision coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. Administrative services provided by Specters, Inc., United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number VPOL.06.TX or VPOLA SJX and associated COC form number VCOC.INT.06.TX or VCOC.CER.1 3.TX. Plans sold in Virginia use policy form number VPOL.06,VA or VPOL.13.VA and associated COG form number VCOC.INT.06.VA or VCOC.CER.13.VA. 100-10980 12/14 02014 United HealthCare Services, Inc. M12345 S c 0 1„yii Why UnlotedHealthcare Visi"on".71 Vision care can be an integral part of your employees' overall health coverage. And, we can make it affordable for you. Choose the plan that works best for your business — and you'll help your employees significantly reduce their out-of- pocket vision expenses. Vision benefits frorn UnitedFlealthcare let you: • Select the flexible plan option that delivers the right combination of affordability for your employees and your bottom line • Access a large network of proven eye -health providers from across the country • Benefit from integrated services that check for serious conditions • Offer your employees the freedom to choose their treatment options and eyewear —all at considerable savings With UnitedHealthcare Vision, your employees will save money. No matter the frames, styles or lenses they select, their out-of-pocket costs will be greatly reduced. A network for every need Dd YOU know? Eighty-four percent of people polled in a recent study said a vision plan is very or somewhat important to them.' So, by offering vision coverage, you may be increasing employee satisfaction and commitment. We can customize our provider network to better meet your needs. Give your employees the power of choice. Our network, including private practices and retail providers, wends to more than 53,000 access points across the country, providing plenty of personalized and convenient care options to choose from. Flexible frame coveragel We've got options, so everyone can get the frames they want. Our frame allowance can be used to fully cover many popular frames. For frames that cost more than the allowance, a discount is applied to the overage, further reducing out-of-pocket costs. Broad contact lens benefitS2 Our Vision benefits cover in ftdI, after applicable copayment, the fitting and evaluation fees, many popular brands of disposable and planned replacement contacts, and up to two follow-up visits. Or if an employee chooses a contact lens that is not covered in our plan, they can apply their allowance to the purchase of the contacts of their choice. Employees also receive savings when they use our online discount ordering program. Lens options Employees participating in our vision program receive discounts on popular lens options like progressive lenses, high index lenses, anti -reflective coatings and more. Standard scratch -resistant coating is included at no charge. Laser vision correction Offer your employees access to discounted laser vision correction procedures through our partnerships with the Laser Vision Network of America and LasikPlus® Vision Centers. Preferred Pricing on Hearing Aids Employees can purchase high -quality, digital hearing aids at an affordable pricing, starting at $649 each through hi Healthlnnovations"These hearing aids use advanced technology to enhance speech understanding and comfort. Easy accessbenefitinformation isbn oare� can affect overa,H wellness Eye health is an excellent window into a person's overall health and wellness. Regular eye exams can detect early warning signs of Type 2 diabetes, hypertension, high cholesterol and vascular disease. Learn more about how our fully integrated services work.3 With UnitedHealthcare, finding the right eye -health provider is easy. At myuhcvision.com, your employees can use our provider locator, get door-to-door directions, print a vision ID card, find answers to frequently asked questions and more — making it easy for your employees to find the information they need without coming directly to you. IFrom a company youtrust When you offer your employees UnitedHealthcare Vision, you're providing them with additional coverage that will save them money while contributing to their overall health. And because it's affordable, integrated and rightly managed, it's healthy for your bottom line, too. Ask your broker or UnitedHealthcare representative for more information. We look forward to serving you soon. Contact, UsToday For more information about UnitedHealthcare Vision, contact your broker or UnitedHealthcare representative. 1 Jobson Report, 2010 Consumer Perceptions of Managed Vision Care 2 Benefit applies to frame or contact lenses. Frame discounts do not apply when prohibited by frame manufacturer. 3 AOA.org UnitedHealthcare vision coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. Administrative services provided by Specters, Inc., United Healthcare Services, Inc. or their affiliates. Plans sold in Texas use policy form number VPOL.06.TX or VPOL.I3.TX and associated COC form number VCOC.INT.06. TX or VCOC.CER.I3.TX. Plans sold in Virginia use policy form number VPOL.06.VA or VPOL.I3.VA and associated COC form number VCOC.INT.06.VA or VCOC.CER.I3.VA. 100-1 1176 5/14 02014 United Healthcare Services, Inc. M12345 ME Standard Scratch Coating Scratch Warranty Tint UV Coating Pholochromic Standard Anti -Reflective Coating Premium Anti -Reflective Coating Platinum Anti -Reflective Coating Roll and Polish Edges Standard Progressive Deluxe Progressive Premium Progressive Platinum Progressive No charge $10 $14 $16 $67 $40 $80 $90 $13 $70 $110 $150 $250 High Index (!� 1.66) $53 High Index (1.67-1.73) $63 Polycarbonate2 $33 'Prices reflected are subject to change. Check with your provider. May not apply at some locations 1$0 for dependent children OCTOBER 2016 k)i ',)M pla"I !I lcl.xde Ir, i l,,flkc�i, I I (n," Y ( :1 J o This gloswry is ��to tl�iel�p YOU Ljd the types of coatings, N m�r�� ��m�H N � m��������� m�am*� ������'������� �mw�� ���/ w����W� ��� ��m��� wens options. Coatings ���C��Protects against scratches onyour eyeglass lenses. This isoffered toyou atno additional charge. Recommended for everyone. i "Umt�Helps toreduce glare, and improve contrast. Recommended for people who play sports, and those who want tnsee with better contrast. y"',Offers protection for your eyes against UV light (sunlight that's harmful tnyou).Recommended for people who spend alot oftime outdoors. Lenses that darken when they are exposed 10certain kinds oflight, and lighten when indoors. Recommended for people who spend alot oftime outside, oraround snow orwater and don't like switching between prescription glasses and prescription sunglasses. R,,o Flo0sit Helps toreduce the appearance ofthe thickness oflenses and provides an improved appearance ofthe edges. Recommended for people who have thick lenses, but want 10make them appear thinner. Sometimes called ^nn-linobdboaa^ because they don't have bifocal ortrifocal segment lines. Let you switch between near and far distance vision easily. There are four levels ofprogressive lenses onour lens options list — standard, deluxe, premium and platinum. Each tier offers different levels ofquality — standard has the base level, where platinum has the highest level ofquality. Recommended for people who need bifocals but don't want visible lines intheir glasses, �Lenses that are coated on Materials both sides toreduce glare that help sharpen vision in K�91,�8t These lenses are thinner than all lighting uonUitionuTheya|ooho|ptomduo*g|am � other lens materials, reducing the weight and reducing when you use acomputer. There are three levels of thickness nfthe lenses. Recommended for people with anti -reflective coatings available — standard, premium higher prescriptions who want thinner, lighter lenses. and platinum. Standard offers abase level ofscratch and glare resistance, with platinum giving the highest �����Made from ethinner, lighter material level o/protection. Recommended for people who use that offers better impact resistance than regular plastic acomputer for work, orwho spend alot oftime driving lenses. Po|ycerbonokelenses also offer increased at night. ultraviolet protection for your eyes. Po|yourbonatelenses for dependent children are offered Voyou u1ooadditional charge. Recommended for children, orpeople who play sports. The company does not discriminate on the basis of race, color, national origin, sex, age, or disability in health programs and activities. VVeprovide free services tohelp you communicate with us. Such as, letters inother languages orlarge print. Or, you can ask for aninterpreter. Tbask for help, please call 1-8OO-638-312O.TTY711� ATENC|()N:Bihub|aeopaho|(Spaniah).hay deaoistonoiodeidiomsm.sin cargo, eeudinpoeicidn. L|unnea|nimenodetel6fonogratuhoqueepanaceenoutsrjstadeidentificecidn. W ���� � PO���� ` (Chinese) ' ���1���������Z����B"����� : 1-800 63E-3120.TTY711 " v"iteuxea^^=revision coverage provided by",through United Healthcare Insurance Company, located mHartford, Connecticut, v"/te*x=n^==Insurance Company mNew York, located m/^/""m".New York, ortheir affiliates. Administrative services provided bySpecters, /nc'u"mmxe"/mC°reo°w=",m".",*°/,"mxat"&p/°ns said /" Texas use policy form number vpnLu=r^",vrouxzxand associated ono There's always a provider 0 1* in sight because there's a large viisiioi p"'i network., Finding a provider you can trust and who meets your lifestyle, eye care and eyewear needs is easy with U n ited Healthcare. With our large national eye care network, Spectera Eyecare Networks, you (,-.an choose to get more personalized care from a private practice. Or, take advantage of the convenience retail chairs offer with evening and weekend hours. Either way, we're focused on providing you with a better eye care experience. Well-kriown practices and brands in ouir larg e natiorml inetwork: • 20/20 Vision Center - Eye Care Center • 3 Guys Optical * Eyeglass World • AccurateOptical * EyeMart Express • All About Eyes - Eyetique • Allegany Optical - For Eyes • America's Best - General Vision Services • Bard Optical o H. Rubin Vision Centers • BXs Optical - Henry Ford OptimEyes • Boscov's Optical - Horizon Eye Care • Clarkson Eyecare, - Houston Eye Associates • Cc/Op Optical - JCPenney Optical • Cohen's Fashion Optical - Midwest Vision Centers • Costco Optical * MyEyeDr • Crown Vision Center - National Optometry • Dr. Tavel Family Eye Care, - National Vision • Eye Boutique - Nationwide Vision • EyeCare Associates - NUCROWN • Eye Express * Optical Shop at Meijer CON T I NUFD Making It easier, for you to flind a Iprovider. To find the provider who best meets Your needs, log in to n yrufl-i f,conrw or call 1-800-638-3120. Some providers or locations may not participate in your plan. Satisfaction with Vision Plans"' ( -UrfitedHealthcaro' • Optyx I, Target Optical • Ossip Optometry * Texas State Optical • Pearle Vision - The Eye Gallery • Rosin Eyecare - The Hour Glass • RX Optical - Thoma & Sutton Eye Care • Sarn's Club * Today's Vision • Schaeffer Eye Centers * Virginia Eye Institute • Sears Optical - Vision4l-ess o, See Inc, - Visionmart Express • Shawnee Optical - Visionworks • Shopko - Vision Source • Site for Sore Eyes - Vision Trends • Spex - Vista Optical • Standard Optical 9 Walmart • Stanton Optical * Warby Parker - New for 20181 • Sterling Optical * Wisconsin Vision • SVS Vision Making it easler for, you t�o fird a pr(cmider'. 1(,i flnciha, pravi�,,,k�,n vvho Ix "t tnc,'al . yow (og in to irriyuhicv1slork,coirn or cal9 I:ocw[dk,,r,F or IocatOF is rii.irr ric)i, in your p[ari, Unitecffiealthcarcl" I initradi-ioair,' . care Cr.rvocf the highost ruinctical ,x)ore in the prop, oart,101 Power 2013-2015, 2017 Vision rim I Report neasures opiniorm of oonsurners with Vision plans, Includes four plans, and is based or, From 1,312 ronswfners. rlopriota,y study arsulls are based on experienoes, and percoproi is of consumers survey akt ber 20"17. Your expenprim-,, rnaywiry. Visit wtow.ldpower.com. The company does not discriminate on the basis of race, color, national origin, sex, age, or disability in health programs and activities. We provide free services to help you communicate with us, such as letters in other languages or large print. Cr, you can ask for an interpreter. To ask for help, please call 1-800-63B-3120, TTY 711, Mondaythrough Friday, 7 a.m. to 10 p.m. CST AT'ENCION: Si habia Pspahol (Spanish), hay servicios de asistencia de idiornas, sin cargo, a su disposici6n. Llarfle al 1-80M3E-3120, TTY 711 �Z (Chinese), ftf I % E A fLP, IVAN., Y fA M ) M M-R- V 2: 1 - 80G 638-312 0, TTY 711 • Note: Our doctors may also refer to us as Spectera Eyecare Networks, United leafthoare relsion coverage provided by or through Insurance Company, locate cl in I anforri, i,",onmxrficut, UrftedHaallhare in. u, a n,,,e Can pany cf NewYark, located in Isiandia, Npw YcA, ()rMaI4 .I Uatrs, Administrative services provided by SpecOra, I lic., Unikod Healthcare SerVcpa, Inc or I heir affiliates, a Facebmk.c,)m/Unitedileafthr.ire [3 Twittecoom/UFIC a In-.tagrm.cc)rri,'UriltedFleaKhrarF4 13 YouTubecom/UniledHealthcare. MTWOO 16 2/ M :;820 18 United Healt I iGafti Somcttn, I rlc, 17 6634 E H cl 0 lk7, 0 gs 0 le, b Pet M13 M 0 E ui cim Xw 0 4) Z z .2 0 E8 04 0 0 ro t 0 E L. C UJ =8 U- Lo z C4 C) 0 IL 2017-2018 fatCITY OF % ORLANDO PERMITTING SERVICES Local Business Tax Receipt (Formerly known as "Business License w changed per state law HB1269-2006) Business Name: FLORIDA LEAGUE OF CITIES INC P.O. BOX 530065 ORLANDO, FL 32853 Business Owner FLORIDA LEAGUE OF"CITES, Business Location 125 E COLONIAL DR NO I I11 I 2-THIS TAX RECEIPT ONLY EVIDENI PAYMENT OF THE LOCAL BUSINESS TAX PURSUANT TO CH.205, FLORIDA STATVII DOES NOT PERMIT THE HOLDER TO OPeF VIOLATION OF ANY CITY, STATE, OR FEDf LAW. CITY PERMITTING MUST BE NOTIFIf ANY MATERIAL CHANGE TO THE INFORM) FOUND HEREIN BELOW. THIS RECEIPT D NOT CONSTITUTE AN ENDORSEMENT OR APPROVAL OF THE HOLDER'S SKILL OR COMPETENTCY, Number: BOS0021708-001 09/24/2017 5US0FP"999,.;INESS OFFICE #0riand, bU ted Year FO 1-8 Scott Randolph, Tax Collector Local Business Tax Receipt Orange County, Florida This local business tax receipt is in addition to and not in lieu of any other tax required by law or municipal ordinance. Businesses are subject to regulation of zoning, health and othe lawful authorities. This receipt is valid from October 1 through September 30 of receipt year. Delinquent penalty is added October 1. 2017 EXPIRES 9/3012018 5000-0974117 5000 BUSINESS OFFICE $50.00 125 EM7PLPWE- TOTAL TAX $50.00 PREVIOUSLY PAID $50.00 *SI IG MIKE EX DIRECTOR TOTAL DUE $0.00 ORIDA LEAGUE OF CITIES INC TTTrIG-MIKE EX DIRECTOR 125 E COLONIAL DR 125 E COLONIAL DR U - ORLANDO, 32801 o? ORLANDO FL 32801-1201 PAID: $50.00 0099-00806902 9/18/2017 This receipt is official when validated by the Tax Collector. I'GUE op Z, YOUR EMIT TEAM AARON CARPER Director, Group Health Mr. Carper is the Director of Group Health at the Florida League of Cities. Aaron joined the Florida League of Cities in 2011 where he served as the Group Health Account Executive. As Director of the Florida Municipal Insurance Trust Group Health program, he oversees the operation of Hometown Health, the Florida League of Cities proprietary health promotions program, as well as the ever - changing compliance landscape around the Affordable Care Act as it relates to municipal employer groups. He earned his B.A. in International Business from Rollins College in Winter Park, Florida and his MBA from the University of Central Florida. Aaron has 9 years of insurance industry experience as well as 15 years in sales and marketing. CINDY CRUMP Wellness Coordinator Mrs. Crump graduated in 2011 with her Bachelor's Degree in Exercise Science from Western Illinois University. She completed her internship in Chicago, as a Wellness Coordinator, before moving to the Sunshine State. Throughout the past 7 years, Cindy has worked in the wellness field where she has gained experience in corporate wellness, personal training, and nutrition. Currently serving as the Wellness Coordinator for the Florida League of Cities, Cindy travels across Florida's municipalities to help implement the League's Hometown Health wellness program. She enjoys building relationships with members and helping them lead healthier, happier lives. GWEN MAHABIR, S, CHES Hometown Health Manager Mrs. Mahabir is a native Floridian, born and raised in Pensacola. She attended the University of West Florida where she earned a Bachelor's in Community Health and a Master of Science degree in Community Health Education. During her graduate program, she specialized in Worksite Wellness and Health Promotion. Gwen has over 8 years of experience in health and wellness programming. She currently serves as Hometown Health Manager for the league where she develops and administers our integrated health promotion program. Gwen is a Certified Health Education Specialist through the National Commission for Health Education Credentialing. RUIPRIT MINI 1111 "IV IL YOUR EMIT TEAM LINDSEYQom ARSON, BS Health Account Executive Mrs. Larson was born and raised in Green Bay, Wisconsin. She attended the University of Wisconsin — Stevens Point where she earned a Bachelor's Degree in Health Promotion and Wellness, with an emphasis in Corporate Health Promotion. She moved to Florida in the summer of 2009 where she began her Wellness career. Prior to joining the Florida League of Cities in 2013, Lindsey worked in the health and wellness field at NASA's Kennedy Space Center. Lindsey began her career at the League as one of the Wellness Coordinator's for the Florida League of Cities where she helped implement the "Hometown Health" program. After a few years with the Hometown Health program, Lindsey transitioned roles and is now the Florida League of Cities Health Account Executive for the State of Florida. ILL Your Florida League of Cities Health Benefits Team Aaron Carper — Group Health Director acarper@flcities.com 407-367-1768 Office 800-445-6248 X 1768 Toll Free 407-489-2222 Cell Cindy Crump — Wellness Coordinator ccrump@flcities.com 407-367-1735 Office 800-445-6248 X 1735 Toll Free 630-677-3906 Cell Doreen Davis — Claims Examiner (Claims & Benefit Questions) ddavis@flcities.com 407-367-1786 Office 800-445-6248 X1786 Toll Free Dana Johnson — Client Service Supervisor (Billing Questions) djohnson@flcities.com 407-367-1755 Office 800-445-6248 X 1755 Toll Free Lindsey Larson — Account Executive Ilarson@flcities.com 407-367-4007 Office 800-445-6248 X 4007 Toll Free 920-606-9716 Cell Gwen Mahabir — Hometown Health Manager gmahabir@flcities.com 407-367-4006 Office 800-445-6248 X 4006 Toll Free 850-221-3302 Cell Cindy Rochester — Benefit Specialist (Enrollment Questions) crochester@flcities.com 407-367-1806 Office 800-445-6248 X 1806 Toll Free yo ADVOCATE I yP Y III REFERENCES Jane Kniffen Human Resources Director City of Tarpon Springs 324 E Pine Street Tarpon Springs Florida 34689 727-938-3711 jk!juiffp,n @Lj tagwi ii iiiiirm s.klj 283 employees/Medical & Dental/03-01-2005 Michele Greene Human Resources Director City of Lake City 205 N Marion Avenue Lake City Florida 32055 386-719-5804 9-Ti fla.nm 192 employees/Medical & Dental/01-01-2005 June Donald Human Resource Administrator City of Oldsmar 100 State St West Oldsmar Florida 34677 813-749-1110 131 Employees/Medical and Vision 12-01-2005 Suzanne Skidmore Director of Human Resources City of Greenacres 5800 Melaluca Lane Greenacres Florida 33463 561-642-2001 itm res,.fI.us 166 employees/Medical & Dental/1 0-01 -2002 your RESOURCE *10p#61 Op r WOW MUNWIML , MURAIVA :14;1:4 Cheryl Berke Human Resources Program Administrator City of Cooper City 9090 SW 50th Place Cooper City Florida 33329 954-434-4300 ext 238 108 Employees/Medical/10-01-2002 Jennifer Yarmitzky Human Resources Generalist City of North Lauderdale 701 SW 71 st Avenue North Lauderdale Florida 33068 954-724-7038 j.Y ItZky@mka —ud.�iAlk ,qm 127 Employees/Medical, Dental & Vision/1 0-01-2004 Shirley Lowrance Finance Director/City Clerk City of Auburndale 1 Bobby Green Plaza Auburndale Florida 33823 863-968-5133 182 Employees/Medical 10-01-2002 your ADVOCATE it 1�11 Florida Municipal Insurance Trust City of Winter Springs Rate Quote for Medical and Prescription Drug Benefit Coverage Current Rates - United Healthcare Choice Plus HSA Plan 5 10Jv2017 - Contract Type Enrollment 9/30/2018 Monthly Premium Annual Premium Single 5 $771.91 $3,859.55 $46,314.60 EE + Spouse 0 $1,850.65 $0.00 $0.00 EE + Children 0 $1,850.65 $0.00 $0.00 Family 0 $2,015.31 $0.00 _ $0.00 Total 5 $3,859.55 $46,314.60 Renewal Rates - UnitedHealthcare Choice Plus HSA Plan 5 10/1/2018 - Contract Type Enrollment 9/30/2019 Monthly Premium Annual Premium Single 5 $686.23 $3,431.14 $41,173.68 EE + Spouse 0 $1,645.23 $0.00 $0.00 EE + Children 0 $1,645.23 $0.00 $0.00 Family 0 $1,791.61 $0.00 $0.00 Total 5 $3,431.14 $41,173.68 Percent Chan e-11.10% Medicare Exchange Available Prescription Drug Copays Retail: $10/$35/$60 Mail Order: $25/$87.50/$150 UnitedHealthearer YOUR BENEFITS Benefit Summary ASO Choice Plus Florida Municipal Insurance Trust HSA Medical Plan 5 ­Gwiiia"Aiwkwdare Services, Inc. and Florida Municipal Insurance —Trust want to help you take control and make the most of your health care benefits. That's why we provide convenient services to get your health care questions answered quickly and accurately: • myuIrc.coms - Take advantage of easy, time -saving online tools. You can check your eligibility, benefits, claims, claim payments, search for a doctor and hospital and more. • 24-hour nurse support — A nurse is a phone call away and you have other health resources available 24-hours a day, 7 days a week to provide you with information that can help you make informed decisions. Just call the number on the back of your ID card, • Customer Care telephone support — Need more help? Call a customer care professional using the toll -free number on the back of your ID card. Get answers to your benefit questions or receive he p loo . fora doctor or hospital._ The Benefit Summary is intended only to highlight your Benefits and should not be relied upon to fully determine your coverage. If this Benefit Summary conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your SPD for an exact description of the services and supplies that are covered, ---those which are excluded or limited, and other terms and conditions of coverage. PLAN HIGHLIGHTS SFXGIF"11 i07PA Page I of 4 THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES. INC.'S PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC, IS PROHIBITED. Page 2 of 4 THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, IND.'S PRODUCTS AND SERVICES TO THE RECIPIENT, ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED. Page 3 of 4 THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC.'S PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED. Kirchase post and asswateo 1i Wage fur eye giasses aria WAIT lemse. Implantable mines usm ooiy W correct a refracove ener(suctras)macs oomea implants). done ancti naming bids except when eimer of Ina following applies: for Covered Persons with cramolacial anomalies whose abnormal or absent ear canals preclude the use of a wearable hearing aid or for Covered Persons with hearing loss of sufficient severity that it would not be adequately remedied by a wearable hearing aid. Eye exercise or vision therapy. Surgery and other related treatment that is intended to correct nearsightedness, farsightedness, presbycpia and astigmatism including, but not limited to, procedures such as laser and other refractive aye surgery and Health services and supplies that do not M661 the 08APIVull Or A UVANIC Health Service —see me toolmison Or 040110 health Services in me Uossary in me bP0 umerea Heath, Services are mesa neaim services including services, supplies or Preacti Drugs, which to Claims Administrator determines to be all of the following; Medically Necessary; described as a Covered Health Service in the SPD; and not otherwise excluded in the SPD. Physical, psyGhiamc or psychological exams, losing, vaccinations, immunizations or treatments when: required solely for purposes of education, school sports or camp, travel, career or employment insurance, marriage or adoption; or as a result of incarceration; related hijudicial or administrative proceedings or orders; conducted for purposes of medical research; required to obtain or maintain a license of any type. This exclusion does not apply to Covered Health Services provided during a clinical flat forwhich Benefit are provided as descilbarl in the SPD. Health services received as a result of war or any act of war, whether dedared or undeclared or caused during service in the armed forces, of any country. This exclusion does not apply to Covered Persons who are civilians injured or othervisr, affected by war, any act of war or temonsin in a non -war zone. Health services received after the date your coverage under the Plan ends. This applies [a all health services, even if the health Service is required to treat a medical cond don that areas before the date your coverage under the Plan ended. Health services for which you have no legal responsibility to pay, or for which a change would not ordinarily be made in the absence of coverage under the Plan. Charges that exceed Eligible Expenses or any specified limitation in the SPD. Foreign language and sign language services. Health services related to a non -Covered Health Service: When a service is not a Covered Health Service, all Services related to that non -Covered Health Service are also excluded. This exclusion does not apply to services the Plan would otherwise determine to be Covered Health Services if they are to teat complications that arse from the non -Covered Health Service. For the purpose of this exclusion, a 'complication' is an unexpected or unanticipated condition that is superimposed on an existing disease and that affiects, or modifies the prognosis of the original disease or condition. Examples of a "oomplication' am bleeding or infections, following a Cosmetic Procedure, that require mosplalizatien. Health services when a provider waives Use Grocery, Annual DeducJbleor Coinsurance amounts Autopsies and other coroner services and transportation services for acori Charges for: missal appointments: mom or facility res"ficros; completion of claim forms; or record processing. Charges prohibited by federal anti -kickback or sef-referral status. Diagnostic test that are: delivered in other than a Physician's office or health care facility; and self-administered home diagnostic tests, including but net limited to HrV and pregnancy terra. Vision therapy when rendered in connection with bei omil health disorders, including but not limited to: lamming and reading disabliftes; attention defthitryperactivaly disorder; T% or Page 4 Of 4 THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, NQ'S PRODUCTS AND SERVICES TO THE RECIPIENT, ANY OTHER USE, COPYING OR DISTRIBUTION WrTI4OLrr THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED. UnitedHealthcare Addendum to the Medical Benefit ►�in, 01,in 111 111111 Choice Plus Florida Municipal Insurance Trust HSA Medical Plan 5 Employee Only These Benefits are available to you in addition to the benefits located on the Benefit Summary. ADDITIONAL CORE BENEFITS Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in the Schedule of Benefits. Prior Authorization is required for certain services. This Gender Dysphoria exclusion applies: Cosmetic Procedures including the following: Abdominoplasty. Blepharoplasty. Breast enlargement, including augmentation mammoplasty and breast implants. Body contouring, such as lipoplasty. Brow lift. Calf implants. Cheek, chin, and nose implants. Injection of fillers or neurotoxins. Face lift, forehead lift, or neck tightening. Facial bone remodeling for facial feminizations. Hair removal. Hair transplantation. Lip augmentation_ Lip reduction. Liposuction. Mastopexy. Pectoral implants for chest masculinization. Rhinoplasty. Skin resurfacing. Thyroid cartilage reduction; reduction thyroid chondroplasty; trachea shave (removal or reduction of the Adam's Apple). Voice modification surgery. Voice lessons and voice therapy. This Procedures and Treatments exclusion no longer applies when Gender Dysphoria applies: Sex transformation operations and related services. Partial Hospital izationllntensive 90% after Deductible has been met per 70% after Deductible has been met per Outpatient Treatment: session for Partial Hospitalization session for Partial Hospitalization /Intensive Outpatient Treatment. /Intensive Outpatient Treatment. Prior Authorization is required for certain services. UnitedHealthcare Insurance Company �« � . ° ; s • . � r w ®�� R irons w _ i Partial Hospitalization/intensive 90% after Deductible has been met per 70% after Deductible has been met per Outpatient Treatment: session for Partial Hospitalization session for Partial Hospitalization /Intensive Outpatient Treatment. /Intensive Outpatient Treatment_ Prior Authorization is required for certain services. This replaces the Mental Health, Neurobiological/Autism Spectrum, and Substance Use Disorders exclusion sections on the Benefit Summary: Services performed in connection with conditions not classified in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Outside of an initial assessment, services as treatments for a primary diagnosis of conditions and problems that may be a focus of clinical attention, but are specifically noted not to be mental disorders within the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Outside of initial assessment, services as treatments for the primary diagnoses of learning disabilities, conduct and impulse control disorders, pyromania, kleptomania, gambling disorder, and paraphilic disorder. Educational/behavioral services that are focused on primarily building skills and capabilities in communication, social interaction and learning. Tuition for or services that are school -based for children and adolescents required to be provided by, or paid for by, the school under the Individuals with Disabilities Education Act. Tuition for or services that are school -based for children and adolescents required to be provided by, or paid for by, the school under the Individuals with Disabilities Education Act. Outside of initial assessment, unspecified disorders for which the provider is not obligated to provide clinical rationale as defined in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Methadone treatment as maintenance, L.A.A.M. (1-Alpha-Acetyl-Methadol), Cyclazocine, or their equivalents for drug addiction. Intensive Behavioral Therapies such as Applied Behavior Analysis for Autism Spectrum Disorders. Transitional Living services. This Benefit Summary Addendum is intended only to highlight your Benefits and should not be relied upon to fully determine your coverage. If this Benefit Summary Addendum conflicts in any way with the Summary Plan Description (SPF), the SPD shall prevail. It is recommended that you review your SPD for an exact description of the services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage. SFTGW 07 UnitedHealthcare Insurance Company United HealthCare Services, Inc. does not treat members differently because of sex, age, race, color, disability or national origin. If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to the Civil Rights Coordinator. Online: UHC_Civil_Rights@uhc.com Mail: Civil Rights Coordinator. UnitedHealthcare Civil Rights Grievance. P.O. Box 30608 Salt Lake City, UTAH 84130 You must send the complaint within 60 days of when you found out about it. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll -free phone number listed on your ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m. You can also file a complaint with the U.S. Dept. of Health and Human Services. Online Il 1���.�.. 1 c ➢ �2, _ " " 1 i.s,'"ism muiTa Complaint forms are available at;� ........ ll�@ Phone: Toll -free 1-800-368-1019, 800-537-7697 (TDD) Mail: U.S. Dept. of Health and Human Services. 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call the toll -free phone number listed on your ID card TTY 711, Monday through Friday, 8 a.m. to 8 p.m. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Please call the toll -free phone number listed on your identification card. ATENCI6N: Si habla espanol (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposici6n. Llame al numero de telefono gratuito que aparece en su tatj eta de identificaci6n. MA #1 : 0WMERrP_�_' (Chinese) , Rfl:%' A!?'!MA p toMMR a. 5*1a#7AA -r"-P9 �11M9t�4 *A Iffil-tM 9 R, M. XIN LUU Y: Neu quy vi n6i tie-ng Viit (Vietnamese), quy vi se duac cung cap Bich vu tra giup ve ngon ngfr mien phi. Vui l6ng goi so dien thoai mien phi a mat sau the h6i vi6n cua quy vi. 01(Korean) _ MigZ &II QT as 7,1 MHI�= $22 01 8[ A! ; dLIQ. �loFol `� `� �F�OiI 71zH T� �I$a `1si�$� �°lof d'A152. PAALALA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga libreng serbisyo ng tulong sa wika. Pakitawagan ang toll -free na numero ng telepono na nasa iyong identification card. BHMMAHI4E: 6ecnrtanmie ycriyrH nepeso,ga gocTynHm xm juogeH, gelk P09HOIR 313blK ABRACTCA pyccuom (Russian). IIO3BOHHTe no 6ecnAaTHOMy HOMepy Teii4oHa, yKa3aHHOMy Ha BanieH UnitedHealthcare Insurance Company �t�,,;l , e-t$1+ �, eta a;yl cl�yll ,J3 A�L"w 4vLtoil 4�ylll b�l� ol+ �1.av �?� (Arabic) A4:kA � +3+ : ATANSYON: Si w pale Kreyol ayisyen (Haitian Creole), ou kapab benefisye sevis ki gratis you ede w nan lang pa w. Tanpri rele nimewo gratis ki sou kat idantifikasyon w. ATTENTION: Si vous parlez frangais (French), des services d'aide linguistique vous sont proposes gratuitement. Veuillez appeler le numdro de tdldphone gratuit figurant sur votre carte d'identification. UWAGA: Jezeli mowisz po polsku (Polish), udostgpnili§my darmowe ushigi tlumacza. Prosimy zadzwonid pod bezplatny numer telefonu podany na karcie identyfikacyjnej. ATENC,AO: Se voce fala portugues (Portuguese), contate o servigo de assistencia de idiomas gratuito. Ligue gratuitamente para o numero encontrado no seu cartao de identificarrao. ATTENZIONE: in caso la lingua parlata sia 1'italiano (Italian), sono disponibili servizi di assistenza linguistica gratuiti. Per favore chiamate it numero di telefono verde indicato sulla vostra tessera identificativa. ACHTUNG: Falls Sic Deutsch (German) sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur VerfUgung, Bitte rufen Sic die gebiihrenfreie Rufnummer auf der Riickseite Ihres Mitgliedsausweises an. i ®*Sll(Japanese)'�'�;�,tL�a�A. 4O�o 0 '�1—C� � +1f�L►t_t�it* o 0 fA 9R-a`-Ei IZpR itL�cft-CLN67V—'Y-f-i"1I.IZJi%o$<t=zk- L�o 1i Y LrAz oaL 1j tau, 4L.A i& uJlS css..) 4S q;qT t7w;T t-: Zrft 3ifcf W' (Hindi) w* f * xq c�v Rm RuzraT #wT f4: %rr + 5gC4 q I ww xq-4 qTwPfzffqTfavZTc4rOFwwzqTwe ;T4I CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb rau koj. Thov hu rau tus xov tooj hu deb dawb uas teev muaj nyob rau titawm koj daim yuaj cim ghia tus kheej . 6�unvsnraon: suer�ne�nmm�R�r (Khmer) snmdammmnsmnrnesesna acneninur�n nre9ariaSvfnrenrt��i� s"dw�nessiscu��nr� �nun�mm�irrny PAKDAAR: Nu saritaem ti Ilocano (Rocano), ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Maidawat nga awagan iti toll -free a numero ti telepono nga nakalista ayan iti identification card mo. DIi BAA'AKONINIZIN: Dine (Navajo) bizaad bee yanilti'go, saad bee dka'anida'awo'igii, t'da jiWeh, bee na'ahoot'i'. Tad shggdi ninaaltsoos nitl'izi bee nddhozinigii bine'dgg' t'aa jiik'ehgo bddsh bee hane'i bika'igii bee hodiilnih. OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyada taageerada luqadda, oo bilaash ah, ayaad heli kartaa. Fadlan wac lambarka telefonka khadka bilaashka ee ku yaalla kaarkaaga aqoonsiga. UnitedHealthcare Insurance Company UnitedHealthcare YOUR BENEFITS Benefit Summary ASO Choice Plus Florida Municipal Insurance Trust HSA Family Medical Plan 5 United HeaithCare Services, Inc. and Florida Municipal Insurance Trust want to help you take control and make the most of your health care benefits. That's why we provide convenient services to get your health care questions answered quickly and accurately: • myuhc.comO - Take advantage of easy, time -saving online tools. You can check your eligibility, benefits, claims, claim payments, search for a doctor and hospital and more. • 24-hour nurse support —A nurse is a phone call away and you have other health resources available 24-hours a day, 7 days a week to provide you with information that can help you make informed decisions. Just call the number on the back of your ID card. • Customer Care telephone support — Need more help? Call a customer care professional using the toll -free number on the back of your ID card. Get answers to your benefit =stions or receive help, lookingfor a doctor or has:ital. The Benefit Summary is intended only to highlight your Benefits and should not be relied upon to fully determine your coverage. If this Benefit Summary conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your SPD for an exact description of the services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage. PLAN HIGHLIGHTS SFXGF"1V" l'"T'07PA Page 1 of 4 THIS MATERIAL. IS PROVIDED ON THE REclPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC.'S PRODUCTS AND SERVICES TO THE RECIPIENT, ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC, 15 PROHIBITED. es of Covera e Network Benefits on-raetwork Benefits Benefits are limited as follows: 90% after Deductible has been met =701%. after Deductible has been :met $2,500 per year and are limited to a single purchase (including repair/replacement) per hearing impaired ear eve three ears. Beinefits are linr�wd as FuNow,,1, 90% after Deductible has been rne-I 70% after Deductible has treen mot WW94S tXf year 90% after Deductible has Nwn met 70% after Deductible has term met 90% after CWducfible has been mta 701K after Deductible has been urel pnevenhve Care S&Aces category, after % �ofto, D�,,ductve rt'as been fftet Inpatient: 90% after Deductible has been met Outpatient: 90% after Deductible has been met hipatient. 90% after Deductible fras been rpel Outicationc 90% after Deductible has been met This includes medications administered in an outpatient 90% after Deductible has been met wetting, in the Phrjicmn's Office or in a Covered Person's home. 90% after Deductible has been met Pnrnary Phvsican Office W6,4 I 905,6afte, Deductible has been met rig upon Health 1 CovPred Heairh SoMcor inrJude but are not hrnded t i5n­­­­ - nry !!Oys L qiB Visit . ...... !?90� __n.Office 5aecialist Physician Office Visit 100% Died I h Y.Ppy - anther prevenIive tests --- - ----------- — ---------- Benefts are limited as follows: 1 90% after A sm9le purchase ofeatype of prosthetic device every I Benefits are limited as follows: 20 visits of physical therapy 20 visits of occupational therapy 20 visits of manipulative treatment 20 visits of speech therapy 20 visits of pulmonary rehabilitation 36 visits of cardiac rehabilitation 30 visits of post -cochlear implant aural therapy 20 visits of cognitive rehabilitation therapy has been met he Covered Hesith Service is MI NA6 after Dedurfibio htis been nwA Inpatient: 70% after Deductible has been met Outpatient: 70% after Deductible has been met Inpatient: �'O% after Deductible has been met Outpatient: 70% after Deductible has been met 70% after Deductible has been met 70% after Deductible has been rrrt,*t 70% after Deductible has been met after 'Deductible has been met' bonalim. Will be the same as those stated under each - — -------- . ....... A 'A�t_h�n­zalbn -a' required ir Inpatient Stay exGuads 48 hours following a normal vaginal delivery or 96 hours following Non -Network Benefits are not available Norte -Network, Beneffts are not AvahhhW I 70% after Deductible has been nnet Llanems wibe Iae same as those iLi-irG'i,—_- —roi Xoloiisrequired. 70% after Deductible has been met Page 2 of 4 THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FORTHE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES. INC.'S PRODUCTS AND SERVICES TO THE RECIPIENT, ANY OTHER USE, COPYING OR DISTRIBUTION WrTHOUT THE EXPRESS WRITTEN PERMISSION OF UNMED HEALTHCARE SERVICES, INC. IS PmHiarrED, to; aromafhempy; hypnadam; massage therapy; rolling (holistic tissue massage), artmusic, dance horwabarck rrwirapyd rvel over fortis of alternalive treatment as defined by to Naito of the National Institutes of Hearn. °rhis exclusion does trot entire to Manloulahas Treatment and non-manityiI w. osmaoalhlx care for whiten Bonefl ann ororided as described in the SPD, I. urs care (wniCh onobatis aentw M+ ys, 6.ppies end atep isomes arm ah assDoatea expenses, including haapeatEalrOn5 and ane5me51a). mieexclusdo(loss not apply to dental care (oral exammaeon, A -rays, extraahonsand nee- surgical ahriinauo'n of oral infacdon) required for the three( treatment of a medical condition for which Benefits are available under the Plan as described in the SPD. Dental care that is required to treat the effects of a medical condition, but that is not necessary to directly treat the medical condition, is excluded. Examples include treatment of dental cartes resulting from dry mouth after radiation treatment or as a result of medication. Endodotall pariodontal surgery and restomtve treatment are excluded. Diagnosis or treatment of or related to the teem, jawbones a gums. Examples include: extraction (including wisdom teeth), restoration, and replacement of tooth; medical or surgical treatment of dental conditions; and services to improve dental rAinlcd outcomes. This exclusion does not apply to accidental -related dental services for which Benefits are provided as described under Dental Services - Accidental Only In the SPD. Dental implants, bone graft and other hnplant-related procedures, This AxelL mion dens not apply to accklent- nutaIedd nreoW zerviceir rim which ki' ,wfcs am u"Nored tam +ueAMbed uctafiun Denial "at,q r - Arxdrym rhN in the S,PD Metal m,Acaau tcvftexkxftcsi. C.cent l Anarmik such an der Jim re &A career, Uevicea used speC9riCauy as so" hems or to affect permrmance in Sports -mutes aet'vitdes. Ot ouc appliances mat straighten or re -shape a deal pan as r viese7 end en Mraryelkwhtau trqutpeneW (I.»Med tin na pll" . is ampas Include IW 061WA ICs, cronial banding, or any arihotic braces available over -me -counter. no following Items are excluded,: blood pressure atifilmooitor, anuresis alarm; non -wearable external de5brdialor; trusses; and ultrasonic nebulizers, Devices and companies m assist in communication and speech except for speech generating devices and trachae-asophcgsal voice devices for which Benefits are provided as described under Durable Medical Equipment Oral opptiances for snoring. Repair and r000comant pmemetic devices when damaged due In misuse, malicious damage or gross neglect. Prosthetic devices. This exclusion does not apply to breast prosthesis, mastectomy bras and ymphederma stockings for which Benefits are provided as described under Retom iftrAl Pme.mrwes in die „PD. the exilusiore listed beidw apply to me medical parson of afro flan only. Prescription `thug coverage is excluded under me moralaal plan because it is a separate banem. Coverage may as available under me Prescription Drug pomon col via Ran. See me W for coverage details and exclusions. Prescription rdruigs liar outpatient use that are filled by a prescription order or refill. Self41njectable medications. This exclusion does not apply to medications which, due to their characteristics (as determined by United HealthCom Services. Inc.), must typically be rel i mu ird or directly supervised by a qualified provider or licansedlcertfied health professional in an outpatient setting. Nondnjectable medications given in a Phyridlan s office. This exclusion does not minly m non-in„ac Ise nodl got we r%viged in o-m Ern mrencv and censumed in the Phi office. Over-the-mamer druos rind treatments. Growth Imrmona memw. even Rmreune Iron Cant. Examples mauoe the Getting or removal or Gems and Cadi rtns exclusion does not apply in preventive rear Dare rnr Covered Persons wuh draoetes for eaver'r laonefas are provided as described under Drab rtas Services in the SPD or when needed for severe systemic disease. Cutting or removal of corns and calluses. Nall ramming, rutting, or debrid'mg. Hygienic and pmvenfive maintenance foot cam; and other services that are performed when there is not a localized Sickness, intay or symptom involving the foot Examples include: cleaning and soaking they lose apply�i g skin creams in order to maintain skin Idea, This exclusion does net apply to preventive foot care for Covered Persons who we at risk of neurological or vascular dsease aruud tram dI,IArYSYss eta n ass dIaRYa TraaimaM a1 sat Swat, Snnar VAiandawid cr restlorn Vets xavd wet .n sCNrae mrthoeceA a nnri tn^wertiw and ans,rl isu .eels. Proscribed or non-preaonbed module suppheb and disposable stadgi, s. f"LMvP6es Include: compression stooxirgs, ace damages, dmdeec snips, and syringes; unary cameters. "i°hie exdumon does not apply to: Disposable supplies necessary forme effective use of Oumble Medical Equipment for which Benefits are provided as deseribed under Durable Medical Equipment in the SPD. + Diabetic supplies for which Benefits are provided as described under Diabetes Services in the SPO. Ostomy bags and related supplies for which Benefits are provided as described under Colony Supplies in the SPD. Tubings,'nasal Cornelius, connectors and masks, except when used with Durable Medical Equipment as described under Durable Medical Equipment as described in the SPD. The repair and replacement of Durable Medical Equipment when damaged due Services paramour In connection with condMvons ace ciatsmed in rim Cunerye@ummr. mryes LsagmasazM8,0014u Me American rsyenraaldASS0CIaaaln. Services orsuppuoa rot me diagnosis or treatment or Mantas lunese, alGmonsm or substance use disorders mat, In the reasonable judgment of the Mantas Health Substance Use Disorder Administrator, am any of the following: not consistent with generally accepted standards of medical practice for the treatment of such conditions; not amsistent with services backed by credible research soundly demonstrating that the services or supplies w It have a measumbto and beneficial health outcome, and therefore considered exporimental; not Consistent with the Mental Health/Substance Use Disorder Administrator's level of care guidelines or best practices as modified lrom Was to time; or not clinically eppropriam, and considered ineffective for the patenPs Mental glassy, substance use disorder a condition based on generally accepted standards of medical practice and benchmerits. Mental Health Services as treatments for V-oode conditions as listed within the current edition of the Diagnostic and Sla6stfcalManual of the Amedcan Psychiefrte Association. Mental Health Services as moment for a prknary diagnosis of insomnia and other sleep disorders, sexual dysfurrction disorders, feeding disorders, neurological disorders and other disorders with a known physical basis. Treatments for the primary diagnoses of looming disabttites, conduct and Impulse control disorders, personality disorders, pamphllias (sexual behavior that Is considered davlanl or abnoni Educallonallbehavloral services that are focused on primarily building skills and capabilities in communication, spool interaction and learning; tuition for or services that are school -based for children and adolescents under the Individuals with Disabilities Education Act Learning, motor skills and primary Communication disorders as def ned in the Current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Mental retardation as a primary diagnosis defined in the current edition of the Diagnostic and Stabi fical Manual of the American PsyG Ire Assocaton. Methadone tmstmenl as maintenance, L.AA.M. (I eidpha-Acetyl-Methadoo. Cyceizocke, or their equivalents for drug addiction. Initiative behavioral therapies such as applied behavioral analysis for Autism Spectrum Disorders. Any treatments or other specialized services Numhonal or cosmese therapy using high ease a mega quanofas or'YWrons.. mirwaara oreierrenM, acre o'bfis n6JM ooY tame end mnex ay. rivuWrKke rMunsetng sxr w9her yiOnidu-ats or groups except as defined under O aoetes Services in the SPD. Food or any land, Foods that are not covered include: answer feedings and other nutritional and electrolyte formulas, including intent formula and donor breast milk unless meyare the only source of nutrition or unless they are specifically created to treat inborn errors of metabolism such as phenyiketonuna (PKU) - Infant formula available over the counter Is always excluded; foods to control weight, treat obesity (including liquid diets), lower cholesterol or control diabetes; oral vitamins and minerals; meals you can order from a menu, for an additional charge, during an Inpatient Stay, and other dietary and electrolyte supplements; and health education classes unless offered by United HealthCare Services, Inc. or its affiliates, including but net limited to asthma, redevvtmn; telephone; beemy9bamer service; guest. service. Supplies, equlpmorrl and ar4nAW drryraruonOr Mreyces and supµ r Mir persocer Comfort. Examples irrtiude: air ooeitonere, air purifiers and )lairs, dehumidifiers and humidifiers, Wearies and battery chargers; breast pumps; car seats; chairs, bath chairs, feeding chairs, toddler chairs, chair lifts, recliners; exercise equipment and treadmills; home modificatons to accommodate a health need such as ramps, swimming pools, elevators, handrails and stair glides; hot tubs; Jacozzds, saunas and whirlpools; ergonomically correct chairs, non -Hospital beds, comfort beds, mattresses; medical alert systems; motorized beds; music devices; personal computers, pillows; power -operated vehicles; radios; rlmenuaAt nI orarer,; Safi a. ul ant vehicle medcaations such as rani kGE, stud w4:ANir taaria.. Cosmetic Procedures, See the deriniarsn in tire SPD _ &emotes include: phamraculogira l regimens, nuulmonal procedures or oeasrwnts; Scar or taduo removal or revision procedures (such as salabiaslon, chemcsurgery and error such skin abrasion j,+rbcedums ; Skin abrasion procedures performed as a treatment fart acne; tmatrnent of hair loss varicose vein treatment of me lower sufremites, when it is, considered ecematic; Licesuchon or removal of fat deu:esfls considsred undget rebIa. InrAudirn tat __..__.. ___�_ _ Page 3 of 4 TI IIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC,'$ PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED. accumulation under the male breast and nipple; Treatment for skin wrinkles or any treatment to improve the appearance of the skin; Treatment for Spider versa; Heir removal or replarxmem by any means. Replacement of an existing intact breast imps the earlier breast implant was performed as a Cosmetic Procedure. Treatment of benign gynecanastia (abnormal breast enlargement in males). Physical conditioning program such as afi lebc training, body -bulldog, exercise, tress, flexibility, heaPo memberships and programs, spa treatments and diversion or general motivation. Weight loss programs whether or not they are under medical supervision. Weight loss programs for medical reasons are also excluded, even Iffor morbid obesity. Wigs Procedure or surgery to remove fatty tissue suers as painniculectomy, abdormnoplasty, thignpiasry, tindaioplaary, or mastopexy. Excislon or elimination of hanging can on any pan of ohs body. Examples mature plastic surgery procedures cause abdomfnoptasty, or abdominal panniculeclomy, and brachioplasty. Medical and surgical treatment of excessive sweating (hyperhidrosis). Medical and surgical treatment for snaring, except when provided as a part of treatment for documented obstructive sleep apnea. Rehabilitation services and Manlpulaka Treatment to improve general physical condition that am provided to reduce potential Oak factors, where significant therapeutic Improvement Is not expected, Including routine, long-term or mainonancofpraventive treatment. Speech therapy except as required for treatment of a speech Impediment or speech dysfunction that results from Injury, stroke, cancer, Congenital Anomaly, or autism spectrum dlearders. Speech therapy to treat stlntarbal stammering or other articulation disorders. Psychosurgery. Sax transformation operations and related services. Physiological modalities and procedures that result In smal or redundant therapeutic effects when perforated on the same body region during the same visit or office encounter. Biafoadback. Manipulative treatment to treat a condition unrelated to spinal mamiptdaten and ancdtary physiologic treatment rendered to restoreAmprava motion, reduce pain and Improve funcdon, such as asthma or auergos. Mardpuladve treatment (the therapeutic application of ch ruprai and osteopathic manipulative treatment with or withrwl ancillary physiologic treatment andlor mhabuitall metmods rendered to resfothrimprove, notion, reduce pain and Improve function), Services fcr the evaluation and treatment of himporomandibuOr land syndrome (TM f), whether the services are considered to be dental in nature, the following services for the diagnosls and treatment of Ti surface eiectudmyography; Doppler onelyl is; vibration analysis; computerized mandibular soon or Jew tracking; crardosocml therapy; onhodontw; occlusal adjustment; denial reaoratons. Upper and lower jawbone surgery, orutognathic surgery and Jaw alignment This exclusion does not apply to reconstructive jaw surgery required for Covered Persons because of a Congenital Anomaly, acute traumatic Injury, dislocation, tumors, cancer or obstructive sleep son ea. Orthognathic surgery (procedure to torrent undertile or oved itel and jaw atgnmmnt. Breast reduction except surgery as coverage Is required by the Women's Health and Cancer Rights Act of 1998 for which Benefits are described under Reconstructive Procedures in the SPD. Non -surgical treament of obesity even t for morbid obesity. Surgical treatment of obesity even if there la a diagnosis of morbid obesityas described under Obesity Surgery In the SPD. Stand-alone multi -disciplinary smoking director programs. These are programs that usually include resign care providers si eclallzing in making cessation and may include a psychologist, social worker or other licensed of cartified professional. The programs usually include intensive psychological support, behavior mod0caten techniques and medications to oontrm Sarvioas patforarm by a provider who Is a famiy Tramper by biro or mamage. Examples Include a spouse, oromer, sister, parent or cruia. r cis includes any service all provider may perform on himself or herself. Services performed by a provider wRa your same legal residence. Services entered or delivered by a Christian Science practitioner. Services performed by an unlearned provider or a provider who is operating outside of the adopts of histher license. Services provided at a free-standing or Hospital - based diagnostic facility without an order written by a Physician or other provider. Services which are self -directed to a frea•standing or Hospaal-based diagnostic facility. Services ordered by a Physician or other provider who is an employee or representative of a tee-slanding or Hospital -based diagnostic facility, when that Physician or other provider has not been actively involved in your medical care prior to ordering the service, or is not actively invoked in your medical care after the advice is Health services and associated expenses tot mrerady constraints, excluding assisted repmuuuuve taunr logy, regataless or via reason for me treatment. i nor exclusion odes not apply to Servces recurrent to treat or correct uneedying causes ur inmrutdy. The following inomfity toatmant-related services: cryo-preservation and other forms of preservation of reproductive materials, long-term storage of reproductive materials such as sperm, eggs, ombryos, overlain tissue, and testicular tissue, donor service Surrogate defending, donor eggs, donor sperm and host uterus. Storage and mail of all reproductive materials. Examples 1nolads eggs, sperm, lestcular tissue and ovarian tssua. The reversal of voluntary sWftubon, Health services and associated expanses for elacitve surgical, rwrreMbeel, or dmg-inducad Pregnancy terimmmion. This exclusion does not apply to treatment of a molar Pregnancy, ectopic Pregnattdy, or missed abortion (commonly known as a miscarriage). Services provided by a Health services for which other coverage is available under another Irian, except for Eligible Expenses payable as descr%tied in the Sr''D. Examples Include coverage required by workers' compensation, no-fault auto insurance, or similar iegeslation. If +.terrdaorge under wokers' cempensatioru, ma -fault auomoblle coveogpi wvarcmr hwpiMxez Ea a metier fvv ydr i tww.ause your could elect if, or could have it elected for you. Health services for treatment of military service -related disabilities, when you am err , I entitled to other cover a and fac fides are reasonably eveldb o o w Hedhm swwma—, w Ai vw, clwu mdiYm elf M, "low W aapri and aa" twwroplants, except as identified uadist Transp lanni Services in the. SPO unless United Hoalihl E*vdex,, Owat: eldmrnmvs dex fuSrrrteESnr 0 he appropirl according to United HealKwe Serwoos,..Inc.'a transplan quurRvineo MwwAai darrfi'rof w gial Rarusplants, except services mail 0, Ilia ImOolant or removal of S rcr uRik'Iry asset IRVKWr IS uvwnr;ar Ind wt' Sm I•ean WI10 the Ia7ub"A Wene, kv a skill"�a 7 dCkutPPkP faary kI tpocafh e RflVw(y9' uutm I, arA dwww cons or ertmirW #p±u`AN trrVM*Wvl En d arc10car 06118011 (these contest maw be oavkMe Ilhroualt the recipient's l^;a!a+ A vW1 Health servtcas twowkled In a rrn'OOD country. unless neWred as eaperadva, even 11oroauned fry u igmrerr pr0giall vi,(Iroiand ort an mplIorrit rid Wnr aculw pain of of exacefaspr di of aMe'mc par. Gus0kil Dare: donvu t ary rare. Fruate, Duty PRdrsing. respite care. Pries exclusion does not apply o respre cam Owl is part of program of services provided to a terminally ill person by a licensed hospice care agency forwhich Benefits are described under Hospice Cam in the SPD, Rest cures; services of personal rare attendants. Work hardening roomnns desinrred to return a nerson to work w to uameare a Deleon for specific work). 1'.d.ranxmse that and associated fiteng charge for eye gasses and correct lenses. Impiantaola lenses used only to correct a mh mMe. arcs (%r.1A as lrruvr s cum : 0194anrs). boric WICNAd h6anng ads ev'Opt when enhef of the olowtng applies: for Covered Persons with craniol-acial anomalies whose abnormal or absent ear canals preclude the use of a wearable hearing aid o r for Covered Persons with hearing loss of sufficient severity that it would not be adequately remedied by a wearable hearing aid. Eye exercise or vision therapy. Surgery and other related treatment that is Intended to correct nearsightedness, farsightedness, presbyopta and astigmatism including, but not limited to, procedures such as laser and other refractive eye surgery and HRrPodr s micesiamo supplies I1w do om minor the 17eana4'wi d a L4ver9dl floam SBfvre'a — sae urea unti lba , a l;nvereJ rirraNPr',drovrrem n rr* Msary In me SPU Upvefed rl 5elvices are those heartn services including services, suppi" or Prescription Drugs, which the Claims Administrator determines to be all of the following: Medically Necessary; described as a Covered Health Service in the SPD; and not otherwise excluded in the SPD. Physical, psychiatric or psychological exams, eating, vaccinations, immunizations or treatments when: required sooly or purposes of education, school, sports or camp, travel, career or employment, insurance, marriage or adoption; or as a result of incarceration; related o judicial or administrative proceedings or orders; conducted or purposes of medical research; required to bell or maintain a license of any type. This exclusion does not apply to Covered Health Services provided during a clinical Vial or which Benefits are provided as described in the SPD. Health services resolved as a result of war orany act of war, whether declared or undeclared or caused during service In the armed forces of any country. This exclusion does not apply to Covered Persons who am civilians injured or otherwise a%oted by war, any act of war ortermdsm in a non -war zone. Health services received after the dale your coverage under the Plan ends. This applies to all heath services, even 0 the health service is required to treat a medical condition that arose before the data your coverage under the Plan ended. Health services for which you have no legal responsibility to pay, or for which a charge would not ordinadty be made to the absence of coverage under the Plan. Charges that exceed Eligible Expenses or any specified Imitation in the SPD. Foreign language and sign language services. Health services related to a non -Covered Health Service: When a service is not a Covered Health Service, all services related to that non -Covered Heath Service are alga excluded. This exclusion does not apply o services the Plan would otherwise determine to be Covered Health Services iftrey am to treat complications that arise from the non -Covered Health Service. For the purpose of this exclusion, a "complication' is an unexpected or unanticipated condition that is superimposed on an existing disease and that affects or modifies the prognosis of the original disease or condition. Examples of a "cemplicatil are blooding or infectons, following a Cosmetic Procedure, that require hospitalization. Health services when a provider waives the Copay, Annual Deductible or Coinsurance amounts. Autopsies and other coroner services and transportation services for a corpse. Charges for: missed appointments; room or faclity reservations; completion of claim Ici or retard promising. Charges prohibited by federal antl-klckbaok or set -referral status. Diagnostic tests that are: delivered in other than a Phys clan's office or health care facitiy; and self-administered home diagnetadc lasts, Including but not firriimd to HIM and pregnancy tests. Vision therapy when rendered in connection with behavioral health disorders, including but not limited to: foaming and reading disabifues; attentions deficithyperactively disorder, T% or Page 4 of 4 THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC.'$ PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYINC OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHMTTED. UnitedHealthcarer Addendum to the Medical Benefit Choice Plus Florida Municipal Insurance Trust HSA Medical Plan 5 Family These Benefits are available to you in addition to the benefits located on the Benefit Summary. ADDITIONAL CORE BENEFITS T�r es of Cavera a Network Benefits Nan -Network Benefits Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in the Schedule of Benefits. Prior Authorization is required for certain services. This Gender Dysphoria exclusion applies: Cosmetic Procedures including the following: Abdominoplasty. Blepharoplasty. Breast enlargement, including augmentation mammoplasty and breast implants. Body contouring, such as lipoplasty. Brow lift. Calf implants. Cheek, chin, and nose implants. Injection of filters or neurotoxins. Face lift, forehead lift, or neck tightening. Facial bone remodeling for facial feminizations. Hair removal. Hair transplantation. Lip augmentation. Lip reduction. Liposuction. Mastopexy. Pectoral implants for chest masculinization. Rhinoplasty. Skin resurfacing. Thyroid cartilage reduction; reduction thyroid chondroplasty; trachea shave (removal or reduction of the Adam's Apple). Voice modification surgery. Voice lessons and voice therapy. This Procedures and Treatments exclusion no longer applies when Gender Dysphoria applies: Sex transformation operations and related services. Partial Hospitalization/intensive 90% after Deductible has been met per 70% after Deductible has been met per Outpatient Treatment: session for Partial Hospitalization session for Partial Hospitalization lintensive Outpatient Treatment. /intensive Outpatient Treatment. Prior Authorization is required for certain services. UnitedHealthcare Insurance Company Partial Hospitalization/Intensive 90% after Deductible has been met per 70% after Deductible has been met per Outpatient Treatment: session for Partial Hospitalization session for Partial Hospitalization /Intensive Outpatient Treatment. /Intensive Outpatient Treatment. Prior Authorization is required for certain services. Network Benefits are available only when services are delivered 90% after Deductible has been met per 70% after Deductible has been met per through a Designated Virtual Visit visit. visit. Network Provider. Find a Designated Virtual Visit Network Provider Group at myuhc.com or by calling Customer Care at the telephone number on your ID card. Access to Virtual Visits and prescription services may not be available in all states or for all groups. This replaces the Mental Health, Neurobiological/Autism Spectrum, and Substance Use Disorders exclusion sections on the Benefit Summary: Services performed in connection with conditions not classified in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Outside of an initial assessment, services as treatments for a primary diagnosis of conditions and problems that may be a focus of clinical attention, but are specifically noted not to be mental disorders within the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Outside of initial assessment, services as treatments for the primary diagnoses of learning disabilities, conduct and impulse control disorders, pyromania, kleptomania, gambling disorder, and paraphilic disorder. Educational/behavioral services that are focused on primarily building skills and capabilities in communication, social interaction and learning. Tuition for or services that are school -based for children and adolescents required to be provided by, or paid for by, the school under the Individuals with Disabilities Education Act. Tuition for or services that are school -based for children and adolescents required to be provided by, or paid for by, the school under the Individuals with Disabilities Education Act. Outside of initial assessment, unspecified disorders for which the provider is not obligated to provide clinical rationale as defined in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Methadone treatment as maintenance, L.A.A.M. (1-Alpha-Acetyl-Methadol), Cyclazocine, or their equivalents for drug addiction. Intensive Behavioral Therapies such as Applied Behavior Analysis for Autism Spectrum Disorders. Transitional Living services. This Benefit Summary Addendum is intended only to highlight your Benefits and should not be relied upon to fully determine your coverage. If this Benefit Summary Addendum conflicts in any way with the Summary Plan Description (SPF), the SPD shall prevail. It is recommended that you review your SPD for an exact description of the services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage. SFTGYYYY 07 Unitedflealthcare Insurance Company United HealthCare Services, Inc. does not treat members differently because of sex, age, race, color, disability or national origin. If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to the Civil Rights Coordinator. Online: UHC—Civil_Rights@uhc.com Mail: Civil Rights Coordinator. UnitedHealthcare Civil Rights Grievance. P.O. Box 30608 Salt Lake City, UTAH 84130 You must send the complaint within 60 days of when you found out about it. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll -free phone number listed on your ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m. You can also file a complaint with the U.S. Dept. of Health and Human Services. Online p ,i/oct L prj _kj)jw 2f is Complaint forms are available Phone: Toll -free 1-800-368-1019, 800-537-7697 (TDD) Mail: U.S. Dept. of Health and Human Services. 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call the toll -free phone number listed on your ID card TTY 711, Monday through Friday, 8 a.m. to 8 p.m. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Please call the toll -free phone number listed on your identification card. ATENCION: Si habla espanol (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposici6n. Llame al numero de telefono gratuito que aparece en su tarjeta de identificacion. MAS (Chinese) MMMM"o XIN LUU Y: Neu quy vi not tieng Viet (Vietnamese), quy vi se dtrac cung cap dich vu tra giitp ve ng6n ngfr mien phi. Vui 16ng goi so dien thoai mien phi a mat sau the h6i vien cita quy vi. ':SG�01(Korean)- Al- a0[Al`o4$°j01Tj Add I�mc__T�-iff010ofIL\1T5UdL-ICE. �Ll0 9° hlICS 7F1-Oil )ITH2 $T=s1Sa E08�� `°aoFd'AI2. PAALALA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga libreng serbisyo ng tulong sa wika. Pakitawagan ang toll -free na numero ng telepono na nasa iyong identification card. BHHMAH14E: 6ecmaTHbie yc.nyrH nepCB09a AoCTyntibl ;jJ1A JatoAeK, gefi pOAHOfi AWK ABJIAeTCA pyceicoM (Russian). II03BOHHTe no 6ecnnaTHOMy HOMepy Tenecpoxa, yKa3axxoMy Ha BanieH UnitedHealthcare Insurance Company La.v11 , e;1e11 �Jj Ldo JL_. T �u�ll 4aL"u aytz.il asyJll e�L.all "La1i vie ;(Arabic) z-,S U :4*4 ATANSYON: Si w pale Kreydl ayisyen (Haitian Creole), ou kapab benefisye sevis ki gratis you ede w nan lang pa w. Tanpri rele nimewo gratis ki sou kat idantifikasyon w. ATTENTION: Si vous parlez frangais (French), des services d'aide linguistique vous sont proposes gratuitement. Veuillez appeler le numero de telephone gratuit figurant sur votre carte d'identification. UWAGA: Jezeli mowisz po polsku (Polish), udostgpnilismy darmowe uslugi thunacza. Prosimy zadzwonic pod bezplatny numer telefonu podany na karcie identyfikacyjnej. ATEN(;AO: Se voce fala portugues (Portuguese), contate o servigo de assistencia de idiomas gratuito. Ligue gratuitamente para o numero encontrado no seu cartao de identificayao. ATTENZIONE: in caso la lingua parlata sia Fitaliano (Italian), sono disponibili servizi di assistenza linguistica gratuiti. Per favore chiamate it numero di telefono verde indicato sulla vostra tessera identificativa. ACHTUNG: Falls Sic Deutsch (German) sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfugung. Bitte rufen Sic die gebuhrenfreie Rufnummer auf der Ruckseite Ihres Mitgliedsausweises an. 31:, * : ®*11(Japanese)V; 'x 'I6*'9=, 1ii� ! cY'l o� os�, 1t9 tan �LwLsw u jlS ajj °S ww vmwr t: zr 3ffq W`'i (Hindi) mt f ;Ffr 3uq + cf�v mw 7frzrm # TIT : Icy + iqc > I zFw v4 �I of � qT fc7 i g �q' � +1 cam' -;Rr f ww qt I CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb rau koj. Thov hu rau tus xov tooj hu deb daawb uas teev muaj nyob rau ntawm koj daim yuaj cim ghia tus kheej. l7fViltlFlmaf1: t5ras fi9tl1101 nwe! (Khmer) 6wQPan1h4Rq gull g1ths etwe culaew SdL11HI0tB9tLlfNEhIR11 Mt1M7IIhfAftY PAKDAAR: Nu saritaem ti Ilocano (Ilocano), ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para. kenyam. Maidawat nga awagan iti toll -free a numero ti telepono nga nakalista ayan iti identification card mo. DIi BAA'AKONINiZIN: Dine (Navajo) bizaad bee yinilti'go, saad bee ika.'anida'awo'igii, t'ii jii7c'eh, bee ni'ahoot'i'. Tii shgQdi ninaaltsoos nitl'izi bee neehozinigii bine'dgg' t'" jiWehgo beesh bee hane'i bika'igii bee hodiilnih. OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyada taageerada luqadda, oo bilaash ah, ayaad heli kartaa. Fadlan wac lambarka telefonka khadka bilaashka ee ku yaalla kaarkaaga aqoonsiga. UnitedHealthcare Insurance Company Florida Municipal Insurance Trust City of Winter Springs Rate Quote for Medical and Prescription Drug Benefit Coverage Current Rates - UnitedHealthcare Choice Plus HSA Plan 6 10/1/2017 - Contract Type Enrollment 9130/2018 Monthly Premium Annual Premium Single 99 $665.10 $65,844.90 $790,138.80 EE + Spouse 6 $1,594.19 $9,565.14 $114,781.68 EE + Children 6 $1,594.19 $9,565.14 $114,781.68 Family 19 $1,741.23 $33,083.37 $397,000.44 Total 130 $118,058.55 $1,416,702.60 Renewal Rates - United Healthcare Choice Plus HSA Plan 6 10/1 /2018 - Contract Type Enrollment 9130/2019 Monthly Premium Annual Premium Single 99 $591.27 $58,536.12 $702,433.39 EE + Spouse 6 $1,417.23 $8,503.41 $102,040.91 EE + Children 6 $1,417.23 $8,503.41 $102,040.91 Family 19 $1,547.95 $29,411.12 $352,933.39 Total 130 $104,954.05 $1,259,448.61 Percent Change -11.10% Medicare Exchange Available Prescription Drug Copays Retail: $10/$35/$60 Mail Order: $25/$87.50/$150 ( UnitedHealthcare YOUR BENEFITS Benefit Summary ASO Choice Plus Florida Municipal Insurance Trust HSA Medical Plan 6 United HealthCare Services, Inc. and Florida Municipal Insurance Trust want to help you take control and make the most of your health care benefits. That's why we provide convenient services to get your health care questions answered quickly and accurately: • myuhc.comO- Take advantage of easy, time -saving online tools. You can check your eligibility, benefits, claims, claim payments, search for a doctor and hospital and more. • 24-hour nurse support —A nurse is a phone call away and you have other health resources available 24-hours a day, 7 days a week to provide you with information that can help you make informed decisions. Just call the number on the back of your ID card. • Customer Care telephone support — Need more help? Call a customer care professional using the toll -free number on the back of your ID card. Get answers to your benefit questions or receive het lookina fora doctor or hospital. The Benefit Summary is intended only to highlight your Benefits and should not be relied upon to fully determine your coverage. If this Benefit Summary conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your SPD for an exact description of the services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage. SFXGF`i -107PA Page 1 of 4 THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT TWILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC.'S PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED. Page 2 of 4 THIS MATERIAL IS PROVIDEDON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC.'S PRODUCTS AND SERVICES TO THE RECIPIENT, ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED. mo massage therapy; rolling (holistic issue massage); art, Plusic, dance, fweeback therapy; and other forms of alternative treatment as daineid by the National CenterdorComf;iemoritmy and Heaim This exckmen does not aoDN to Manipulative Treatment anal norm vRNrsal^adv„a oADDIIIhic care rbrwhich Bdflefitsare imavdal:d astletvitlyd in the SPD. uentai care (what includes dental x-rays, supplies and appliances aria airassoraatea expenses, mauaing nospnanzasans aria anesalesta). I ins exclusion coos not apply to oemai care torai exammaaon, x-rays, exaacuoce aria non-surgmat earninaliDn or oral infection) required for the direct treatment of a medical condition for which Benefits are available under the Plan as described in the SPD. Dental care that is required to treat the effects of a medical condition, but that is not necessary to directly treat the medical condition, is excluded. Examples include treatment of dental caries resulting from dry mouth after radiation 7cetrnenI or as a result of medlcedon. Enclodonlics, periodontal surgery and restorative treatment are excluded. Diagnosis or treatment of or related to the teeth, jawbones or gums. Examples include: extraction (including wisdom teeth), restoration, and replacement of teeth; medical or surgical ireatmenlofdental conditions; and services to improve dental clinical outcomes. This exclusion does not apply to accidentaHelated dental services for which Benefits are provided as described under Dental Services —Accidental Only in the SPD. Dental implants, bone grafts and other implant -related procedures. This exclusion does not apply to accident - Devices used specifically as salary items or to affect performance in sports-relatea activities. Drmouc appliances that straignten or resnape a today pan as eesonmea unaer uureole Mealcal tquipmem (umtl In the sru. txamples Include mot ormobca, cranial banding, or any orlhotic braces available over-the-counter. The following items are excluded,: blood pressure cuff/monitor; enuresis alarm; non -wearable external defibrillator, trustee; and ultrasonic nebulizem. Devices and computers to assist in communication and speech except for speech generating devices and tracheo-esephogeal voice devices for which Benefits are provided as described under Durable Medical Equipment Oral appliances forsnoring. Repalrand replaosmenlprosthede devices when damaged due to misuse, malicious damage or gross neglect Prosthetic devices. This exclusion does not apply to breast prosthesis, mosteethmy bras and lymphedema stockings for which Benefits are provided as described under Reconstructive Procedures In the SPD. The exclusions listed below apply to the medical poron of the Plan only. Prescription Ding coverage is excluded under the medical plan because it is a separate benefit. Coverage may be available under the Prescription Drug potion of the Plan. See the SPD for coverage details and exclusions. Prescription drugs for outpatient use that are filled by a prescription order er refill. Self -injectable medicesons. This exclusion does not apply to medications which, due to their characteristics (as determined by United Healthcare Services. Inc.), must typically be administered or directly supervised by a qualified provider or licensed/ceNfled health professional In an outpatient setting. Norf Injsclabls medications given in a Physician's office. This exclusion does not aennee In me bro. I nis exclusion applies even IT rxpermil l oar urovesegasonal oeivice it or unprc^mxn aasrvce% uaaunemre, CuveredHealth Services DromdridburncannliininallriefaroArAoPenn% am, rimyklednsdliscritedunalnr'Idiuwr TrbiriIradin Routine toot rare. Examples include the cuffing or removal of cams and catiuses. This exclusion does not apply to preventive tool care for DOVerea Persons WM cilabeti for WnICn Benetae are provided as described under Diabetes YiarvlCe6ln the SPU or when needed for severe systemic disease. Cutting or removal of cams and calluses. Nall trimming, cutting, or debriding. Hygienic and preventive maintenance care; and other cervices that are performed when there is not localized Sickness, Injury or symptom involving the foot. Examples include: cleaning and soaking the feet; applying skin creams in order to maintain skin tone. This exclusion does not apply to preventive foot care for Covered Persons who are at risk of neurological or vasculardisease adsvin from diseases such as diabetes. Treatment of flat feet. Shoes (standard or customl.. lifts and wednes; shoe orhotics: shoe inserts and arch su000rts P resernpapf imr ¢arer•C"eiscr0.dr'rti mtntlh",al :, lies and dk{„naaoawr aa'p era F.rsareip4ae Imv'Vtmw crnrrca;xceasacwr stewnrorxga, At.barldypis& duatmi: s 11%, Arm I'VI MV01:. iRr ally daaneAaN unissncwaswm cocoa mew a'Pd0y ¢roc u UdewA71e dawre,5lr€x wassary far ¢laws o0fsc1 ve Irsa of Co oWik M *gxrat E'rtwpnem for w twh $, to it are providal as aercribed a n97a r*o MedO Eq uifdr ern n rite Sao • Duabod .;vxrupaie; 1"' 0hO P,sarrams am provaded ars rtoV'iboo uaadwa Dbeb lot rA'A a' in Ind ti;P' D w Dsxacry tags and relratod Vapflr fat v Nch Baf*ks we pcoyidW as dlemirbed urft u;,k„ stm,v Pupp*% iw tali SPD- I ufm iga, alnsai csMno v donuts"llird and rot A, e#Ciapa wheri waled Will1 hrw Rolt Oet9'R;al Equgimarn ad 0%rslbe d (under Duradwa tihngiral ppulcyrrwenf, as oftat d fa the aft""O the ropatr end replxemenl of Durable Medical Fgwisrnena wrterr ihamagrbl dun. ro mdrmae6fl r. huhrk 15 done, artrAmic+ari m,9m tve. a1&he wbaua rwnewa7d a, Oyer 0mv,k t[i area not rsmcli iftBeYstlbPHd in ft, Mn'F O rvtres Droved con dfJm6"+Rfb1Y1 waaVu d�rmodlb!rtrs rnrt cwasgrd pr mho amrrmwrd tnd+atarr or ffae D¢exynur'neaorr Maaoaaa af bwomJ rkfm Arrmra ae w+waN¢ aavpmrdr A�rAaaodts, rvuces or sakes urtu^ ekr dmgrwaafs nr beafsmrir, rk MetNrak ¢amass, ;nexinirotwrorue soetwalwrr aloe di;v„adnrn mrcau. an the relxbwnalhle fudgmorif oil the Mentai H61Ml1SAaaA0W U5a @twmxa w Aimmnafrakom tiro arty of trey foilowarg. not ravvlW9 mth 9, ,m asy a+a:wlziaed Ttaridardy of medaaas marbca iu;e ,Mwr fraraamreowf crf swdw cofldl%ons; naa rswwn¢dfanM wlNfe sorviena HaCkerM Nry rrrmfiM ausaarvk, amnaalP,y denrnrumstvAlru�wT tlha I mu>ztuptraf ev raudrpkias evliPo inarin ab rmna.maeaafa to amid honofr;'Iwt Ir�thr twom'arwyar. cart drerqalare uwerretwMmd exfxntiemwMal, vvat rawudurEonp w8ar ikura Nr,Ars4ai VWeaPbarSuCaaerurtr,o tnw.e Oev,dea Ada qkaiors camel at rare hyulioetman s W ae5l teri h", 5 as MoWlrerd MDmrero rfnwu r bane; x not Omicaalky ag7fo'Wath awl r.,onaid.,ed oreffiardrvo far men toonts Miens 11i tmbatailo@ ulse diorycof a W' 'WA 'M hna"d ono gnfoorully w.coplao ,tamxt,Wdsof rvunullcal Viacom Ind im othmaarks Nor,,W HdSiMlgh S rnian am R matmon1% hsrVa"ode o:rrd'htrnsa W Woo Y Ahiat it* e ifmM 46kon of hwrr Dwgn to aamd,d'ap4auc�aM avcark arh ma Amtnx w P+ayaf+walafr Astic alirm RkourPsl Heal* Seraicv, as traaftill for a Prvmary, dri gr vsu. nib Imomril a and other Mearp drxcwn4om, SnuuAI, dyshy'non dn,orrct�ers, ferafin t,f em neurolo;lwast drrdays wdl Os w fkzopdArs waftr+a kst wrr puapdN,°ast tNgsls nneaamnantls kin Ilse fw'ora P durs"Q as 4,9 saming disabilib f,,, a'NrdsM;i and wrrpulse rielnm'rrd dlsmdsrs pevsi:awaleq dlarn re. p imq; has (5mro al behaoryrffia. na oons4wad dowrarul or nbnn^arrWf Ee9rneoN'venaa"rwv,Rraaiaxal ser—T, thntlitre lom,*ed der pnr^W"r hasW ng shills a+xt eap,+mY;udGRme m CUht^Y+uUNrCatbsaa, 6_,al otmanilcr and IaardxMtg; rl drat kv N 54ru$; A brat cum SCh AN -bat&l fit, aleiugl on mm4l adok" arimb land., tt.4 fn fMtdud,,%vsM CJraa%,°ed d.%h'ducat or, AalhLesotho r'4k".09s and t,Alwity tommna mra' ko dmor&f l m,, de7i1n4 d tilt tho cur1'Sr i iialinPwn 0 ins Do gnrasbe and SronbaWrir rM lmmiaf aclan Am ewan r'syor„Nmuusatie: As.,uu.wkron Venial rekndatris m,, ra rarustraoy Jkagnowi defined =n rile aamenI W airs of E "' onignosbu: and k4M'+m4"wi Mamumr 0 fro Arnwe;asn Peyd,,ad AssuwsM on Mertm0llia heatnrortt rw rawaoftnimca. LA A M, JI-AIb6n AnedyidMedlddoip crlazoe'l e rid thoin aequ4nArrrs Mm dani ar!r, char, dvWan sva+, bohd oarel ihemp sir zQch as appdwtl sehavwarad amnalyaa4 for Atm Spmun'ramn 0,rrwdrs,w An4.atare is ❑, olf- %aoo[sl d w, v c. N iiiKAmai or cosmetic therapy using high doss or mega quanuuos of vitamins, mlnerac or eiemeres, aria oher nu i a m based therapy. Nut ixmai caunsaing for 01c,ar A41WxJN.daad or groups except as 60ftod under i5laPsnWS , 9rvici s in Bho ; PD.'r000 of any kind. Foods that are not covered include: enteral feedings and other nutritional and electrolyte formulas, including Infant formula and donor breast milk unless they are the only source of nutrition or unless they are specifically created to treat inborn errors of metabolism such as phenylketonuria (PKU) — infant formula available over the counter is always excluded: foods to control weight, treat obesity (including liquid diets), lower cholesterol or control diabetes; oral vitamins and minerals; meals you can order from a menu, for an additional charge, during an Inpatient Stay, and other dietary and electrolyte supplements; and health education classes unless offered by United Healthcare Services, Inc. or its affiliates, including but not limited to asthma, 9 etervision; mispnone; beautylbarber service; guest service. Suppiiss, equipment anti similar incioenrar services and suppbes rrer personal ix➢A atlwII "amp- in"Aa; sw axvwoawmars, air puwirs ants Mum, aehumwrorrars and ralivo acrers; matenes am, battery chargers; breast pumps; car seats; chairs, bath chairs, feeding chairs, toddler chairs, chair lifts, recliners; exercise equipment and treadmills; home modifications to accommodate a health need such as ramps, swimming pods, elevators, handrails and stair glides; hot tubs; Jacuzzis, saunas and whidpodls; ergonomically caned chairs, non -Hospital beds, comfort beds, mattresses; medical start systems; motorized beds; music devices; personal computers, pillows; power -operated vehicles; radios; Page 3 of 4 THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC.'S PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. 15 PROHIBITED. accumulation under the male breast and nipple; Treatment for skin wrinkles or any treatment to Improve the appearance of me skml Treatment for splder veins; Hair removal or replacement by any means. Replacement of an existing intaCi breast implant if the eadier breast implant was performed as a Cosmetic Procedure. Treatment of benign gyneoomastia (abnormal breast enlargement in males). Physical conditioning programs such as athlatic veining, body-building, exercise, fitness, flexibility, health club memberships and programs, spa treatments and dlveri or general motivation. Weight loss programs whether or not they are under medical supervision. Weight loss programs for medical reasons are also excluded, even If for morbid obesity. Wigs Procedure or surgery to remove Wli stern sum as pannidulacmmy, abdis minoplasty, tAignioaaly, bracnioplasty, or mastopoxy. Fxeislon or warenaten of mangfoll skin on any pan it ma body, Examplas include pi"bo surgery procedures u"r W abdomidoplasty or abdominal panniculectomy, and bmchioplasty. Medical and surgical treatment of excessive sweating (hyperhidrosis), Medical and surgical treabnent for snoring, exceplwhen provided as a partof teatmnt for documented obstructive sloop aphaic. Rehabilitation services and Manipulative Treatment to improve general physical condition that are provided to reduce potential risk factors, where significant therapeutic improvement is not expected, Including routine, long-term or malntonancetprevioni treatment, Speech therapy except as required for treatment of a speech impediment or speech dyshmction that results from Injury, stroke, cancer, Congenital Anomaly, or autism spectrum disorders. Speech therapy to treat stuttering, stammering or other articulation disorders. Psychosurgery. Sex Ironsformation operations and related services. Physiological mcidelflies and procedures that result in similar or redundant therapeutic effects when performed on the same body region during the same visit or office encounter. Biofeedback. Mamlptdafive treatment to treat a condition unrelated to spinal manipulation and ancillary physiologic treatment rendnrraf to msMrsfimprove motion, reduce pain and knp rave function, such as asthma of allergies. Manipulative treatment (the iterapaulic application of chiropractic and cetaupathic manipulative treatment with or without ancillary physiologic treatment ands rehabilitative methods rendered to ramrebmpmve motion, reduce pain and improve furribon)Services for the evaluation and treatment of temporomandibular joint syndrome (TMJ), whether the sai are considered to be dental In nature, the following services for the diagnosis and treatment of TMJ: surface alechomyogrephy; Doppler analysis; vibration analysis; computerized mandibular scan or Jaw tracking; craniosacral therapy; orthodontics; occlusal adjustment; dental restorations. Upper and lower jawbone surgery, oriiognathic surgery and jaw alignment This exclusion does not apply to reconstructive jaw surgery required for Covered Persons because of a Congenital Anomaly, acute traumatic Injury, dislocation, tumors, cancer or obstructive sleep apnea, Odhognathic surgery (procedure to correct underbite or overbite) and jaw alignment. Breast reduction except surgery as coverage is required by the Women's Health and Cancer Right's Act of 1998 for which Benefits are described under Reconstructive Procedu res In the SPD. Nonsurgical treatment of obesity even If for morbid obesity. Surgical treatment of obesity even if there is a diagnosis of morbid obesity as described under Obesity Surgery in the SPD. Stand-alone multi -disciplinary smoking castration programs. These are programs that usually include health care providers specializing in smoking cessation and may include a psychologist, social worker of other licensed or certified profassional, The programs usually include intensive psychological support, behavior modification techniques and medications to control services "frormeu by a provider wine is a la ni memoar by elan or drainage. Exawnplas include a spouse, bmrrer, sister, parent or able, this includes any service me provider may performed himself or herselt. Services performed by a provider with your same legal residence. Services ordered or delivered by a Christian Science practitioner. Services performed by an unlicensed provider or a provider who is operating outside of the scope of stainer license. Services provided at a free-standing or Hospital. based diagnostic facility without an order written by a Physician or other provider. Services which are set -directed to a free-standing or Hospital -based diagnostic facility. Services ordered by a Physician or other provider who is an employee or representative of a free-standing or Hospital -based diagnostic facility, when that Physician or other provider has not been actively involved in your medical care prior to ordering the service, or is not acimly involved in your medical care after the service is Heem services and associated expenses for imemmy raprodcliu9 r arments, including assisted raouu;oiogy, mgarmesa of do reason roc me treatment- ¢ nit exevo an usion does not apply services required to treat or cement undying causes of imartmry. The following Infantility treatment -related services: cryo joreservaion and other forms of preservation of reproductive materials, long-term storage of reproductive materials such as sperm, eggs, embryos, ovarian tissue, and tssllcuiar tissue, dater servics Surrogate parenting, donor eggs, donor sperm and host uterus. Storage and retrieval of at reproductive materials. Examples include eggs, sperm, lestoular tissue and ovarian tissue. The reversal of voluntary sr9rfkstion. Health services and essoated expenses for cloche surgical, non -surgical, or drug -induced Pregnancy termination. This exclusion does not apply to treatment of a molar Pregnancy, Adagio Pregnancy, or missed abortion (oornmoaly known as a miscarriage). Services proNdad by a Haa+h sarnces for which other coverage, ids avariobie under another plan, except for Exgibie Expenses payable as deacnbed in cos SPD. Examples include coverage required by workers' compensation, no-fault auto insurance, or similar legislation. If aowir&Ws under workers' coaprsnnanarr, i1a,rau fit automobile cowanrra r or similar epwaMfron is OiHJoaai for you because pram could else[ ib or could have it elected for you. Heath services for treatment of milltary service -related disabilities, when you are tar fid aavtitied to other awwarp unrl faeiiaWs we reasonably avaiable to Wou. HefNtt nerviras while on activa mildmryck' i Heaflh sewe;ea kit oigen and tissue transplants, except as 6M 0rid under Transplantation Services in the SPD unless United HealthCw v Services. Inc dairwmmirrirm the eawTr pWit as be appropriate accord+urg to United Healthcare Seivireq. he iF ba nsptam quKkAnes. Wrpw,ruroancM or animal organ transplants, except awwwas related to the implant or removal of a circulatory aOvist diva few tort orA, ihdk UpPou Me Varrwl wbin ere puro aP W80a Ow, a si*ft domuor NN O tun bitamnan aumekwrtlaf and *vier orwestir oxtre p"'O' &' MY Pau, manegemeni Pmgraina pru ieao on an mpdra»rwi beers fu awl. pain el ru, enwitiation dr chronic pao, k;ussS,ltai care; ennnivaari care. Purvate Duly Numing. Raspite care.'19s exclusion does not appiy to respite care iwdn is pad of hospice care program of services provided to a terminally III person by a licensed hospice care agency for which Benefits am described under Hospice Care in go SPD. Rest cures; services of personal care attendants. Work hardening I beatmerd Dio arams deasmed to return a mareon to work or to oraarare a Person for stimifih works. Pumnaso Post and associated Bring charge for eye glasses and caMaet kanees. fmpfaarmobie lessee aecad Only 0 owyrre„ za rerrarlvre Ann ifitiCh as inea. comeai can jaft). Bone unchyed hearing Ws evrem when 0" itI the fokeehg aNzowc for Covered Parsons with crantofar>{al anomalies whose abnormal or absent ear canals preclude the use of a wearable hearing aid or for Covered Persons with hearing loss of aulfidient savadiy that t would not be adequately remedied by a wearable hearing aid. Eye exercise or vision therapy. Surgery and other related treatment that is intended to correct nearsightedness, farsightedness, presbyopia and astigmatism including, but not limited to, procedures such as laser and other refractive eye surgeryand Iifi ea111068 and 6uPP44s lflhdt da lot meet the aednidun or a Covered Health Servka—see me defimaon ei Covered Heafih Services in the Glossary in tnb 5PO Coveed Haadin Smrvtcas are those heafm services Incwaing serous, supplies or Prescription Drugs, which the Claims Administrator determines to be all of the following: Medically Necessary; described as a Covered Health Service in the SPD; and not otherwise excluded in the SPD. Physical, psychiatric or psychological exams, teeing, vaccinations, Immunizations or treatments when: required solely for purposes of education, school, sports or camp, travel, career or employment Insurance, manage or adoption; or as a result of Incarceration; related tojudiciai or administrative proceedings or orders; conducted for purposes of medical research; required to obtain or maintain a license of any type, This exclusion does not apply to Covered Health Services provided during a clinical Mel for which Benefits are provided as described in the SPD. Health services received as a result of war or any act of war, whether declared or undeclared or caused during service in the armed forces of any country. This exclusion does not apply to Covered Persons who are civilians injured or otherwise Affected by war, any act of war or terrorism in a non -war zone. Health services received after the date your coverage under the Plan ends. This applies to all heath services, even it the health service is required to treat a medical condition that arose before the date your coverage under the Plan ended. Heath services for which you have no legal responsibility to pay, or for which a charge would not ordinarily be made in the absence of coverage under tie Plan. Charges that exceed Eligible Expenses or any specified Imitatbn in the SPD. Foreign language and sign language services. Health services related to a non -Covered Health Service: When a service Is not a Covered Health Service, all services related to that non -Covered Health Service are also excluded. This exclusion does not apply to services the Plan would otherwise determine to be Covered Health Services t they are to treat complications that arse from the non -Covered Health Service. For the purpose of this exclusion, a'remplicatien' is an unexpected or unanticgiated condition that is superimposed on an existing disease and that affects or modifies the prognosis of the original disease or condition. Examples of a'complloadon' are bleeding or Infections, following a Cosmeffc Procedure, that require hospitalization. Heath services when a provider waives the Copay, Annual Deductible or Coinsurance amounts. Autopsies and other coroner services and transportation services for a corpse, Charges for; missed appointments; roan or ladlity reservations; completion of claim forms; or record procosaMg. Charges prohibited by fedarai anti -kickback or set-reforral status, Diagnostic tests that are: delivered in other lines a Physician's o0da or health care facility; and seN4rehisiskered home diagnostic tests, Including but rot limited to HIV and pregnancy tests, vision Therapy when rendered in connection with behavioral heath disorders, including but not invited lo: faarMng and reading disabi lies; attention defiaUhyperactivaty disorder; TBI; or Page 4 of 4 THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INi PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED. µ, UnitedHealthcare® Addendum to the ��Medical Benefit Choice Plus Florida Municipal Insurance Trust HSA Medical Plan 6 Employee Only These Benefits are available to you in addition to the benefits located on the Benefit Summary. ADDITIONAL CORE BENEFITS Benefits Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in the Schedule of Benefits. Prior Authorization is required for certain services. This Gender Dysphoria exclusion applies: Cosmetic Procedures including the following: Abdominoplasty. Blepharoplasty. Breast enlargement, including augmentation mammoplasty and breast implants. Body contouring, such as lipoplasty. Brow lift. Calf implants. Cheek, chin, and nose implants_ Injection of fillers or neurotoxins. Face lift, forehead lift, or neck tightening_ Facial bone remodeling for facial feminizations. Hair removal. Hair transplantation. Lip augmentation. Lip reduction. Liposuction. Mastopexy. Pectoral implants for chest masculinization. Rhinoplasty. Skin resurfacing. Thyroid cartilage reduction; reduction thyroid chondroplasty; trachea shave (removal or reduction of the Adam's Apple). Voice modification surgery. Voice lessons and voice therapy. This Procedures and Treatments exclusion no longer applies when Gender Dysphoria applies: Sex transformation operations and related services. r r Partial Hospitalization/Intensive 80% after Deductible has been met per 70% after Deductible has been met per Outpatient Treatment: session for Partial Hospitalization session for Partial Hospitalization /Intensive Outpatient Treatment. /Intensive Outpatient Treatment. Prior Authorization is required for certain services. Partial Hospitalization/Intensive 80% after Deductible has been met per 70% after Deductible has been met per Outpatient Treatment: session for Partial Hospitalization session for Partial Hospitalization /Intensive Outpatient Treatment. /Intensive Outpatient Treatment. Prior Authorization is required for certain services. UnitedHealthcarc Insurance Company Partial ntensive Outpatient Treatment: Network Benefits are available only when services are delivered through a Designated Virtual Visit Network Provider. Find a Designated Virtual Visit Network Provider Group etmyuhc-oomor bycalling Customer Care atthe telephone number onyour |D card. Access 0oVirtual Visits and prescription services may not be available inall states nrfor all 80% after Deductible has been met per 70% after Deductible has been met per session for Partial Hospitalization session for Partial Hospitalization /intensive Outpatient Treatment. /intensive Outpatient Treatment. Prior Authorization isrequired for certain 80% after Deductible has been met per 70% after Deductible has been met per visit. visit, This replaces the Mental Health, Neu Spectrum, and Substance Use Disorders exclusion sections mnthe Benefit Summary: Services performed in connection with conditions not classified in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Outside of an initial assessment, services as treatments for a primary diagnosis of conditions and problems that may be a focus of clinical attention, but are specifically noted not to be mental disorders within the current edition of the Diagnostic and Statistical Manualo/the American Psychiatric Association. Outside of initial assessment, services as treatments for the primary diagnoses of learning disabilities, conduct and impulse control disorders, pyromania, kleptomania, gambling disorder, and paraphilic disorder. Educationallbehavioral services that are focused on primarily building skills and capabilities in communication, social interaction and learning, Tuition for or services that are school -based for children and adolescents required to be provided by, or paid for by, the school under the Individuals with Disabilities Education Act. Tuition for or services that are school -based for children and adolescents required to be provided by, or paid for by, the school under the Individuals with Disabilities Education Act. Outside n[initial assessment, unspecified disorders for which the provider iunot obligated hoprovide clinical rationale as defined in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Methadone treatment as maintenance, L.A.A.M. (1 -Alpha-Acetyl-Methadol), Cyclazocine, or their equivalents for drug addiction. Intensive Behavioral Therapies such as Applied Behavior Analysis for Autism Spectrum Disorders. Transitional Living services. This Benefit Summary Addendum isintended onlhighlight your Benefits o7mot be relied upon to fully determine your coverage. |fthis Benefit Summary Addendum conflicts in any way with the Summary Plan Description (SPF), the SPD shall prevail, It is recommended that you review your SPD for an exact description of the services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage. UnitedHealthcare Insurance Company United HealthCare Services, Inc. does not treat members differently because of sex, age, race, color, disability or national origin. If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to the Civil Rights Coordinator. Online: UHC_Civil_Rights@uhc.com Mail: Civil Rights Coordinator. UnitedHealtheare Civil Rights Grievance. P.O. Box 30608 Salt Lake City, UTAH 84130 You must send the complaint within 60 days of when you found out about it. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll -free phone number listed on your ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m. You can also file a complaint with the U.S. Dept. of Health and Human Services. Online W!Irn;L�'&IqcmbauQ3�9 !/PQ ,taWQ by hf Complaint forms are available at;�vj?.-j° Ey l i �u m ffi e/ ile/in exjityrii Phone: Toll -free 1-800-368-1019, 800-537-7697 (TDD) Mail: U.S. Dept. of Health and Human Services. 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call the toll -free phone number listed on your ID card TTY 711, Monday through Friday, 8 a.m. to 8 p.m. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Please call the toll -free phone number listed on your identification card. ATENCI6N: Si habla espanol (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposici6n. Llame al numero de teldfono gratuito que aparece en su tatj eta de identificaci6n. lft �, : #iAA (Chinese) , M9 9P,A21V R R tA-M A RX5. 010#T*- -�-TRA N ,ll *jRIMM* o XIN LU'U Y: Neu quy vi n6i tieng Viet (Vietnamese), quy vi see doge cung cap Bich vu trg gifip ve ng6n ngtr mien phi. Vui long goi so dien thoai mien phi ct mat sau the h6i vien cita quy vi. mo o' : LF Oi (Korean) � AF C= f0 � T of Qi zl �a d l h � T � � OI Q of � `u' d LI EJ Pj10 21 hl 9FS0 II 717HIS $T. -1 N J E�0�sJ 2_ `2101d'AIc?. PAALALA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga libreng serbisyo ng tulong sa wika. Pakitawagan ang toll -free na numero ng telepono na nasa iyong identification card. BIIHMAH%iE: 6ecnnaTHbie ycnyrH nepesoga g0CTyHHbI XM nto,geA, aeH po,gHOH 3I3blK xsnsteTCSI pyceicom (Russian). IIo3BOHHTe no 6ecruiaTHOMy HOMepy Teae(�011a, yKa3aHHOMy Ha Bainei3 UnitedHealthcare Insurance Company Laalf �1g11 r,9J L�- JL-z'11 4-Jl ,L i U— ZPLa_Ji LyxilI blalunoll ul oli j19 c(Arabic) Z u5 U :A*L l L s�1 ATANSYON: Si w pale Krey61 ayisyen (Haitian Creole), ou kapab benefisye sevis ki gratis you ede w nan lang pa w. Tanpri rele nimewo gratis ki sou kat idantifikasyon w. ATTENTION: Si vous parlez frangais (French), des services d'aide linguistique vous sont proposds gratuitement. Veuillez appeler le numdro de tdldphone gratuit figurant sur votre carte d'identification. UWAGA: Jezeli m6wisz po polsku (Polish), udostgpniligmy darmowe uslugi tlumacza. Prosimy zadzwonid pod bezplatny numer telefonu podany na karcie identyfikacyjnej. ATENgAO: Se voce fala portugues (Portuguese), contate o servigo de assistencia de idiomas gratuito. Ligue gratuitamente para o numero encontrado no seu cartao de identificayao. ATTENZIONE: in caso la lingua parlata sia Fitaliano (Italian), sono disponibili servizi di assistenza linguistica gratuiti. Per favore chiamate it numero di telefono verde indicato sulla vostra tessera identificativa. ACHTUNG: Falls Sie Deutsch (German) sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfugung. Bitte rufen Sie die gebuhrenfreie Rufnummer auf der Ruckseite Ihres Mitgliedsausweises an. ;_S)A : 8 *M(Japanese) iH1 i�L 7.) * , ) A IREUVA H"— Eo�- o f=�f�l��l���ci��'1.Z•���7�J—�'-f���i��'�a�<t��t-�o �L';vl� �' a,to.y L, isl�i •a:LL � La.'.,,linl �� �jL'r.�IJ J.91' 4� �L�, j el.�.a1 ul..o.� ��,I (Faisi) �y�++�La t.�.� �L�� y5) :`�s� .LAt)"t-'t.&�LaluuuBLSc59>`_'� ww t--ai' t: �• 3fTq I, (Hindi) wt f c� w* is v ww T *nv I': �1c; + 3qi w I ww 3iq' t v4T; ' � qT f4 v zTcT-I� � Tiw qT ww 44 I CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub-dawb rau koj. Thov hu rau tus xov togJ hu deb dawb uas teev muaj nyob rau ntawm koj daim yuaj cim ghia tus kheej. snm$rnrgnn: svrira�rscnncsmtv�ierr (Khmer) mma°amen utrnwerA Ea Fisnaniniwr-i r;ugahsAnrah iets idnimasa9srvaiir,rmnnnnnnmtistmg PAKDAAR: Nu saritaem ti Hocano (Ilocano), ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Maidawat nga awagan iti toll -free a numero ti telepono nga nakalista ayan iti identification card mo. DIi BAA'AKONINIZIN: Dine (Navajo) bizaad bee yanilti'go, saad bee aka'anida'awo'igii, t'aa jWeh, bee na'ah6&T. Taa sh44di ninaaltsoos nitl'izi bee nddhozinigii bine'dgg' t'Aa jiWehgo bddsh bee hane'i bika'igii bee hodiilnih. OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyadataageerada luqadda, oo bilaash ah, ayaad heli kartaa. Fadlan wac lambarka telefonka khadka bilaashka ee ku yaalla kaarkaaga agoonsiga. UnitedHealthcare Insurance Company ( UnitedHealtheare7 YOUR BENEFITS Benefit Summary ASO Choice Plus Florida Municipal Insurance Trust HSA Family Medical Plan 6 ni ad HealthCare Services, Inc. and Florida Municipal Insurance Trust want to help you take control and make the most of your health care benefits. That's why we provide convenient services to get your health care questions answered quickly and accurately: • nryubc.cori - Take advantage of easy, time -saving online tools. You can check your eligibility, benefits, claims, claim payments, search for a doctor and hospital and more. • 24-hour nurse support —A nurse is a phone call away and you have other health resources available 24-hours a day, 7 days a week to provide you with information that can help you make informed decisions. Just call the number On the back of your ID card. • Customer Care telephone support — Need more help? Call a customer care professional using the toll -free number on the back of your ID card. Get answers to your benefit auestions or receive help looking for a doctor or hOSDIt8l. The Benefit Summary is intended only to highlight your Benefits and should not be relied upon to fully determine your coverage. It this Benefit Summary conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your SPD for an exact description of the services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage. SFXGF M1 07PA Page I of 4 THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC.'S PRODUCTS AND SERVICES TO THE RECIPIENT, ANY OTHER LISF, COPYING 3OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED. Benefits are limited as tollOWS: $2,500 per year and are limited to a single purchase (including repair/replacement) per hearing impaired ear every three nears. Benefits are lmwfed as fr)Ila)Ws_ two VRSMa per yffiv Pmvonlive Cam Seovites s,afalfohy, 9 his includes medications administered in an ou Setting, in the Physician's Office or in a Covered Primary Physician Office Visit Specialist Physician Office Visit met fid' % after f')edut ih4e has hoen tTw jl 80% after Deductible has been rndat 80% aftef Deduc&Ne has been met Inpatient: 80% after Deductible has been met Outpatient: 80% after Deductible has been met Inpatient: 80% after Deductibie has been met Outpatient: 80% after Deductible has been met has been met Non-NetwoO, Benet"0s has been mart ' d'0 % after @; ,Mucbble has been met " 7096 after DeduciJbirt has been met 70% after Deductible hits been met ' Inpatient: 70% after Deductible has been met • Outpatient: 70% after Deductible has been met " Inpatient: i D"/o arer DedUCLIDIe has bean met " Outpatient: 70% after Deductible has been met after Deductible has been met has been met V 70% after Deductible has been met has been met - 70% after Deductible has been met .............. ............ has been met ......�...e,.... _.. ' 70% after Deductible has been met upon where Me Oovered Health :;arvice is provided, t ene-05 Will be the same as those slated under eac alth Service catecol in this Benefit Sgmmpg,_,m,,,, uthodzatlon Is required if Inp lien! Sfay exceeds 48 I hours following a normal vaginal deliveryor 96 hours following Primary . o„Deductible does not alrply. _ Physician Office Visit 10D S. ecialist Physician Office Visit 100% Deductible does not at ply ..Non Network Benefits not available _ Non -Network Benefits are not available sal , X-Ra or kher reventive tests 100% Deductible does not Apply . Non-Nelwork Benefits, are net ava0ablo Benefits are limited as follows: 80% after Deductible has been met • 70% after Deductible has been met n single ptvc hase of each type of prosthetic device every hrlt,r, eaa'S. ` e Depending upon where the hovered i lQ1 &&nice is provided, benefits will be the same as those stated under each Covered Health Service cate2qeyin,this Berwfit Summa y, .. ,abanw'.4wtseonzation is required.IiIi Benefits are limited as follows: 80% after Deductible has been met • 70% after Deductible has been met 20 visits of physical therapy 20 visits of occupational therapy 20 visits of manipulative treatment 20 visits of speech therapy 20 visits of pulmonary rehabilitation 36 visits of cardiac rehabilitation 30 visits of post -cochlear implant aural therapy 20 visits of cognitive rehabilitation therapy Page 2 of 4 THIS MATERIALIS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILLONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, Ill PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED. Issue massagel; sa, rnuirt dance, horseback uhelafiy, and oftich, tons at ailernative treatment as deltned by he National Center for Compremonlary and Dental care (which includes cancer X-rays, supplies and appliances and all associatrd expel des. W�rlh.UnghDN*,011atx�v+sieeuliamMOOI. This exclusion does not apply to denial care Intel ocarainhoon, X-iays, &aadlkins it non-suioa Wmriabcoi of oral infection) required for the direct treatment of a medical condition for which Benefits are available under the Plan as described In the SPID. Dental cans that Is required to treat the effects of a medical condition, but that is not necessary to directly from the medical condition, is excluded. Examples include treatment of dental dares resulting from dry mouth after mailmen treatment or as a result of medication. Enclodmilics, parkalorital surgery and restorative treatment are excluded. Diagnosis or treatment of or related to the learn, jawbones or gums. Examples include: extraction (including wisdom teeth), restaradfican, and replacement of teeth; medical or surgical threarmentaf dental candidate: and Services to improve dental clinical oulcomea. This exclusion does not apply to accidental -related dental services for which Benefits are provided as described under Dental Services - Accidental Only in the BED. Dental implants, bone grafts and other implant -related propeclures. This exclusion does not apply to accident- wtoced dentolsomm kwMildh Soofft a's ivmnloom, danoTilhad undas Corneal Ser Acrxlont 0" mole -SIND . . ... ......... ..... . . ...... Devices used speadfithury as salary hems or to affect performance ci sports-miated &&;Ieh. 0;ftoL appliances car allegretto or re -shape a way pan as came I me taper Duraw h4rdadi Equipment dDMEp in Me SPD. EAampries Include AwA onhoscs, cranial banding, or any arthrolic amass available over-the-counter. The following Items are excluded,: blood pressure curfOrtionitic enviable alarm; non -wearable external defibrillator, trusses; and ultrasonic riebulizers. Devices and computers to assist in communication and speech except for speech generating devices and tracheo-emphogesil voice devices for which Benefits are provided as described under Durable Medical Equipment Oral appliances harshening, Repair and rexacarmentprosthedc devices when damaged due to misuse, malicious damage or gross neglect Prosthetic devices, This exclusion does not apply to breast prosthesis, mastectomy bras and lymphodema stockings for which Benefits are provided as described under Recbnslmlolvih Procedureo, In the SPD. The exotusions isaid baiu* atifin, to me medical portion ON 016 Plan only, Piesankrini Drug coverage is exciudisai under the medical plan because It is a separate benefit Coverage may be available under me Prescription Drug pormin of aria Mw See the SPD for coverage details and exclusions. Prescription drugs for outpatient use that are filled by a prescription order or refill. Self -injectable medications. This exclusion does not apply to medications which, due to their characteristics (as determined by United HealthCom Services, Inc.), must typically be administered or directly supervised by a qualified provider or ficeirsed1ceriffiral health professional in an outpatient setting. Norvinjeclable madicalicris given In a Physichan's office. This exclusion does not Rt In La nnnntrlsuatn rnmdaruuluorra tkrm arc cis u'verl Sr an P"„"rpmr en andoerusumedinthe Ph ' hirft office. Ovor-thiscovAkv In at had veakwft Cmmwth honnione therapy, Expermenim or invesugauonai or unproven Sonmers, unless the plan had agreed to cover them as ft(mW it Ore SK, Rim crIgumon agpk,, even 4 EXPtiPlafflUg "A,irWQ0pAIK9Ql S01*cvs W Unp.No, "Aurpenr . d(,�hxS or pharmauiGagMal Ire 'On. W 4mrm Routine mot cam. kolaimphis inducer ins cueing or removal (9 cores ArNt calluses. G da exclusion does not appry al, preventive fool care for Covered Pensons with matietes, for which Benefits are provided as ifeunued turdail Dtabov% 1*,rvnos fri Ole S�FID or when needed for severe systemic disease. Cutting or removal of come and calluses. Nall trimming, cutting, or debricirg. Hygienic and preventive maintenance foot care; and other services that are performed when there is not a localized Sickness, Initury or synnintram, Involving trut fool- Examples include: cleannin and mating the feet; applying skin creams in titter In maintain skin tone. This exclusion does not apply to preventive foot rare for Covered Persons who are at risk of neurological or vascular disease atilsing from debases such " debeteb Irmatment of fiat cent. 9, "1 1s storwWrh rX nuir,waro Ms arid wedge ; Ow* afthinv shoo 01AF% arm , r: J,, eat anr,7A, Pvesraiiidd or norHcremobea meoicai supistais and arsposabie supplies. 6ampkis include: care,prosswsn stockings, am bandages, chathatic Since, and sylirges: urinary cameters. True exclusion does not apply to: Disposable supplies necessary for the effective use of Durable Medical Equipment for which Benefits are provided as described under Durable Medical Equipment in the SPD. Diabetic supplies for which Benefits are provided as described under Diabetes Services in the SPD. Ostomy bags and related supplies for which Benefits am troubled as described under Ostomy Supplies in the SPD. Tubings.•nasal cammulas, connectors and masks, except when used with Durable Medical Equipment as described under Durable Medical Equipment as described in the SPD. The repair and replacement of Durable Medlcal Equipment when damaged due to mrsum. malicious brosicaue m wmc, vlraa and 4orklarrants. fifters. IvIcAotints- Idea. anearone nFicut,, allove a0hrme rooman or o0wirony, tritc are m4spockaky Oens!,W 1. into SPD SpIrve" 01010MOKI if, wrifleaun with conditions not daegsTed if, Ole cumeol omion of are Diagnostic aria scswimtr marl file AMOrrien PSYChlat'16 A&Sit6hshin. bftNicib; or supplies lof ink) diagnosis or treatment or reeneii Illness, inconcesm or substance use disorders that, in the reasonable judgment of the Mental HerilthilSubstance Use Disorder Administrator, are any of the fielloviing: not consistent with generally accepted standards of medical practice for the treatment of such conififirinsl not consistent with services backed by credible research soundly demonstrating that the services or supplies will have a measurable and beneficial health outcome, and therefore considered experimental; not consistent with the Mental Health/Stilloslance, Use Disorder Administrators larval of cam guidelines or best practices as mooll fied fool time to time; or not clinically appropriate, and considered Ineffective for the patients Mental Illness, substance use disorder or condition based on generally awApoed standards of medical practice and benchmarks. Mental Health Services as treatments for V-oods conditions as listed within this current edition of the Diagnostic and StarfishicalManual of the American Psychiatric Assmefion. Mental Health Services as treatment for a primary diagnosis of insomnia and other sleep disorders, sexual dysfunction disorders, feeding disorders, neurological disorders and other disorders with a known physical basis. Treatments for the primary diagnoses of teaming disabilities, conduct and impulse control disorders, personality disorders, primphillas (sexual behavior that is considered deviant or abnormal) Educallonalifibehavioral services that am focused on primarily building skills and capabillies in communication, social interaction and learainil button for or services that are school -based for children and adolescents under the Individuals with Disabilities Education Act. Learning, motor skills and primary communication disorders as defined in the current edition of the Diagnostic and Sisifiticat Mainual of the American Psychiatric Assochatfort. Mental retardation as a primary diagnosis defined in the current edition of the Diagnostic and Stafisboal Manuel of the American Psychiatric Association. Methadone treatment as maintentarrica, LRAM, (11 -Abiloa-Atary-Metakfol), Cyclazoicine, or their equivalents far drug addiction. Intensive behavioral tempos such as applied behavioral analysis for Aularn Spectrum Disorders. Any traistmandar or other spridalood servors, Numtronal or marshal; vierapy using hiifn dose or mega quanmos or viaticum, moderate or shamems, and over not, loan cresea mierapy. 40ftirwi co.risefing R9 drttar vronodutre or groups except as defined under Uvxbntlft Sarvicas . the SK% Face of any kind. Foods that are not covered include: enteral feedings and other nutritional and electrolyte formulas, including infant formula and donor breast milk unless they are the only source of nutrition or unless they are specifically created to must inborn orrom, of metabolism sock as otherrylkettinuria (PKU) - infant formula available over the counter is always excluded; foods to control weight, treat obesity (including liquid diets), [war cholesterol or control diabetes; oral vitaturnins, and minerals; meals you can order from a menu, for an additional charge, during an Inhalant Stay, and other dietary and electrolyte supplements: and health education classes unless offered by United Healthcare Services, Inc. or N affiliates, including but riot limited to helium , ileelasion: isheirmorre: neauryltorroer service: quest service, tsupplies, equipment and sminar inciatemi services and supplies mr perminin crunrcut. —infhas Monn air oundiffuners, hit pi.052b`; ithd ffircins, aernuritudeery and nurnotter m; hararm avid battery chargers; breast pumps; car seats; chairs, Win chairs, feeding chairs, toddler chairs, chair fill, recliners; exercise equipment and Imadmills; home modifications to accommodate a health need such as ramps, swimming pool elevators, handrails and stair glides; hot tubs; Jacuzzis, saunas and whirlpools; ergonomically correct chairs, non -Hospital beds, comfort beds, mattresses; medical alert systems; motorized beds; music devices; personal computers, pillows; power -operated vehicles; radios; chamosurgery and other such skin abrasion Page 3 of 4 THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREFMFN7 THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC. 'S PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, I NG, 15 PROHISf T ED. Purchase rest and asaa oacv trng charge 0 eye glasses end ouroact i6flato Implarnamer lenses usera only to correct a revacerve error (such as Interne remain implami I ancrimer; havenng arise excapiwTan ramisi dvie whoneng applies: for Covered Persons with crantle,a)i anomalies whose abnormal Or aclovent ear canals produce the use of a wearable hearing aid or for Covered Persons with boamill tess of sufficient sovedly that R would not be adequately remedied by a wearable hearing aid, Eye exercise of vision therapy. Surgery and other related thealphint that Is irroended is correct nearsightedness, mrsightsidness, prespylopla and asIgneacsfor Including, but not traded to, procedures such as ri and other relyarrive five fiLirgatir and HOW services and lutist Gas IW 60 ro Me her doorthicar Or a Covered torsarM Suryse, -sae are des Arn el C—ed B Wrier 51 in OR uiasdry In vie 5FI13 Goverad Hicann Survioss are those Ai Services Including services, supplier; Is Prosodplion linage, which the Claims Administrator determines to be all of the following; Medically Nereseary; described as, a Covered Health Gainers in the SPD; and not Otherwise excieurd In the SPD. Physical, psychiamn an psydhrdrrgical exams, testing vaccinations, immunizations or treatments where required solely for purposes of educai srhi sports or tamp, Moral Carrier or armplaymand, Insurance, marriage or admrtmn; or as a result of Incarceration; related tojisficial or administrative proceedings Or coders; conducted for purposes of medical research; required W obtain or maintain a license of any "a. This exclusion uses not apply to Covered Health Services provided during a clinical Mal for which Benefit are provided as described !I the SPD. Health seardaria, moral as a result of war of any act of war, whether declared or undeclared or caused during service in the armed forces of any county. This exclusion does not apply to Covered Persons who are die lans Injured or otherwise affected by war, any off of war or leffarean In a non -war zone. Health services waived after the date your coverage under the Plan ends. This applies as all health services, even r Ore health service is required to treat a medical candrion Ural arose bull the date your coverage under the Plan ended. Health services for which you have no legal manorial billity, to pay, or for which a charge would not ordinerfly be made in the absence of coverage Under W Plan r Charges that exceed Efignate Expenses or any spudded limputchn in the SPD. Foreign language and sign language verssoc& Health services related to a non -Covered Health Service: When a service is not a Covered Health Service, all services related to that non,Covered Health Serene are also excluddi This exclusion don not apply to services the Plan would otherwise determine to be Covered Health Sorvines if Jay are to beat complications that arise from the non-Cuvered Health Service. Fur tire purpom of this exclusion, a 'mintrificcusn' is an unexpected or ranalarcipared condition that is superimposed on on existing disease and that effects or modifies the prognal of the origin at diseases or condition. Examples of a 'comploofton' are standing or infections, following a Cashiers Procedure, that require hosphallsaftion. Health services when a provider waives the Copay. Annual Deductible or Coinsurance amounts. Autopsies and other coroner services and transportation services fora corpse. Charges far: missed appointments; room or facility frearrenfici completion of claim forms; or record pnxrasming. Charges prohibited by federal anti-kickbovA or self-reforral status. Diagnostic tests that are: delivered in other than a Physician's offlOe or heath cam facility and self-adminninered horm, diagnostic tests, inclurfing IsA not retired to H N and pregnancy III Vision thercany, when rendered in connection with behavioral hafth disorders, including but net limilsof ta: laximho and undhip ibeabliffles; aterril defidt1hyperactivey disorder, TBI; or Page 4 of 4 THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE or DESCRIBING UNITED HEALTHCARE SERVICES, INO,'S PRODUCTS AND SERVICES TO THE RECIPIENT, ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUr THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED, UnitedHealthcare Choice Plus Florida Municipal Insurance Trust HSA Medical Plan 6 Family These Benefits are available to you in addition to the benefits located on the Benefit Summary. ADDITIONAL CORE BENEFITS T es of Cov era a Network Benefits Non -Network Benefits Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in the Schedule of Benefits. Prior Authorization is required for certain services. This Gender Dysphoria exclusion applies: Cosmetic Procedures including the following: Abdominoplasty. Blepharoplasty. Breast enlargement, including augmentation mammoplasty and breast implants. Body contouring, such as lipoplasty. Brow lift. Calf implants. Cheek, chin, and nose implants. Injection of fillers or neurotoxins. Face lift, forehead lift, or neck tightening. Facial bone remodeling for facial feminizations. Hair removal. Hair transplantation. Lip augmentation. Lip reduction. Liposuction. Mastopexy. Pectoral implants for chest masculinization. Rhinoplasty. Skin resurfacing. Thyroid cartilage reduction; reduction thyroid chondroplasty; trachea shave (removal or reduction of the Adam's Apple). Voice modification surgery. Voice lessons and voice therapy. This Procedures and Treatments exclusion no longer applies when Gender Dysphoria applies: Sex transformation operations and related services. Partial Hospitalization/Intensive 80% after Deductible has been met per 70% after Deductible has been met per Outpatient Treatment: session for Partial Hospitalization session for Partial Hospitalization /Intensive Outpatient Treatment. /Intensive Outpatient Treatment. Prior Authorization is required for certain services. Partial Hospitalization/Intensive 80% after Deductible has been met per 70% after Deductible has been met per Outpatient Treatment: session for Partial Hospitalization session for Partial Hospitalization /Intensive Outpatient Treatment. /Intensive Outpatient Treatment. Prior Authorization is required for certain services. UnitedHealthcare Insurance Company Partial Hospital ization/Intensive 80% after Deductible has been met per 70% after Deductible has been met per Outpatient Treatment: session for Partial Hospitalization session for Partial Hospitalization /Intensive Outpatient Treatment. /Intensive Outpatient Treatment. Prior Authorization isrequired for certain Network Benefits are available only when services are delivered 80% after Deductible has been met per 0%ufter Deductible has been met per through aDesignated Virtual Visit visit. visit. Network Provider. Find a Designated Virtual Visit Network Provider Group otmyuhc.00mor bycalling Customer Care atthe telephone number onyour |O card. Access toVirtual Visits and prescription services may not be available inall states orfor all This replaces the Mental Health, Neumbio|og ical/Autism Spectrum, and Substance Use Disorders exclusion sections omthe Benefit Summary: Services performed in connection with conditions not classified in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Outside of an initial assessment, services as treatments for a primary diagnosis of conditions and problems that may be a focus of clinical attention, but are specifically noted not to be mental disorders within the current edition cf the Diagnostic and Statistical Manual o/the American Psychiatric Association. Outside of initial assessment, services as treatments for the primary diagnoses of learning disabilities, conduct and impulse control disorders, pyromania, kleptomania, gambling disorder, and paraphilic disorder. Educational/behavioral services that are focused on primarily building skills and capabilities in communication, social interaction and learning. Tuition for or services that are school -based for children and adolescents required to be provided by, or paid for by, the school under the Individuals with Disabilities Education Act. Tuition for or services that are school -based for children and adolescents required to be provided by, or paid for by, the school under the Individuals with Disabilities Education Act. Outside of initial assessment, unspecified disorders for which the provider is not obligated to provide clinical rationale as defined in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Methadone treatment as maintenance, L.A.A.M. (1 -Alpha-Acetyl-Methadol), Cyclazocine, or their equivalents for drug addiction. Intensive Behavioral Therapies such as Applied Behavior Analysis for Autism Spectrum Disorders. Transitional Living services. This Benefit Summary Addendum is intended only to highlight Benefits and should not Le relied upon to fully determine your coverage. If this Benefit Summary Addendum conflicts in any way with the Summary Plan Description (SPF), the SPD shall prevail. It is recommended that you review your SPD for an exact description of the services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage. UnitedHealthcare Insurance Company United HealthCare Services, Inc. does not treat members differently because of sex, age, race, color, disability or national origin. If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to the Civil Rights Coordinator. Online: UHC Civil_Rights@uhc.com Mail: Civil Rights Coordinator. UnitedHealthcare Civil Rights Grievance. P.O. Box 30608 Salt Lake City, UTAH 84130 You must send the complaint within 60 days of when you found out about it. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll -free phone number listed on your ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m. You can also file a complaint with the U.S. Dept. of Health and Human Services. Online iii."./:ilm��.im;ll:�rli✓�o�;br. Complaint forms are available at im�:Iro °'wow ..w h uy/oc:/offi„ e/f59inde htTn1. Phone: Toll -free 1-800-368-1019, 800-537-7697 (TDD) Mail: U.S. Dept. of Health and Human Services. 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call the toll -free phone number listed on your ID card TTY 711, Monday through Friday, 8 a.m. to 8 p.m. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Please call the toll -free phone number listed on your identification card. ATENCI6N: Si habla espanol (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposici6n. Llame at numero de teldfono gratuito que aparece en su tarjeta de identification. MAN : PAA1,s11RrZ (Chinese) , R1f tIA2,191 PItAMAR o =# #T*jR+PP1PA� ,4f *A 19R, iAo XIN LUTJ Y: Neu quy vi n6i tieng Viet (Vietnamese), quy vi se" dirgc cung cap Bich vu trq gitip ve ng6n ngrx mien phi. Vui long goi so lien thoai mien phi a mat sau the h6i vie"n cita quy vi. M=: �F�4Oi(Korean) Be A♦o 1FAI a0i Tl a AdHl;:L ME T_�-' _�2_ 01o51N T °!dLi14. -7loFal L� 3F�Oil 7IzN-q_ T2 sl a LJX' I Q-T-- s°l Ad'Al2. PAALALA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga libreng serbisyo ng tulong sa wika. Pakitawagan ang toll -free na numero ng telepono na nasa iyong identification card. BHHMAHHE: 6ecnriaTHbie yc.riyrH nepesoAa AocTynHbr AJIH n>E09eH, q0A pOAHofi 3I3bIK 31BJIACTC31 PycciKOM (Russian). 1Io3BOHHTe no 6ecroaTHOMy HOMepy Teiie()OHa, yKa3aHHOMy Ha BaHieii UnitedHealthcare Insurance Company V:,La I'J61+11 Zmt­ 2-P _Z1;L 11I a l cjuA& DP t(Arabic) A4a yal z-1:6 I!$ :4µ4L ATANSYON: Si w pale M-ey6l ayisyen (Haitian Creole), ou kapab benefisye s6vis ki gratis you ede w rian hang pa w. Tanpri rele nimewo gratis ki sou kat idairtifikasyon w. ATTENTION: Si vous parlez franVais (French), des services d'aide linguistique vows sont propos6s gratuitenient. Veuillez appeler le numero de 1616phone gratuit figurant sur votre carte d'identification. UWAGA: Je&li m6wisz po polsku (Polish), udostgpniligiiiy dannowe uslugi t1untacza. Prosinty zadzwonk pod bezlAatny nutner telefonu podany na karcie identyfikacyjnej. ATENQAO: Se voc8 fala portugu&s (Portuguese), contate o servigo de assist6ncia de idionias gratuito. Ligue gratuitainente para o tuinicro encontrado no seu cartAo de identificagao. ATTENZIONE: in caso la lingua parlata sia l'italiano (Italian), sono disponibili servizi di assistenza linguistics gratuiti. Per favore chianiate it numero di telefono, verde indicato sulfa vostra tessera identificativa. ACHTUNG: Falls Ste Deutsch (German) sprechen, stehen Ihnen kostenlos sprachliche Hilfidienstleistungen zur Verfitigung. Bitte rufen Sie die gebfthrenfreie Rufnurnmer auf der Rackseite 1hres Mitgliedsausweises an. t=* (t WW tWW t: � 3TTcr ** (Hindi) mt WT4; W Rm RUzraT #wv fk ig�+ 3q-.Fr.v # i ww 3Tq-,k qvnw rrT qT tv zw4r wYq �iw qT zFw Tt i CEEB TOOM: Yog koj hais Lus Hmoob (fhnong), muaj kev pab txhais lus pub dawb rau koj. Tbov hu rau tus xov tooj hu deb dawb uas teev nivaJ nyob rau ntawrn koj dairn yuaJ cirn qhia tus kheej. (Khmer) &naOfnilarhm Ulm AWIMB11 r�evq PA.KDAAR: Nu saritaern ti Ilocano (Ilocano), ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyani. Maidawat nga awagan iti toll -free a numero ti telepono nga nakalista ayan iti identification card mo. Dii BAA!AKONiNiZIN: Dink (Navajo) bizaad bee ydnilti'go, saad bee ika'anida'awo'igii, VAA j Welt, bee nXab66Vi'. TAA shg(?di ninaaltsoos nitt'izf bee n66hozinigii bine'dee�'t'iijiiWehgo b66sh bee hane'i bik-Rigii bee hodiilnih. OCKW: Haddii aad ku liad&sho Sooinaali (Somali), adeegyada taageerada luqadda, oo bilaash ab, ayaad heli kartaa. Fadlan wac larnbarka telefonka khadka bilaashka ce ku yaalla kaarkaaga aqoonsiga. UnitedHealthcare Insurance Company UnitedHealthcare YOUR BENEFITS Benefit Summary Outpatient Prescription Drug Florida Municipal Insurance Trust Pharmacy Plan - HSA Your Copayment and/or Coinsurance is determined by the tier to which the Prescription Drug List Management Committee has assigned the Prescription Drug. All Prescription Drugs on the Prescription Drug List are assigned to Tier-1, Tier-2 or Tier-3. Find individualized information on your benefit coverage, determine tier status, check the status of claims and search for network pharmacies by logging on to www.myuhc.com@ or calling Customer Care at the telephone number on the back of our ID card A deductible and out-of-pocket maximum may apply. Please refer to the medical plan documents for the annual deductible and out-of-pocket maximum amounts, which include both medical and pharmacy expenses. This means that you will pay the full amount we have contracted with the pharmacy to charge for your prescriptions (not just your copayment), until you have satisfied the deductible. Once the deductible is satisfied, your prescriptions will be subject to the copayments outlined below. If Lou reach the Out -of -Pocket maximum, ou will not be re wired to a a co a ment. This summary of Benefits is intended only to highlight your Benefits for Prescription Drugs and should not be relied upon to determine coverage. Your plan may not cover all of your Prescription Drug expenses. Please refer to the Prescription Drug section of the Summary Plan Description (SPD) for a complete listing of services, limitations, exclusions and a description of all the terms and conditions of coverage. If this description conflicts in any way with the Prescription Drug section of the SPD, the Prescri tion Dru section of SPD shall prevail. Individual Deductible See Medical Benefit Summary Famil Deductible See Medical Benefit Summa AwP m Individual Out -of -Pocket Maximum - See Medical Benefit Summary Family Out -of -Pocket Maximum See Medical Benefit Summary " Only certain Prescription Drugs are available through mail order; please visit www.myuhc.comO or call Customer Care at the telephone number on the back of your ID card for more information. An Ancillary Charge may apply when a covered Prescription Drug is dispensed at your [or your provider's] request and there is another drug that is chemically the same available at a lower tier. When you choose the higher tiered drug of the two, you will pay the difference between the higher tiered drug and the lower tiered drug in addition to your Copayment and/or Coinsurance that applies to the lower tier drug. Note: If you purchase a Prescription Drug from a Non -Network Pharmacy, you are responsible for any difference between what the Non -Network Pharmacy charges and the amount we would have paid for the same Prescription Drug dispensed by a Network Pharmacy. S FXRD"dl""""I""IV""07 PA THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC.'S PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. 13 PROHIBITED. You are responsible for paying the lower of the applicable Copayment and/or Coinsurance or the retail Network Pharmacy's Usual and Customary Charge, or the lower of the applicable Copayment and/or Coinsurance or the mail order Network Pharmacy's Prescription Drug Cost. For a single Copayment and/or Coinsurance, you may receive a Prescription Drug up to the stated supply limit. Some Prescription Drugs are subject to additional supply limits Some Prescription Drug or Pharmaceutical Products for which Benefits are described under the Prescription Drug section of the Summary Plan Description (SPD) are subject to step therapy requirements. This means that in order to receive Benefits for such Prescription Drug or Pharmaceutical Products you are required to use a different Prescription Drug(s) or Pharmaceutical Product(s) first. Also note that some Prescription Drugs require that you notify us in advance to determine whether the Prescription Drug meets the definition of a Covered Health Service and is not Experimental, Investigational or Unproven. You may be required to fill an initial Prescription Drug Product order and obtain one refill through a retail pharmacy prior to using a mail order Network Pharmacy. THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC.'S PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED. Pharmacy Exclusions Exclusions from coverage listed in the SPD apply also to this Prescription Drug section.LLuIn addition, the following exclusion i rs • Coverage for Prescription Drugs for the amount dispensed (days' supply or quantity limit) which exceeds the supply limit. • Coverage for Prescription Drug Products for the amount dispensed (days' supply or quantity limit) which is less than the minimum supply limit. • Prescription Drugs dispensed outside the United States, except as required for Emergency treatment. • Drugs which are prescribed, dispensed or intended for use during an Inpatient Stay. • Experimental, Investigational or Unproven Services and medications; medications used for experimental indications and/or dosage regimens determined to be experimental, investigational or unproven, unless United HealthCare Services, Inc. and the Florida Municipal Insurance Trust have agreed to cover. • Prescription Drugs furnished by the local, state or federal government. Any Prescription Drug to the extent payment or benefits are provided or available from the local, state or federal government (for example, Medicare) whether or not payment or benefits are received, except as otherwise provided by law. • Prescription Drugs for any condition, Injury, Sickness or mental illness arising out of, or in the course of, employment for which benefits are available under any workers' compensation law or other similar laws, whether or not a claim for such benefits is made or payment or benefits are received. • Any product dispensed for the purpose of appetite suppression or weight loss. • A Pharmaceutical Product for which Benefits are provided in the Summary Plan Description (SPD). This exclusion does not apply to Depo Provera and other injectable drugs used for contraception. • Durable Medical Equipment. Prescribed and non -prescribed outpatient supplies, other than the diabetic supplies and inhaler spacers specifically stated as covered. • General vitamins, except the following which require a Prescription Order or Refill: prenatal vitamins, vitamins with fluoride, and single entity vitamins. • Unit dose packaging of Prescription Drugs. • Medications used for cosmetic purposes. • Prescription Drugs, including New Prescription Drugs or new dosage forms, that Florida Municipal Insurance Trust determine do not meet the definition of a Covered Health Service. • Prescription Drugs as a replacement for a previously dispensed Prescription Drug that was lost, stolen, broken or destroyed. • Prescription Drugs when prescribed to treat infertility. • Certain Prescription Drugs for smoking cessation. • Compounded drugs that do not contain at least one ingredient that has been approved by the U.S. Food and Drug Administration and requires a Prescription Order or Refill. Compounded drugs that are available as a similar commercially available Prescription Drug. (Compounded drugs that contain at least one ingredient that requires a Prescription Order or Refill are assigned to Tier 3. • Drugs available over-the-counter that do not require a Prescription Order or Refill by federal or state law before being dispensed, unless the Plan Administrator has designated the over-the-counter medication as eligible for coverage as if it were a Prescription Drug and it is obtained with a Prescription Order or Refill from a Physician. Prescription Drugs that are available in over-the-counter form or comprised of components that are available in over-the-counter form or equivalent. Certain Prescription Drugs that the Plan Administrator has determined are Therapeutically Equivalent to an over-the-counter drug. Such determinations may be made up to six times during a calendar year, and the Plan Administrator may decide at any time to reinstate Benefits for a Prescription Drug that was previously excluded under this provision. • Certain New Prescription Drugs and/or new dosage forms until the date they are reviewed and assigned to a tier by our Prescription Drug List Management Committee. • Growth hormone for children with familial short stature (short stature based upon heredity and not caused by a diagnosed medical condition). • A Prescription Drug that contains (an) active ingredient(s) available in and Therapeutically Equivalent to another covered Prescription Drug. • A Prescription Drug that contains (an) active ingredient(s) which is (are) a modified version of and Therapeutically Equivalent to another covered Prescription Drug. THIS MATERIAL IS PROVIDED ON THE RECIPIENT'S AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC.'s PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED. • A Prescription Drug typically administered by a qualified provider or licensed health professional in an outpatient setting. This exclusion does not apply to Depo provera and other injectable drugs used for contraception. • Certain PresairUon Drug Produces that have riot been prescribed by a Specialist Physician. THIS MATERIAL IS PROVIDED ON THE RECIPIENTS AGREEMENT THAT IT WILL ONLY BE USED FOR THE PURPOSE OF DESCRIBING UNITED HEALTHCARE SERVICES, INC.'S PRODUCTS AND SERVICES TO THE RECIPIENT. ANY OTHER USE, COPYING OR DISTRIBUTION WITHOUT THE EXPRESS WRITTEN PERMISSION OF UNITED HEALTHCARE SERVICES, INC. IS PROHIBITED. Print Search Directory I Find Care Page I of 140 ( Unil,ufflealthcare." 06.07.20118 Results for Primary Care Physician 1000 In -Network Doctors found within 50 miles of 32708 Choice Plus Selected Sort/Filters Preferred Providers Our network of doctors and facilities is always evolving. Before making an appointment, please check that the doctor, facility, or medical group is in your network. To find out, you can ask your doctor or facility or you can check on myuhc.com - — - ...... . . . ......... ....... Hernandez, Danielle, MID I Pediatrics 501 W blate Road 434 ID: 00005461203 007 f# V Premium Care Physician FIRST CHOICE PEDIATRICS Winker Springs, FL 32708 +1 407 249 1234 Accepting All Patients Florettl Martins Ferreira, Flavia, MD I Pediatrics 501 W State Road 434 ID: 00006368649 008 f# V Premium Care Physician PAST CHOICE FEDIATRiCS Winter Springs, FL 327D8 41 4U-249-1234 Accepting All Patients Portugal, Cassia 113, MD I Pediatrics 501 W State Road 434 0: 00001822491 017 V# (# Premium Care Physician FIRST CHOICE PEDIATRICS Kilter Springs, FL 32708 ,1 407-249-1234 Accepting All Patients Jorge, Vanessa, MD I Internal Medicine, Pediatrics 5 1301 Sundial Pt ID: 00002509676 016 11V V Premium Care Physician DAVITA MEDICAL FLORIDA Winter Springs, FL 32708 1140 (-69M009 Accepting Existing Patients Only Walker, Erik C, MD I Family Practice [406 Red Bug Lake Rd ID; 00001815445 013 Premium Care Physician PHYSICIAN ASSOCIATES Oviedo, FL 32765 IT 407-381-7387 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page-1?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 2 of 140 Wiest, Karyn M, MID I Pediatrics 7410 Red Bug Lake Rd 113: 00002112208 014 11W Premium Can, Physician PHYSICIAN ASSOCIATES Oviedo FL 32765 +1 407-381-7345 Accepting Existing Patients Only Lacy, Thomas A, MD I Pediatrics 745.5 Pinamire Dr IN: 000011LY3520 024 A# III Premium Care Physician CHILDREN'S HEALTH ALLIANCE Oviedo, FL 32765 ,1 407-542-1733 Accepting Existing Patients Only Desiraju, Madhushree, MD I Pediatrics 7455 Pinerrilre Dr ID: 00002016392 008 f* ## Premium Care Physician CHILDREN'S HEALTH ALLIANCE Oviedo, FL 32765 -1 407-542-1733 Accepting Existing Patients Only Westberry, area R, MID g Pediatrics, General Practice 7455 Pincmirc Or ID: 000012BI 587 019 f# ## Premium Care Physician CHILDREN'S HEALTH ALLIANCE Oviedo, FL 32765 ,1 407-542-1733 Accepting All Patients Evans, Melia A, IMD p Family Practice I 1 1 587 EStale Road 434 Unit 1071 10: 00002658498 011 40 11# Premium Care Physician PHYSICIAN ASSOCIATES Longwood, 7L 32750 407-611,3027 Accepting All Patients Kelley, Thomas R, MD 0 Family Practice 587 E State Road 434 Unit 1071 11); 0000 1221527 019 1# #* Premium Care Physician PHYSICIAN ASSOCIATES Longwood, rL 32750 ,1 407-7678500 Accepling All Patients Gupta, Radhika, MID (Internal Medicine .. . ...... .......... 946 State Road 436 ID: 00002553662 010 f# Premium Care Physician Casselberry, FL 32707 +1 407-8313141 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page- 1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 3 of 140 Cabreira, Anthony L, MD I Family Practice 550 E Stale Road 434 ID: 00002111560 U07 (0 Premium Care Physician PHYSICIAN ASSOCIATES Longwood, FL 32750 ,11 407-381-7367 Accepting All Patients Gagliano, Nicole M, MD I Pediatrics 650 E State Road 434 ID: 00001998102 009 4# Premium Care Physician PHYSICIAN ASSOCIATES Longwood, FL 32750 +1 407-261-2917 Accepting All Patients Smith, Samuel N, DO I Pediatrics 1000 W Broadway St Ste 100 ID: 00001106401 008 f# 4 Premium Care Physician NEW INTERLACHEN PEDIATRICS Oviedo, FL 32765 +1407-767-2477 Accepting All Patients Aguilar, Emily M, MID I Pediatrics 1000 W Broadway St Ste 1 CO ID: 00002077113 005 Oviedo, FL 32765 ,1407-767-2477 Accepting All Patients Dyer, Sareh S, MD I Pediatrics 1000 W Broadway St Ste 100 ID: 00005620861 004 Oviedo, FL 32765 +1 407-767-2477 Accepting Ail Patients Ward, Julie A, DO I Pediatrics 1000 W Broadway St Ste. 100 ID: 00002077121 005 Oviedo, FL 32765 ,1 407-767-2477 Accepting All Patients Rosen, Matthew H, MA I Family Practice 1000 W Broadway St Ste I C2 ID: 00001476866 009 Ovieco, FT. 32765 ,1407-359-8580 Accepting All Patients %* 0# Premium Care Physician NEW INTERLACHEN PEDIATRICS F# V Premium Cam Physician NEW INTERLACHEN PEDIATRICS A# ## Premium Care Physician NEW INTERLACHEN PEDIATRICS 4V f* Premium Care Physician SEMINOLE SPORTS & FAMILY MED https://connect.werally.com/searchD!rectory/32708/page- I?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Fisk, Thomas A, MD I Pediatrics 1000 W Broadway St Ste 100 ID: 00D00996219 012 Oviedo, FL 32765 ,1 407-767-2477 Accepting All Patients Likens, Robert L, MD I Family Practice 515 State Road 436 Ste 1000 ID: 00000603904 003 Casselberry, FL 32707 +1 407-83"456 Accepting Existing Patients Only Mandani, Sadiq S, MD I Pediatrics I / 10 W Bmadway St,",te i 04 1 1). E000241094 i U 10 Oviedo, FIL 32a65 +11 40 7 97 7 1135 ArT,,njpfing Xi Paripwis Elias, Sally S, MD l Pediatrics 8300 Red Bug Lake Rd ID: 00002540464 011 Oviedo, FL 32765 ,1 407-89D-2273 Accepting Existing Patients Only Blecla, Daniel, DO 6 Family Practice 1120 State Road 436 li 00001977668 015 Casselberry, FL 32707 +1 407-322-8645 Accepting All Patients Mapa, Rita T, MD I Pediatrics 1120 State Road 436 ID: 00002320124 007 Casseltierry, FL 32707 +1 407-322-8645 Accepting All Patients Dyclus, Richard, DO I Family Practice 30 Winrtsomi Way Ste. 100 ID, 000023170 659 OD5 Oviedo, FL 32765 ,I 407-7D6-G688 Accepting All Patients Page 4 of 140 1, ## Premium Care Physician iqcw Li-i lini ACI fl!"N PZ:)IATi::V('7� 1# qp Premium Care Physician 41# ff Premium Care Physician OVI EDO 3 11,11) il H.1114S I J UL T i-i CENTERU ?# f# Premium Care Physician Cl 101l DRUN'S ICALI'll I ALLIANCE ff ill Premium Care Physician CENTRAL FL MIGRIGOMM HLTH CTR ## f# Premium Care Physician CENTRAL FL MIGR/COMM HLTH CTR Ill * Premium Care Physician DYGUS FAMILY MEDICINE https://connect.werally.com/searchDirectory/32708/page-I?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 5 of 140 Silverman, William M, DO I Family Practice 590 Rudy Ct I D: 0000 1384799 001 f# qV Premium Care Physician LAKE HOWELL FAMILY MEDICINE AS Maitland, FL 32751 + 1407 677 4867 Accepting All Patients Toth, Susan, DO I Family Practice "q0 I Ruby Ct ID: 00001406160 005 1 Premium Care Physician LAKE HOWELL FAMILY MEDICINE AS Maitland, FL 32751 41 407.b77-4867 Accepting All Patients . .......... Block, Bradley M, MD I Family Practice 2441 VV State Road 426 Ste 2011 ID: 00000990483 008 Premium Care Physician BLOCK , NATION,CHASE & SMOI EN Oviedo, FL 32765 FAMILY IVIED +1 407-678-6886 Accepting Existing Patients Only Chase, Craig P, MD I Family Practice 18 2441 W State Road 426 Ste, 2011 ID: 00001875422 002 Premium Care Physician Oviedo, FL 32765 11 407-6788888 Accepting All Patients Cameron, Nicole L, MD I Pediatrics 2672 W State Read 426 Ste 1048 ID: 00003061068 003 f# Premium Care Physician JOSEPH F SAVONA MD PA Oviedo, FL 32765 ,1 407-3654499 Accepting All Patients Savona, Joseph F, MID I Pediatrics 2672 W State Road 426 Ste 1048 11): 00000850452 005 1# premium Care Physician Oviedo, FL 32765 +1 407-3654499 Accnpflng All Patients Sontag, Todd J, DO I Family Practice 2572 W Stem Road 426 Ste 1040 ID: 00002954401 009 Oviedo, FL 32765 11407-366-9800 Accepting All Patients 40 fo Premium Care Physician PHYSICIAN ASSOCIATES https://connect.werally.com/searchDirectory/32708/page-l?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Vazquez -Rojas, Oclefte, MD I Pediatrics 521 W State Road 434 Ste '01 10: 00003170881 010 Longwood, FL 32750 +1 407-830-5437 AuuQp0rig AI Patients Hoffman, Kent S, DO I Family Practice 406 Lake Howell Rd ID: 0000 1153615 004 Maitland, FL 32751 +1 407-69"960 Accepting All Patients Page 6 of 140 il f# Premium Care Physician CHILDREN'S HEALTH ALLIANCE IV 40 Premium Care Physician Rocker, Jeffry F, DO I Family Practice 110 Alafaya Woods Blvd Ste A ID: 00001356655 017 f# q# Premium Care Physician ALAFAYA WOODS FAMILY MEDICAL Oviedo, FL 32765 +1 407-3663577 Accepting All Patients Afflin, Elleuterlot R, MD 9 Farrifly Practice 7221 Alcma Ave Ste 200 ID: 00002379353 007 Ill f# Premium Care Physician Br. N D ALILIN MD Winter Park, FL 32792 1 407-657-2111 Accepting All Patients Weil Mark E, MD I Family Practice 685 Palm Springs Dr Ste 1A ID: 00000 138081 001 f# 11# Premium Care Physician MARK E WEIGLEY MD Altamonte Springs, FL 32701 -1 4C7-399-5959 Not Accepting Patients Zaldi, Tazeen, MID I Family Practice 142 Parlil Loop Ste 1018 ID: 00003293949 006 Lake Ivory, FL 32746 ,1 407.320-8100, +1 407402-2303 Accepting All Patients Barimo, Michael J, DO I Family Practice 483 N Semoran Blvd Ste 206 ID: 00000902323 004 Winter Park, FL 32792 11407-678-2400 Accepting All Patients %* ## Premium Care Physician ACCESS FAMILY CARE f# *# Premium Care Physician MJQHAEL J BARIMO DO https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 7 of 140 Watzman, Max S, DO I Family Pralctic.,' 13 483 N Sernoran Blvd Ste 206 ID: 000D0459031 002 f# %* Premium Care Physician MICHAEL J BARIMO DO Winter Park, FL 82792 ,1 407,678-2400 Accepting All Patients Barnes, Thomas J, MID I Family Practice 260 Lookout PI Ste 107 ID: 00000404524 004 %0 f# Premium Care Physician Maitland, FL 32751 + 1 407-6284545 Accepting All Patients Douglas, Anthony E, MD I Internal Medicine 670 IN Orlando Ave Ste 204 10: 00002339398 004 41P f# Premium Cate Physician Maitland, FL 32751 ,1407-644-7551 Accepting All Patients Thielhelm, Jennifer, MD I Pediatrics 800 N Maitland Ave Ste 102 10: 00001815854 C13 40 Premium Care Physician PHYSICIAN ASSOCIATES Maitland, FL 32751 -1 407-660-700C Not Accepting Patients . ....................... Coronado, Boris E, MD I Internal Medicine 800 N Maitland Ave Ste 103 ID; 00001 7151689 019 Premium Care Physician PHYSICIAN ASSOCIATES Maitland, FL 32751 -1 407-660-7150 Accepting All Patients Newman -Dufresne, Lindsey, DO I Family Practice 2304 Aloms Ave Ste 100 ID: 00005765098 001 II Premium Care Physician WINTER PARK FAMILY HEALTH CTR Winter Park, FL 32792 ,1407-679-9222 Accepting All Patients Van Wert, Anne K, MID I Adolescent Medicine, Pediatrics 100 E Sybella Ave Ste 100 ID: 00001103555 015 Premium Care Physician CHILDREN'S HEALTH ALLIANCE Maitland, `L32751 .1 407-638-6620 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 8 of 140 I 9964 University Blvd ID: 0000101 247B 015 f# A# Premium Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32817 -1 407-261-2934 Accepting All Patients Rai, Sunita, MD I Pediatrics 9964 University Blvd ID: 00001816027 1011 4# ## Premium Care Physician PHYSICIAN ASSOCIATES Orlando, FL 321317 +1 407-261-2930 Accepting All Patients Cabiac, Annette, MID I Internal Medicine, Pediatrics 9964 University Blvd ID: 00003066430 006 Premium Care Physician PHYSICIAN ASSOCIATES Orlando. FL32817 ,1 407-261-2966 Accepting All Patients Raley, Jane -Marie, DO � Family Practice t 0055 Urdvenslty Blvd ID: 00001238383 001 111* Premium Care Physician UNIVERSITY FAMILY MEDICINE Orlando, FL,32B17 CENTER �1 407-6704KO Accepting All Patients ................ Sison, Rosemarie G, MID I Pediatrics 1884 W County Road 419 Ste 1000 ID: 00002920146 009 40 Premium Care Physician FIRST CHOICE PEDIATRICS Oviedo, FL 32765 +1 407-249-1234 Accepting All Patients Young, Mary Helen, MD � Pediatrics 1884 W County Road 419 Ste I COD ID: 00002197719 012 4# Ir Premium Care Physician FIRST CHOICE PEDIATRICS Oviedo, FL 32765 +1 407-249-1234 Accepting All Patients Chang Yang, Francisco, MID � Pediatrics 1884 W County Road 419 Ste 1000 ID: 00003629938 008 4W Premium Care Physician FIRST CHOICE PEDIATRICS Oviedo, FL 32765 +1407-249-1234 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Gavric, Amra, MD I Pediatrics 1884 W County Road 419 Ste 1000 ID: UG003bl 2807 012 Oviedo, FL 32765 ,1 407-249-1234 Accepting All Patients Trout, Pamela C, MID I Pediatrics 201 N Lakemont Ave Ste 200 113: 00D02658882 010 Winter Park, FL 32792 d 1 321-2034410 Accepting All Patients Page 9 of 140 Or I# Premium Care Physician FIRST CHOICE PEDIATRICS 0 fl#� Premium Care Physician DOG PAM PA Ryan, John J, MID I Internal Medicine 4106 W Lake Mary Blvd Sle 301 ID: 00000545013 004 it Premium Care Physician FLORIDA INTERNAL MEDICINE Take Mary, FL 32746 ,1407-333-2503 Accepting Existing Patients Only Johnson, Jesse W, MD I Internal Medicine 4106 W Lake Mary Blvd Ste 100 ID: 60001094014 004 ± Premium Care Physician HEATHROW INTERNAL MEDICINE Lake Mary, FL 32746 +1 407-333-2273 Accepting All Patients Gabor, Elena Mirela, MD I Internal Medicine 11cviews 4 106 W Lake Mary Blvd Ste 100 ID: 0)001855186 019 P1 cP Premium Care Physician HEATHROW INTERNAL MEDICINE Lake Mary, FIT. 32746 �1 407-333-2273 Accepting All Patients Pham, Vivien D, MID I Pediatrics I 167 IN Lakemont Ave ID: 00003009464 002 Premium Care Physician LAC H PHAM MD Winter Park, FL 32792 ,1407-644-6618 Accepting All Patients LAKEMONT PEDIATRICS Ahluwalla, Charanjilt Singh, MD I Internal Medicine, Cardiology 1655 Hollywood Ave ID, 00001471658 009 1# V Premium Care Physician WINTER PARK INTERNAL MED Winter Park, FL 32789 +1 407-645-2334 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 10 of 140 Josh!, Dhanashree D, MD d Family Practice 829 Douglas Ave I D: 00004463246004 IV V Premium Care Physician ORLANDO FAMILY PHYSICIANS Altamonte Springs, FL 32714 +1 407-332-0003 Accepting Ali Patients Lopes Bermudez, Felix 1, MID I lnternai Medicine, Generai Practice 829 Douglas Ave ID: 00005610301 002 1# f# Premium Care Physician ORLANDO FAMILY PHYSICIANS Altamonte Springs, FL 32714 +1 407-332-0003 Accepting All Patients Herrera, Emma Margarita,q General Practice 829 Douglas Ave ID: 00005682640 003 111 V Premium Care Physician ORLANDO FAMILY PHYSICIANS Altamonte Springs, FL 32714 +1 407-332-0003 Accepting All Patients Ortiz Mendez, Dimary, MID p General Practice 829 Douglas Ave ID: 00003512375 004 '# f# Premium Care Physician ORLANDO FAMILY PHYSICIANS Altamonte Springs, FL 32714 +1 407-332-0003 Accepting All Patients Faterni, Zia, MID � internal medicine 758 N Sun Dr Ste 104 ID: 00001424093 002 11111111 Premium Care Physician SUNSTATE MEDICAL ASSOCIATES Lake Mary, FL 32746 +1 4073333303 Accepting All Patients ruthg Pothen C, MD U internal Medicine 758 N Sun Dr Ste 104 ID: 00001910546 002 Premium Care Physician Lake Mary, FL 32746 +1 407333-3303 Accepting All Patients Hudson, John Buflord, MID � Familly Practice 2071 Dundee Dr ID: 00000404466002 'f* 4 Premium Care Physician JOHN B HUDSON MD Winter Park, FL 32792 +1 407-628418B Accepting All Patients https:Hconnect.wera I ly.com/search Directory/32708/page-1?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Paulson, Joyce A, MD I Internal Medicine 3400 Citiadrangle, Blvd ID: OnD09334112 001 q# V Premium Care Physician LK,'F PEGASUS HEALTH Orlando, FL 32817 +1 407-266-3627 Accepting All Patients Tamayo, Raul E, MD I Internal Medicine 1325 S International Plkwy Ste 2241 ID; 00000603061016 Lake Mary, FL 32746 -1407-636-9663 Accepting All Patients Page 11 of 140 f# ## Premium Care Physician VITALGENIX HEALTH & WELLNESS Quinn, James Ellsworth, MD I Family Practice 2209 S French Ave ID: 00000110796 OD4 calq# Premium Care Physician HFATHROVJ INTERNAL MEDICINE Sanford, FL 32771 +j 407-321-4230 Accepting All Patients Nguyen Siddiql, Yung 0, MD I Family Practice 4000 Central Florida Blvd 10: 00002245358 011 Premium Care Physician UNIVERSITY OF CTRAL FL HEALTH S Orlando, FL 32816 +1 407-823-3702 No, Accepting Patients Benitez, Orlando, MD I Geriatric Medicine, General Practice 280 Weklva Springs Rd Ste 1000 ID, OD001715842 006 q# q# Premium Care Physician MID FLORIDA ADULT MEDICINE Longwood, FL 32779 +1 407-78&-2273 Accepting All Patients Bougoullias, Michael, MD I Family Practice 715 Rodel Cv Ste 2001 ID, 00001816186 015^ Premium Care Physician PHYSICIAN ASSOCIATES Lake Wry, FL 32746 ,1 407-3D2-3115 Accepting Existing Patients Only Cagglano, Christopher L, DO I Family Practice 725 Rodel Cv ID: 00001876255 014 r# Premium Care Physician PHYSICIAN ASSOCIATES Lake Mary, FL 32746 ,1407-302-3119 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page- I?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 12 of 140 Rodgers, Robert M, MD U Farn ly Practice 755 Rinehart Rd ID: 00001969195 004 qo 40 Premium Care Physician Lake Mary, FL 32746 +1 407-333-1550 Accepting Ail Patients Kumar, Sivapriya, MD q Family Practice 3'Mt W , uP if I'alnn HI ti9:e 200 III➢ Wft7321,'49U I; 01 1 No f# Premium Care Physician DAVITA MEDICAL FLORIDA I..rrror,rv¢yjd, I-L 32(7 3 +t •10 f f6kR-1399 k'•,atc,eelirig All P alerts Jativa Castaneda, Marcela, MD I Pediatrics 8701 Maitland Summit Blvd ID: 00003335515 009 110 f#r Premium Care Physician RDV SPORTSPLEX PEDIATRICS Orlando, FL 32810 +1 407-916-4520 Accepting All Patients Weaver, Howard D, IDO tl Farnily Practice 3120 Corrine Dr ID: 00000675373 001 fo Premium Care Physician JACK T WEAVER DPM DO MD Orlando, FL 32803 +1 407-395-4707 Accepting All Patients --------- Srivastava, Vinay Chandra, NID p lnternal Meftc ne 1621 W1st St ID: 00001775911006 f l Premium Care Physician SANFORD MEDICAL GROUP PA Sanford, FL 32771 +1 407-322-4431 Accepting All Patients Irizarry, Belmar A, MD � Internal Medicine 580 Lexington Green Ln ID: 00005293167 003 fW V Premium Care Physician BAI MEDICAL Sanford, FL 32771 +1 407-67R-1734 Accepting All Patients Andree, Debra S, MD I Pediatrics 7900 Forest City Rd fl) 00002 4;.23''.9 017 f# 11F Premium Care Physician CHC F-ATONVILLE FAMILY HEALTH Orlando, FL 32810 CTH +1 407-9058827 P�ccepitir"q AH 9atimsr'otrt https://connect.werally.com/searchDirectory/32708/page- I?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Mejia, Cesar R, MD I Pediatrics Page 13 of 140 7900 Forest City Rd ID: 00003491990 010 4W 111# Premium Care Physician CHC NC/FOREST CITY MEDICAL - Orlando, -L 32810 DENTAL + 1 407-90M827 Accepting All Patients Proskovec, Connie L, DO I Adolescent Medicine, Pediatrics 11715 Orpington St Ste A ID: 00001677402 012 40 f# Premium Care Physician CHILDREN'S HEALTH ALLIANCE Orlando, FL 32817 +1 407-380-91115 Accepting All Patients Patel, Ashwinkurnar R, MD I Internal Medicine 1403 Medical Plaza Dr Ste 106 ID: 00001829820 002 40 ff Premium Care Physician Sanford, FIE 32771 ,11407-328-1575 Accepting All Patients Janouslay, Stuart, MD I Pediatrics 855 Outer Rd 10: 00001815987 013 4W 40 Premium Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32814 -1 407,261-2928 Accepting All Patients Paez-Munoz, Yobanka P, MD I Pediatrics 5 lleview.,-� 11881 A E Colonial Dr ID: 000032B0550 014 %V f# Premium Care Physician CENTRAL FL MICR/COMM HILTH CTR Orlando, FL 32828 ,1 407322-8645 Accepting All Patients Mcconkey, Stacy J, MD I Pediatrics 3 601 E Rollins St V: 0000 1701049 025 11# ## Premium Care Physician rLOPIDA HOSPITAL MEDICAL GROUP Orlando, FL 32803 ,1407-975-0412 Accepting All Patients Albors Mora, Melanie M, MD I Internal Medicine 2501 N Orange Ave Ste 235 1 D: 00002806002 010 A# f# Premium Care Physician FLORIDA HOSPITAL M EDICAL G ROUP Orlando, FL 32804 -it 407-303-7270 Accepting All Patients https://connect.werally,com/searchDirectory/32708/page-1?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 14 of 140 Rincon, Camilo A, MD I lnternai Medicine 7624 Lakf: Undolill) Rd Sic A lf): 0000263013 LOS ll Premium Care Physician INTEanATED MEDICAL CARE OrIanIR,, l"L,32322 + 1 40 7-vB,1 Ac,opting A J PaUerits Herlba, Hayat M, MD I Farnily Practice 3328 E So moran Blvd ID: 00000904522 005 Apopka, FL 32703 ,1407-869-6661 Accepting All Patients Burzynski, Yolanda, MID I Pediatrics 12780 Waterford Lakes Pkwy Ste 135 ID; 0001015 Orlando, FL 32828 11 407390-5888 Accepting All Patients Flayne, Thomas W, MD I Pediatrics 127D0 Waterford Lakes Pkwy Ste 135 ID: 00001966852 COB Orlando, FL 32828 it 407380-5888 Aocopfinp All Patients ................. .. . . . ......... Karaman, Gunce, MID I Pediatrics 5844 N Orange Blossom TrI ID: 00003495273 008 Orlando, FL 3281 O 1 407-905-8827 Accepting Al Patients V qr Premium Care Physician WILKIVA HEALTH CARE I# V* Premium Care Physician PHYSICIAN ASSOCIATES V ## Premium Care Physician PHYSICIAN ASSOCIATES ## q# Premium Care Physician PINE HILLS FAMILY HEALTH GENTE9 019 N Mills Ave ID: 00003633200 003 0* Premium Care Physician MARK I IOANG MD Orlando, FL 32803 +l 407.897-3260 Accepting All Patients Che, Tuiong Ouy, MID I Pediatrics 813 Kenilworth Ter ID: 00003058486 00? 1# qP Premium Care Physician LITTLE ONES PEDIATRICS Orlando, FL 32803 -1407-228-2126 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 15 of 140 Toochinda, Pinida, MD I Internal Medicine 3191 E Semoran Blvd ID: 00001925550 004 Premium Care Physician HUNT CLUB MEDICAL Apopka, FL 32703 il 407-78M500 Accepting NI Patients Gordon, Michael D, MD I Internal Medicine 3191 E Sprroran Blvd ID: 00000844745 002 V* Premium Care Physician HUNT CLUB MEDICAL Apopka, FL 32703 ,1407-783-6500 Accepting All Patients Middleton, Michael A, MID I Pediatrics 200 E Marks St 10: 00002082734 019 Orlando, FL 32803 +1 407-284-6460,+1 407-4805986 Accepting All Patients Rego, Armando, MID I Internal Medicine 'q f# W, Premium Care Physician MICHAEL A MIDDLETON MID PHYSICIAN SERVICES OF FLORIDA VAXCARE 601 E Colonial Dr ID: 00000679960 005 Premium Care Physician PRIMARY HEALTHCARE ASSCC Orlando, FL 32803 ,1 407-895-9255,-1 407-895-9255 Accepting All Patients Lagod, Lucyna, MD I Adolescent Medicine, Pediatrics 414 N MIls Ave ID: 00000926628 010 1# A# Premium Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32803 ,1407-841-7290 Accepting All Patients Gordon, Gregory D, MID I Adolescent Medicine, Pediatrics 414 N Mills Ave ID: 00001975054 006 Orlando, FL 32803 .1 407-841-729D Accepting All Patients Bow, Lesley Kyle, MID I Pediatrics 4442 Curry Ford Rd I D: 00003608878 004 Orlando. FL 32812 +1 859-608-5260 Accepting All Patients V# f# Premium Care Physician PHYSICIAN ASSOCIATES F# Vp Premium Care Physician COMPASSION PEDIATRICS https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 16 of 140 Orliel-Connenencla, Nema, MID I Family Practice 7148 (uruy ll$tnr: lid .htt*'i o LID: 00001YaA 6,32 009 f# 40 Premium Care Physician EDNEM FAMILY MEDICINE CLINIC Orllando, F L 3282 ?. +-'r 14r 14832..2221 A'xanptlnu Aill111.1 ttir;?rrN menen ia, Edsel J, MID � Family Practice 7148 Curry Ford Rd Ste 100 ID: 00DO1517056 007 11# 1 Premium Care Physician EDNEM FAMILY MEDICINE CLINIC Orlando, FL 32822 +1 407482-2221 Accepting All Patients Salehi, Simin, MD j Family Practice 7200 Curry Ford Rd ID: 00002365635 025 4P XV Premium Care Physician ORLANDO FAMILY PHYSICIANS Orlando, FL 32822 +1 407-587-7552 Accepting All Patients Hudson, George M, DO I Famiiy Practice 1537 S Alafaya Trl Ste 104 ID: 00001446496 014 Ilk 40 Premium Care Physician Orlando, FL 32828 +1 321-235-0970, +1 407-203-3888 Accepting All Patients reu, Nerelda C, MID p Internal Medicine 4614 E Michigan St ID: 00002371121 016 Premium Care Physician Orlando, FL 32612 +1 407-720-3780 Accepting All Patients Torres, Anabella, MID 6 Pediatrics 83 Columbia St ID: 00002785378 019 Premium Care Physician ORLANDO HEALTH PHYSICIAN Orlando, FL 32806 GROUP +1 321-8433220 Accepting All Patients alhel, Hainane, MID 11 Pediatrics 86 W Underwood St Ste 202 ID: 00003265720 003 Premium Care Physician ORLANDO HEALTH PHYSICIAN Orlando, FL 32B06 GROUP +1 407-64MB76 Accepting All Patients https://connect.weral ly.com/search Directory/32708/page-1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 17 of 140 1200 Sigh Blvd ID: OD001649255 005 ITV f# Premium Care Physician PEDIATRIC PLUS OF CENTRAL FL Orlando, 7L 32806 + 1 407 859 7239 Accepting At Patients Lehman, Gary G, MD I Geriatric Medicine, Family Practice 2881 S Bumby Ave ID: 00000077759 007 f# Premium Care Physician GARY G LEHMAN MID Orlando, FL 32806 +1 407-894-D005 Accepting All Patients Janovitz, Richard H, MD I Family Practice 11 2863 Delaney Ave ID: 00000619858 002 fp 0 Premium Care Physician JANOVITZ PARILLO & DELGADO MD Orlando, FL 32806 ,1 407-843 1620 Accepting All Patients Tran, Deanna, DO I Family Practice 1117 N Pine Hills Rd ID: 00003087090 001 Premium Care Physician Orlando, FL 32908 rl 407-297-0805 Accepting All Patients Nandam, Venkateswara R, MD I Internal Medicine 6200 Silver Star Rd D: 00001959923 007 f# 4W Premium Care Physician ORLANDO PRIMARY CARE Orlando, FL 32808 +1 407-298-0912 Accepting All Patients Gomez, Hernan A, MD I Internal Medicine 3160 Southgate Commerce Blvd Ste 34 ID: OD002952736 008 0# Premium Care Physician VVELLMED MEDICAL MANAGEMENT Orlando, FL 32806 OF FLORIDA 11 407-423-5178 Accepting All Patients Jueng, Paul, MD I Family Practice 225 E 7th S1 10i 00001734327 002 Premium Care Physician GHG/APOPKA FAM HILTH CTR Apopka, FL 32703 ,1407-905-8827, +1 407-905-8827 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 18 of 140 Gates, Noelle D, MD I Pediatrics 61 &3 S p 0, oM Avo ID: 00002120961 021 Oil Premium Care Physician WINTER GARDEN CHILDRENS FILTH Apopka, P. 32703 0 JR -1 40MXX-882( Accepting A I Patients Franco, Cathy E, MD I Pediatrics 618 S Forest Ave ID: 00002743281007 ff ## Premium Care Physician CHO INC/APOPKA PEDIATRICS Apopka,FL 32703 I 407-905-B827 Accepting All Patients Barnes, Allison L, MD I Family Practice 3615 8 Orange Ave ID: 000053807110013 f# Of Premium Care Physician PRIMARY CARE SPEC ORLANDO Orlando, FL 32806 -1 407.855-2526 Accepting All Parents Paganrodriguez, Damaclo, MDp General Practice 5425 S SGrnoran l Ste 7C ID: 00003347376 007 caw Premium Care Physician ORLANDO FAMILY MEDICAL Ol FL 32822 ,I 407-674-7886, +1 407-931-0444 Aocepting All Patienis Jean -Charles, Gutteridge, MID( Internal Medicine 453 N Kirkman Ad Ste 203 ID: 00003503581 004 q# 1W Premium Care Physician Orlando, FL 32811 +1 407 914 2325 Acwpting All Patients Crespol Emanuel, IMD I Farrffly Practice 8! N Nowell St Ill 00000299668 027 Premium Care Physician ORLANDO FAMILY PHYSICIANS �) 0(aodo, f"L 32808 - I 43-29Dll55f, Accepting All Patients Siddlquil, Muclueet, MID I Family Practice 7?4 Charles St ID: 0OD00766109 003 Ill Premium Care Physician Orlando, FL 328D8 +1 407-295-5625 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page- 1?coverag---Tx,/pe= medic... 5/7/2018 Print Search Directory I Find Care Page 19 of 140 8734 Lee Vista Blvd Ste 400 ID: 00002185301012 f# f# Premium Care Physician LITTLE HOUSE PEDIATRICS Orlando, FL 32829 407-910-2340 Accepting All Patients Jimenez, Santiago A, III I Pediatrics 8734 Lee Vista Blvd Ste 400 ID: 00001838034 021 111# Premium Care Physician Orlando, FL 32829 t 1 407-910-2340 Accepting All Patients Fleischmann, Arnold W, MD I internal Medicine (i Old Winter Carder Rd ID: 0(X)03260487 006 Premium Cam Physician FAMILY PI JYGICIANS /METRO W Orlando, FL 32835 -1 407-290-0555 Accepting Existing Patients Only Joseph, Anthony P, MD I Internal Medicine Roviem-, 793 Health Care Dr Ste 101 ID: 0000 1438325 005 Orange City, FL 32763 ,1 386-753-0000 Accepting All Patients Cardona, Hernando, MD I Pediatrics 54 1515 Park Center Dr Ste 2D 0: 00002336959 002 Orlando, FL 32835 �1 407-704-6912 Accepting All Patients 1507 S Hiawassee Rd Ste 107 ID, 00001894723 020 Orlando, FL 32835 ,I 407-445-9545,,1 407-445-9545 Accepting All Patients Crispin, David, MD I Pediatrics 1603 S Hiawassee Rd Ste 110 10: 00002503314 014 Orlando, FL 32835 +1 407-5785600 Accepting All Patients Premium Care Physician ANTHONY P JOSEPH MD 1# qP Premium Care Physician PEDIATRICS OF GRTR ORLANDO ill* f# Premium Care Physician ORI ANDO INTFRMAL MrDIGINF 111# V Premium Care Physician DC PEDIATRICS https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 20 of 140 Ahmed, Syed-BlIal, MID � internal Medicine 2555 S Volusia Ave Er: 00001988275 009 J# 110 Premium Care Physician CENTRAL FLORIDA MEDICAL ASCS Orange City, FL 32763 -1386-774-0401 Accepting All Patients Rarnkishun, Loakhnauth, MD I Internal Medicine 6150 Metrowest Blvd Ste 202 10:00001758799 008 f# ## Premium Care Physician GOOD HEALTH Orlando, 132835 +1 407-291-2620 Accepting All Patients Shukla, Kishorkurnar N, MID I Pediatrics 25016 Volugia Ave Ste 100 ID: 0000189001B 010 1# f# Premium Care Physician KIDZ CLINIC Orange City, FL 32763 ,1 385-789-9000 kxupting All Patients Samaan, Maged S, MID I General Practice 734 Elkcain Blvd 10: 00001952971 D22 Premium Care Physician ADVANCED MEDICAL CARE Deltona, FL 32725 1 386 532 8200 Accepting All Patients George, Aju, MD I Geriatric Medicine, internal Medicine . . . . . ...................... .......... 16694 Winchover Dr ID: 00002675184 007 f# ## Premium Care Physician AJIJ GEORGE MD Orlando, FL 32819 41407-226-3335 Accepting All Patients ..... . .... Rahmatullah, Mehr T, MID n internal Medicine . . . . ........... F173.5 Conroy Rd Ste 223 ID: 0000 1727358 005 4 4W Premium Care Physician Orlando, FL 32835 ,I 407-870-6220 Accepting All Patients Rojas -Sanchez, Teresa, MD I Pediatrics 2160 Howland Blvd Ste 110 ID: 00005286122 002 111# Premium Care Physician NORTHEAST I-LORIDA HEALTH DeltDna, FL 32738 SERVICES +1 386,532-0515.,1 386-749-9449 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-I?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 21 of 140 Crum, Stephanie P, MD I Pediatrics 10000 W Colonial Dr Ste 390 ID: 0000815087 003 Premium Care Physician PREMIER PEDIATRICS Ocoee. FL 34761 ,1 407-290-2394 Accepting All Patients Mathur, Pradeep, 8 999 S Volusia Ave ID: (X)000555694 002 f# (# Premium Care Physician Orange City, FL 32763 11386-775-7001 Accepting All Patients Fiallo-Coronado, Ingrid T, MID I Internal Medicine I Review 7479 Conroy Windermere Rd Ste A ID: 00003498450 004 11# 1# Premium Care Physician PHYSICIAN A330CLATES Orlando, FL, 32835 +1407-291-7257 Accepting All Patients Posgall, Scott S, MD I Family Practice 7479 Conroy Windermere Ad Ste A 10! 00000097215 007 f# Premium Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32835 +1 407-291-7257 Accepting All Patients Cappleman, John M, MD I Internal Medicine 436 N Dillard St ID: 00000434192 012 Premium Care Physician CAPPELMAN EDWARDS & CASTELLO Winter Garden, FL 24787 ,1 407-877-8080 Accepting All Patients Kayalleh, Lauri J, IVID I Pediatrics 7051 Dr Phillips Blvd Ste 1 ID- 00001764290 005 ff f# Premium Care Physician PERSONAL PEDIATRICS Orlando, FL 32819 -,1407-345-9929 Accepting All Patients Frelier, Richard D, MID I Family Practice 7243 Della Dr ID: 00003396715 009 G# Premium Cam Physician PHYSICIAN ASSOCIATES Orlando, FL 32819 +1 407-381-7366 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-I?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Dyer, David, MID � Family Practice 7243 Della Or ID: 00001816145 017 Orlando, FL 32819 +1 407-381-7366 Accepting Existing Patients Only Page 22 of 140 11 1# Premium Care Physician PHYSICIAN ASSOCIATES Rodriguez, Sandra I, MD I Internal Medicine 54 E Plant St ID: 00002757282 012 1# 4V Premium Care Physician FLORIDA MEDICAL ASSOCIATES Winter Garden, FL 34787 +1 407-287-6363 Accepting All Patients Ponce, Frances C, MD I Internal Medicine 7450 Or Phillips Blvd Ste 204 ID: 00002813346 010 f# IF Premium Care Physician MARISSA ESTIVA MAGSINO MD Orlando, FL 32819 +1 407-292-6778 Accepting All Patients De La Riva, Michelle E, MD I Internal Medicine, Family Practice 7350 Sand lake Commons Blvd ID: 00003452632 009 "# f# Premium Care Physician SOUTH WEST ORLANDO FAM MED Orlando, FL 32819 +1 407-352-9717 Accepting All Patients Martin, John A, MID p Family Practice 7350 Sandlake Commons Blvd ID: 00002477602016 Orlando, FL 32819 +1 407-352-9717 Accepting All Patients f# 1# Premium Care Physician SOUTH WEST ORLANDO FAM MED e nan, Michael G, MID Q Family Practice 6675 Westwood Blvd ID: 00001651584 009 40 Premium Care Physician DEGNAN FAMILY MEDICINE Orlando, FL 32821 +1 508-475-0450 Accepting Existing Patients Only Patel, Mona, MID U pediatrics 3712 Winter Garden Vineland Rd ID: 00001446266 017 qP fe Premium Care Physician ADVANCED PEDIATRICS Winter Garden, FL 34787 +1 407-656-2229 Accepting All Patients https:Hconnect.weral ly. com/search Directory/32708/page-1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care 3712 Winter Carden Vineland Rd Q 00001889486 011 Winter Garden, FL 34787 +1 407-65&2229 Accepting All Patients Sichurr, William B, DO I Family Practice 5151 Winter Garden Vineland Rd I D: 00003634613010 Windermere, FL 34786 +1407-614-8320 Accepting All Patients Moorjanl, Anita V, MD I Pediatrics 15502 Stuneybroulk West Pkwy it 2-108 ID: 00002274676 020 Winter Garden, FL 34787 +1407-656-0042 Accepting All Patients Patel, Niral C, MD I internal Medicine Page 23 of 140 f* V Premium Care Physician ADVANCED PEDIATRICS to to Premium Care Physician OR[ ANDO PHYSICIANS NETWORK f* 1# Premium Care Physician FLORIDA HOSPITAL MEDICAL anour, 11600 �keside Village Ln ID: 00002689727 012 f# f# Premium Care Physician PATEL MEDICAL VENTURES Windermere, FL 34786 +1407-876-2273 Accepting All Patents Gonzalez -Pena, Manuel D, MD I Internal Medicine 4151 Hunters Park Ln Ste 132 ID: 00001796979 0-11 Op Premium Care Physician Irl MED CTR OF S ORLANDO Orlando, FL32837 -1407-251-4486 Accepting All Patients Sharma, Mohan L, MD I Internal Medicine F Rich Ave ll): 00001770473 006 Deland. FL 32724 ,1 3136-736-1444 Accepting All Patients Aung, Mathuzar, MID I Internal Medicine 1`1 18550 Us Highway 441 Ste A ID: 00002739417 002 Mount Dora, FL 32757 0 352-735-3755 Accepting All Patients f# Q# Premium Care Physician MOHAN L SHARMA MD f# V Premium Care Physician https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 24 of 140 Fernandez ao iro, Juan, MD I General Practice 3071 Michigan Ave ID: 00003005457 018 11111111' 10 Premium Care Physician PRIMARY HEALTHGARE ASSOC Kissimmee, FL 34744 +1 407-348-9111 Accepting All Patients Reinertsen, Jeffery S, MD I Pediatrics 809 N Stone St ID: 00001238341 001 t* VP Premium Care Physician WEST VOLUSIA PEDIATRICS Deland, FL 32720 +1 386-734-1824 Accepting All Patients Nguyen, lHugh V, MID I Geroatric Medicine, lnternal Medicine 2255 Crescent Dr ID: 00002786766 005 4V IV Premium Care Physician LAKE DORA INTERNAL MEDICINE 8 Mount Dora, FL 32757 GERIATRICS +1 352-3833B26, +1 352-383-3826 Accepting All Patients Wadsworth, Lyle E, MD I Internal Medicine 890 N Boundary Ave Ste 102 ID: 00000502661 005Premium Care Physician LYLE E WADSWORTH MD Deland, FL 32720 +1 386740-0224 Accepting All Patients ILuon , Priscilla, MD I lnternal Medicine, Pediatrics 905 N Stone St ID: 00002784145 005 40 ff Premium Care Physician VOLUSIA MEDICAL CENTER Deland, FL 32720 +1 386-424-1584 Accepting All Patients atell, Usha P, MD I Pediatrics 999 N Stone St Ste A ID: 00001237832 002 4W to Premium Care Physician DELAND PEDIATRIC ASSOC MD Deland, FL 32720 +1 386-738-6B04 Accepting All Patients Lopez -De -Arco, Javier, IMID I internal Medicine, Diabetes 3074 Dyer Blvd ID: 00002157020 023 ^ Premium Care Physician PHYSICIAN ASSOCIATES Kissimmee, FL 34741 +1 407-635-3011 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Silver, Margaret G, MD I Pediatrics, Pediatrics Specialist Reviews Page 25 of 140 17325 Pagonia Dr ID: 00001835738 009 Ckwilunt, FL 34711 +1401.9056014 Accepting All Patients 4V it Premium Care Physician PHYSICIAN ASSOCIATES Rodger, Scott A, MD I Family Practice 2200 S Bay St Ste A ID: ODOOCS02005 005 qr to Premium Care Physician Eustis, FL 32726 1352483-1466 Accepting All Patients Frame, Edward L, MD I Internal Medicine 11 512 W Cherry Sit Ste A ID: 000010131216 Oil f# Premium Care Physician FRAME INTERNAL MEDICINE Kissimmee, FL 34741 41407-933-2445 Accepting All Patients Vu, Chuong H, MD I Family Practice 1755 David Walkw Dr 10: OOOOP 135799 004 f# Premium Care Physician PI ORinA HOSPITAL MEDICAL GROUP Tavares, FL 32778 +1 352-742-6830 Accepting Existing Patients Only . . . . ................... Boggus, Dan A, MD I Family Practice IH 1755 David Walker Dr ID: 00000142845 012 qV Ill Premium Care Ptl Tavares, FL 32778 + 1 352-742-8830 Accepting All Patients Diaz, Rolando E, MID I Family Practice 217 E Oak St ID, 00003118101 Dig f# f1i Premium Care Physician I AZARO FRAGA MD Kissimmee, FL 34744 ,1 407-98B-1035 Accepting All Patients Shah, Mandan Ill MD I Orthopedic Surgery 604 Oak Commons Blvd ID: 00003310593 007 Ill ## Premium Care Physician ORTHOPAEDIC ASSOCS OF Kissimmee, FL 34741 OSCEOLA +1407-846-6004 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType=medic... 5/7/2018 Print Search Directory I Find Care I ula, alath! L, MID a Geriatric Medickie, Internal Medicine 691 Oak Commons Blvd ID: 00002542034 011 ' Premium Care Physician Kissimmee, FL 34741 +1 407-343-2700 Accepting All Patients Atiquzzaman, Tahsina Y, MD I Internal Medicine Page 26 of 140 WELLMED MEDICAL MANAGEMENT OF FLORIDA 505 W Oak St Ste 202 ID: 00002602232 001 rr Premium Care Physician DOCTOR FOR ADULTS Kissimmee, FL 34741 +1 407-846-6331 Accepting All Patients Sobrino, Mario R, MD I Geriatric Medicine, Family Practice 911 N Central Ave ID: 00001287333 003 'Q# Premium Care Physician MEDICAL 8 GERIATRIC ASSOCIATES Kissimmee, FL 34741 +1 407-933-2690, +1 407-933-2690 Accepting All Patients alball on, Abner Jose, MD ! Family Practice, General) Practice 705 N Main St ID: 00003122710 007 Premium Care Physician Kissimmee, FL 34744 +1 407-6045019 Accepting All Patients Singh, Shanti, MID p Internal Medicine 1910 W Oak St ID: 00001764860 007 Premium Care Physician KISSIMMEE MEDICAL CENTER Kissimmee, FL 34741 +1 407-343-4338 Accepting All Patients o it tt , Nibha, MD 9 Internal Medicine 1970 Hospital View Way Ste 1 ID: 000019D9925 016 IV 4p Premium Care Physician NIBHA MFDIRATTA Clermont, FL 34711 +1 352-2434',01 Accepting All Patients asir, Shazia, MID 0 internai Medicine 1950 Hospital View Way ID: 00002407063 007 1# Premium Care Physician SOUTH LAKE MEDICAL CENTER Clermont, FL 34711 +1 352-24M443 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page- I?cove rageType = medic... 5/7/2018 Print Search Directory I Find Care Page 27 of 140 iIl 111111 111111111111 11;�111110111� q! I 0197MMA 1745 E Highway 50 Ste C 0: OODOIC73880 011 f# 1# Premium Care Physician LAKEVIEW INTERNAL MEDICINE Clermont, FL 34711 ,l 352_394-8060 Accepting All Patients Cruz, Edgar, MID I Family Practice 1725 E Highway 50 Ste A ID: 00002534643 015 f# V Premium Care Physician CRUZ MEDICAL SERVICES Clermont, FL 34711 +1 392-70P,6097 Accepting All Patients Sawh, Annill Chet, MD I Internal Medicine 13 841 Oakley Seaver Dr Unit A ID: 00002099078 009 0, Premium Care Physician ORI ANDO MIFDCAL GROUP Clermont, FL 34711 +1352-241-0037 Accepting All Patients Aggarwall, Amit, MID I Family Practice 865 Oakley Seaver Dr ID: D0003768907 014 f# 40 Premium Care Physician LAKE AMERICA FAMILY PHYNS Clermont, FL 34711 -,1 352-432-3939 Accepting All Patients Collazos Martling, Ana Millena, MID I Pediatrics .500 N Washington Ave Ste 105 ID: 00002636591 015 f# Premium Care Physician RRFVARF) HFAL TH ALLIANCE Titusville, FL 32795 ,1 321-263-0267 AGrepting All Patients Delvadia, Raslklall N, MID I Internal Medicine 2185 Cheney Hwy Ste A ID: 00001132223 004 f# A# Premium Care Physician SHREEJI MEDICAL Titusville, FL 3278D +1 321-20-9800 Accepting All Patients Madarang, Melchor E, MD I Infectious Disease Medicine, Internal Medicine 210 N Highway 27 Ste 7 ID: 00002272489 029 ff 4P Premium Care Physician PREMIER SPECIALTY ALLAN Clermont, FL 34711 +1 352-259-2153,+1 352-259-2159 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-I?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 28 of 140 Baltodano, Rodrigo, MID p Internal Medicine 3125 Citrus Tower Blvd Bldg C ID: 00002464856 003 f# Ill Premium Care Physician RODRIGO BALTODANO Clermont, FL 34711 +1 352394-0043 Accepting All Patients Mohib, Saiyed A, MD I Internal Medicine, Cardiovascular Disease 3101 Citrus Tower Blvd ID: 00002372027 024 411F V Premium Care Physician HEART AND VASCULAR CLINIC OF Clermont, FL 34711 CLERMONT +1 352-432-7200 Accepting All Patients Ly, Dustin N, MD I Internal Medicine 4737 Old Canoe Creek Rd ID: 00003653279 002 +il "V Premium Care Physician Saint Cloud, FL 34769 +1 407-7053222 Accepting All Patients 'Thorne, David Paul, MID � Family Practice 3100171h St ID: 00001981424 002 fr f# Premium Care Physician FAMILY PRACTICE ST CLOUD Saint Cloud, FL 34769 +1 407-892-0002 Accepting All Patients s ann, Stephen M, MID 9 Family Practice 1135 Lake Ave ID: COOD0876322 004 ¢ i Premium Care Physician CLERMONT MEDICAL CENTER Clermont, FL 34711 +1 352-394-4035 Accepting All Patients Crowley, o , DO fl Osteopathic Manipulative Medicine, Family Practice 1135 Lake Ave ID: 00001645102 003r1 Premium Care Physician CLERMONT MEDICAL CENTER Clermont, FL 34711 +1 352-394.4035 Accepting All Patients Winfrey, Gary Michael, DO I Family Practice 1135 Lake Ave ID: 00003621069 001 ff 11F Premium Care Physician CLERMONT MEDICAL CENTER Clermont, FL 34711 +1 352-394-4035 Accepting All Patients https://connect.weral ly.com/search Directory/32708/page-1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Fredette-Huff man, Patricia, MD I Family Practice Page 29 of 140 1404 S Ridgewood Ave lg,; 00001950872 009 Op I# Premium Care Physician COASTAL FAMILY PRACTICE Edgewater, FL 32132 , 1 386-4268166 Accepting All Patents Chang, Margaret M, MD I Family Practice 1404 S Ridgewood Ave ID: 00001223361010 f# J# Premium Care Physician COASTAL FAMILY PRACTICE Edgewater, FL 32132 1 3136-424-5777 Accepting All Patients ... . .. . ............... .... . . --- ....... Schlauder, Melanie S, MD I Pediatrics 1530 Celebration Blvd Ste 301 ID: 00003172785 009 IV Premium Care Physician Gi I ION PEDIATRICS Kissimmee, FL 34747 ,1407-56&9700 Accepting All Patients Heraud, Diego M, MD I Pediatrics 1530 Celebration Blvd Ste 101 ID: 00005512229 007 111# Premium Care Physician CELEBRATION PEDIATRICS Kissimmee, 134747 1407-566-9700 Accepting All Patients Herdel, George Fredrick, MD I Internal Medicine .. . .... . . . ....... 845 State Road 44 ID, 00002202052 002 Premium Care Physician G FREDRICK HERDEL MD New Smyrna Beach, FL 32168 + I 38GA23-2550 Accepting All Patients Ownby, Thomas Wit MID I Internal Medicine 401 Palmetto St ID: 00000223334 003 IN* f# Premium Care Physician SOUTHEAST VOLUSIA MEDICAL New Smyrna Beach, FL 32168 SERVICES + 138&424-5000 Accepting All Patients Lopez, Ruben James, MD I Pediatrics Revlevv, 1728 Dunlawton Ave Ste I ID: 00002256296 019 to V Premium Care Physician PORT ORANGE PEDIATRICS Port Orange, FL 32127 '1386-322-5390 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 30 of 140 Hussain, Farld M, MID � Pediatrics 7227 N Highway 1 ID: 00002167208 017 Premium Care Physician BREVARD HEALTH ALLIANCE Cocoa, FL 32927 +1 321-877-2740 Accepting All Patients Zaffar, Nauman, MD I Internal Medicine 7810 Lake Wilson Rd ID: 00002825292 02D 40 IV Premium Care Physician Z MEDICAL CENTER Davenport, FL 33896 +1 863-420-7617 Accepting All Patients Bello, Maria B, MD I Geriatric Medicine, Family Practice 25010 Us Highway 27 Ste G ID: 00001450757 013 A# Premium Care Physician Leesburg, FL 34748 +1 352-32&6011 Accepting All Patients Hawk, Steven E, MID i Family Practice 1801 Us Highway 441 Bldg 100 ID:00000943893 018 111# Premium Care Physician LAKEVIEW INTERNAL MEDICINE Leesburg, FL 34748 +1 352-4604004 Accepting All Patients Kendrick, Mark D, MD Y Family Practice 790 Dunlawton Ave Ste D ID: 00001118357 014 f# ff Premium Care Physician DUNLAWTCN FAMILY MEDICINE Port Orange, FL 32127 -13B6304-9556,+1386-760-1877 Accepting All Patients m p, Kenneth C, MID 9 Family Practice 802 E Dixie Ave ID: 0000333441E 010 +IV IF Premium Care Physician FLORIDA HEART & VASC MULTI SPEC Leesburg, FL 34748 GRP +1 352-7B7-1324 Accepting All Patients Foster, Larry , MD � Geriatric Medicine, Family IPrac.flce 802 F Dixie Ave ID: 00001080604 010 + + Premium Care Physician FLORIDA HEART & VASC MULTI SPEC Leesburg, FL 34748 CAP +1 352-787-1324 Accepting All Patients LEESBURG FAMILY MEDICINE https://connect.werally.com/search Directory/32708/page-1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Banala, Dwaraknadh R, MD I Internal Medicine Page 31 of 140 620 S Lake St Ste 6 0: 00002211631 007 f# q# Premium Care Physician FLORIDA INTERNAL MEDICINE Leesburg, FL 34748 +1352-365-0099 Accepting All Patients Ion, Adina M, MD I Internal Medicine 705 Doctors Ct ID: 00002394066 013 f# Premium Care Physician CARDIOVASCULAR ASCS-LAKE CO Leesburg, FL 34748 ,I 3M2-323-5700 Accepting All Patients Gegaj, Florian, MID I Internal Medicine :'5 5 11 Medical Plaza Dr Ste 101 ID: 00003331363 010 00 11# Premium Care Physician FLORIDA HEART & VASC MULTI SPEC Leesburg, FL 34748 GAP +1 352-728-6508 Accepting All Patients Friedman, Jeffrey, DO I Family Practice Reviews 401 Venture Dr Ste A ID: 00D00841758 004 IN# f# Premium Care Physician FAMILY CARE PHYSICIANS South Daytona, FL 32119 1 386-761-8888 Accepting All Patients Franks, William J, MID I Pediatrics, General Practice 225 N 1 at St ID: 0000 1118259 012 V# ii Premium Cam Physician CHC INC/UEESBURG Leesburg, FL 34748 +1 352,160-0490 Accepting All Patients Lichtinger, David, DO I Internal Medicine 29320 Us Highway 27 ID: 00001023144 002 Premium Care Physician CENTRAL FLORIDA MEDICAL CARE Leesburg, FI 34748 ,I 352-36D 040C Accepting All Patients Khan, Golhar S, MD I Family Practice 905 Seville Rd ID: 00000453231 005 Premium Care Physician GOHAR 8 KAHN MD South Daytona, FL 32119 11366-767-9000 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 32 of 140 Zeballos, Hilbert C, MID I Internal Medicine 1038 W North Blvd Ste 102 ID: 00002413620 014 Premium Care Physician Leesburg, FL 04748 11 321-917-2042 Accepting All Patients Patel, Toralben K, MD I Cardiovascular Disease 1330 Citizens Blvd Ste 301 ID: 00005719391007 4W 1# Premium Care Physician CARDIAC AND VASCULAR GNST MD Leesburg, 134748 1352-728-1252 Accepting All Patients Karovska, Ana, MD I Internal Medicine 1004 IN 14th St Ste 109 ID. 00003676904 005 Leesburg, FL 34 748 ,1352-259-2159 Accepting All Patients Marrese, Roxy, MD I Family Practice 201 N Clyde Morris Blvd Ste 240 ID; 0000 1652'14P C18 Daytona Beach, FL 32114 ,l 385.4254622 Accepting All Patients Jennings, Lane, MD I Family Practice 201 N Clyde Morris Blvd Ste 200 ID: 00001950785 009 Daytona Beach, FL 32114 +1 386-425A165 Accepting Existing Patients Only Prevatte, Edwin E, MID I Family Practice 201 IN Clyde Morris Blvd Ste 200 ID: 00000245148 012 Daytona Beach, FL 32114 ,1386,425-4165 Accepting Existing Patients Only Rees, Ryan R, MID I Family Practice 201 N Clyce. Morris Blvd Ste 240 ll): 00002518549 013 Daytona Beach, FL 32114 +1 386-425,4822 Accepting All i V f# Premium Care Physician PREMIER MEDICAL ASSOCIATES (# li Premium Care Physician FALIPAX HEALTHCARE SYSTEMS qV 40 Premium Care Physician HALIFAX HEALTHCARE SYSTEMS �u 1 Premium Care Physician HALIFAX HEALTHCARE SYSTEMS %* ii Premium Care Physician HALIFAX HEALTHCARE SYSTEMS https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 33 of 140 1050 Cypress Pkwy ID: 00000621687 014 41* NP Premium Care Physician FAMILY PHYSICIANS OF WINTER Kissimmee, FL 34759 PARK +1 407-483-1400 Accepting All Patients Kinne, Sandford H, DO I Geriatric Medicine, Family Practice 1455 Dunn Ave ID: 00001239467 017 f# f# Premium Care Physician AZALEA HEAL tH Daytona Beach, FL 32114 +1 386-323-9600 Accepting All Patients Carratt, Evan D, MD I General Practice 1243 3 Ridgewood Ave ID; 00003063726 001 All Premium Care Physician EVAN D CARRATT MD Daytona Beach, FL 32114 41386-252-2504 Accepting All Patients Florescu, Lucian L, MD I Internal Medicine Ill 7 W Point Dr 113: 00001238900 017 A# V Premium Care Physician STEWARD MEDICAL GROUP Cocoa, FL 32922 ,1 321-636-2621 Accepting All Patients Sarnitas, Effie D, MD I Infectious Disease Medicine, Internal Medicine 1317 IN Point Dr ID: OOD01 147936 019 1' V Premium Care Physician STEWARD MEDICAL GROUP Cocoa, FL 32922 +1 321.636-2621 Accepting All Patients Knappman, John W, MD I Family Practice 12 1317 W Point Dr ID: 00001761501 011 IV IV Premium Care Physician STEWARD MEDICAL GROUP Cocoa, FL 32922 +1 321-636-2621 Accepting All Patients Pinkowskil, Mark K, MD I Family Practice 1317 W Poira Dr ID; 000012,39030 015 4V Vp Premium Care Physician STEWARD MEDICAL GROUP Cocoa, FL 32022 ,1 321-636-2621 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Shapiro, David S, MD I Internal Medicine Page 34 of 140 1317 W Point Dr 10* 00000490436 020 111# Premium Care Physician STEWARD MEDICAL GROUP Cocoa' FL 32922 -1 321-636-2621 Accepting Atl Patients Vellody, Raj, MD I 1mrminopathology, Internal Medicine 1317 W Point Dr ID: 00001983871 014 #* ## Premium Care Physician STEWARD MEDICAL GROUP Cocoa, 182922 -1 321'36-2621 Accepting All Patients Geiger, Ralph B, MID I Internal Medicine 1317W Point Dr ID: 00000043630 016 f# A# Premium Care Physician STEWARD MEDICAL GROUP Cocoa, rL 32922 +1 321-636-2621 Accepting All Patients Cork, Steven D, DO I Family Practice 724 S Beach St Ste 2 [D: 00001936385 015 40 Premium Care Physician STEVEN D CORK DO Daytona Beach, 7L 32114 'l 38C,2534546 Not Accepting Patients ... . ........... . ...... Elsel Joshua R, MID � Family Practice 305 Memorial Medical Pkwy Ste 502 ID: 00002904131 008 i P Premium Care Physician MEMORIAL HEALTH SYSTEMS Daytona Beach, FL 32117 +1 386,231-3570 Accepting All Patients Crouch, Eugene M, MD I Family Practice 165 S Halifax Ave ID: 00000045082 007 11# I b Premium Cam Physician CROUCH & DUNN MD Daytona beach, FL 3211 B +1 388.252-7119 Accepting Existing Patients Only internJaime E, MD I Pediatric Critical Care Medicine, Pediatrics 1688 W Granada Blvd ID: 00002189256 005 111* 40, Premium Care Physician Ormond Beach, FL 32174 +1 386-42r.4414 Accepting All Patients https://connect.werally,com/searchDirectory/32708/page-I?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 35 of 140 Abraham, Bobby, MID I Internal Medicine 1027 Florida Ave S Ste A 0: 0000 1120181 012 Rockledge, FL 32955 ,132 1u04-3999 Not Accepting Patients Torres, Diego T, MD I Family Practice 325 Clyde Morris Blvd Ste 320 ID: 00002244638 008 Ormond Beach, FL 32174 'l 386-676-2367 Accepting All Patients Fair, Susan C, DO I Family Practice 595 N Gourtenay Pkv4y Ste 102 ID: 000018B8282 011 Merritt Island, FL 32953 +1 321-455-1226 Accepting Existing Patients Only Casimiro, Jessy, MD I Family Practice 290 Clyde Morris Blvd Ste A2 ID: 00001844066 009 Ormond Beach, �L 32174 +1 386B/3-9790 Accepting All Patients ## f# Premium Care Physician 1*1 W, Premium Care Physician ABA FAMILY MEDICINE 4# ## Premium Care Physician SUSAN C FAIR DO f# f# Premium Care Physician MEMORIAL HEALTH SYSTEMS Khalil, Taher Aly, MID I Cardiovascular Disease 1425 Hand Ave Ste K ID; 00001685308 022 40 ## Premium Care Physician CARDIOVASCULAR CENTER Ormond Beach, FL 32174 ,I 38&B73-5404 Accepting All Patients Peck, Rebecca A, MID I Family Practice 1400 Hand Ave Ste L ID: 000020B9652 008 V* f* Premium Care Physician Ormond Beach, FL 32174 'i '3R6-677-2018 Accepting All Patients O'Donnell, Erica Lynne, DO I ....... . . . ....... ... ....... . Family Practice 1400 Hand Ave Ste K 10: 00002092618 005 N f# Premium Care Physician ERICA LYNNE O'DONNELL DO Ormond Beach, FL 32174 it 366-673-0517 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 36 of 140 Buck, Dannie E, MD I Internal Medicine 800 S Nova Rd Ste A ID: 000D1350547 006 qP %V Premium Care Physician YOUR DOCTORS OFFICE Ormond Beach, FL 32174 +1 386-676-0505 Accepting All Patients Harchandani, Preeti, MD I Internal Medicine 2209 North Blvd W ID: DOD02245509 D06 qk f# Premium Care Physician RIDGE MEDICAL ASSOCIATES Davenport, FL 33837 +1 863-679-6000 Accepting All Patients Robbins, Rena M, MD I Family Practice 621 S Nova Rd ID: 00000457748 004 f# 0 Premium Care Physician Ormond Beach, FL 32174 +1 386-677-0005 Accepting Existing Patients Only Ulrich, Mary W, MD I Pediatrics 124 S Woods Dr ID: 00000906228 010 qip 4f Premium Care Physician PEDIATRICS IN BREVARD Rockledge, FL 32955 +1 321-6363D66 Accepting All Patients Dozier -Thornton, i b rl 11 Pediatrics 134 S Woods Dr ID: 00004250891007 f# f Premium Care Physician PEDIATRICS IN BREVARD Rockledge, FL 32955 +1 321-6363D66 Accepting All Patients Pena, Monica A, MD I Pediatrics 134 S Woods Dr ID: 00005423035 001 4V 0 Premium Care Physician PEDIATRICS IN BREVARD Rockledge, FL 32955 +1 321-6363066 Accepting All Patients ILei a, Robert E, MID d Pediatrics 134 S Woods Dr ID: 00001106358 001 40 V Premium Care Physician PEDIATRICS IN BREVARD Rockledge, FL 32955 +1 321-635-2545, +1 321-636-3066 Accepting All Patients https://connect.weral ly.com/searchD!rectory/32708/page-1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 37 of 140 2==' Z-Mm- Mg "TT I t 134 8 Weeds Dr M 00000413146 014 40 1* Premium Care Physician PEDIATRICS IN BREVARD Rockledge, FL 32955 -1 321-636-2545, +1 321-6361066 Accepting All Patients Nguyen, Hlep L, MD I Pediatrics 134 S Woods Dr ID: 00001969024 009 40 %* Premium Care Physician PEDIATRICS IN BREVARD Rockledge, FL 32955 ,I 321-636-306e Accepting All Patients Gonzalez, Luis A, MD I Pediatrics, Urgent Care Medicine 270 N Sykes Creek Pkwy Ste 108 ID: 00000960006 018 #0 4' Premium Care Physician ATLANTIC COAST PEDIATRICS RIGS MerrittIsland, FL 12953 ,1321-4512-1061 Accepting All Patients Jain, Manuel G, MD I Geriatric Medicine, Family Practice 141 Webb Dr Ste 200 ID: 0000293355 014 Premium Care Physician WELLMED MEDICAL MANAGEMENT Davenport, FL 33837 OF FLORIDA -1862,4228574 Accepting All Patients Sosa, Felix A, MD I Internal Medicine 780 E Merritt Island Cswy Ste BIG ID! 00001644185 007 11# Premium Care Physician Merritt Island, FL 32952 +1 321-631-5566 Accepting Ali Patients Jordahl, David W, MD I Family Practice 280 Farrier PI ID: 00001842038 016 f* Premium Care Phi VILLAGES HEALTH SYSTEM The Villages, FL 32163 +1 352-674-1710 Accepting All Patients Zimmerman, Heidi L, MD I Family Practice 280 Farner PI ID: 00001168695 COB Premium Care Physician THE VILLAGES HEALTH The Villages, FILL 32163 +1 3521-674 1710 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page-1?coverageType=medic... 5/7/2018 Print Search Directory I Find Care 01livierre, Denise C, MD � internal Medicine Page 38 of 140 280 Fanner Pi ID: 00001055835 C04 d4 ^ Premium Care Physician VILLAGES HEALTH SYSTEM I he Villages, FL 32163 -1 352-674-1710, 0 508-47"450 Accepting AJ -atients Buddha, Chaithanya Deepithi, MD I Family Practice 2070 Us Highway 1 Ste 103 ID: 00005188901006 Premium Care Physician VINAY K KUMAR MD Rockledge, 132955 -1 32"32-0562 Accepting All Patients VINAYA KUMAR PA Shahmirl, Anip A, MD I Internal Medicine 749 Highway 466 ID: 00002027120 041 4W f* Premium Care Physician PULSE MEDICAL DOCTORS Lady Lake, PIE 12159 +1 352.350-512l 352-350MI30 Accepting All Patients Blogiclanovski, Dragi, DO I AMercy and Irnmunology, Family Practice 009 Sterthaus Dr ID: 00003134639 011 f# 4W Premium Care Physician BOGDANOVSKI Ormond Beach, FIE 32174 *1 386-673-1717 Accepting All Patients Kasturl, Savitha By DO I Family Practice 279 S Yonge St ID: 0000MB8276 010 f* 00 Premium Care Physician SAVITHA B KASTURI MD Ormond Beach, FL 32174 ,1 386-944-9704, -1 386-944-9704 Accepting All Patients Larrazabal, Christopher, MID I InternaI Medicine 500 Memorial Cir Ste A ID: 00001913159 011 Premium Care Physician LANA MEDICAL CARE Ormond Beach, FL 32174 38"76-2779 Accepting Existing Patients Only Woodard, Vivian J, MD I Internal Medicine . ....... --- 918 Rolling Acres Rd Ste I ID: 00001666114 003 Premium Care Physician EMMANUEL CHRISTIAN HEALTH Lady Lake, FL 32159 CENTER 11352-259-1991 Not Accepting Patients https://connect.werally.com/searchDirectory/32708/page-1?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 39 of 140 Carpenter, David W, MD I Family Practice 77 W Granada Blvd ID: 00002N)3524 003 It qP Premium Care Physician ORMOND MEDICAL ARTS Ormond Beach, FL 32174 1 386677-0453, >1 386-677-0453 Accepting All Patients Mejia, Melissa Y, MD I Internal Medicine 910 Old Camp Rd Ste 200 ID; 00005298402 005 4IN# Premium Care Physician I.AKIVIEVV INTERNAL MEDICINE The Villages, FL 32162 + 1 't52 775-4868 Accepting All Patients Roethlisberger, Mirko, MD I Internal Medicine 1050 Old Camp Rd Ste 100 ID: 00002215311 005 4W 40 Premium Care Physician VILLAGES HEALTH SYSTEM The Villages, FL 32162 'l 352-674-1760 Accepling Existing Patients Only Reilly, Robert C, IVID I Internal Medicine 1050 Old Camp Rd Ste 100 ID: 00002604900 012 4 f# Premium Care Physician VILLAGES HEALTH SYSTEM TI-0 Villages, FL 32162 .1 352-674-1760 Accepting All Patients Ojha, Smita, MID I Emergency Medicine, Family Practice I C5D Old Camp Rd Ste 100 ID: 00002312485 008 Premium Care Physician VILLAGES HEALTH SYSTEM The Villages, FL 32162 +1352-674-1760 Accepting All Patients Conti, Andrew D, MD I Internal Medicine 1400 IN Us Highway 441 Ste 912 ID: 00001990293 010 1411 Premium Care Physician ANDRDN D CONTI MD The Villages, FL 32159 ', 152-75D-1 277 Accepting All Patients Rosenblum, Saul, MD I Internal Medicine I C20 Lake Sumter Lndg ID: 000000463.52 003 IV Premium Care Physician VILLAGES HEALTH SYSTEM The Villages, Fl. 32162 ,1352-674-8850 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 40 of 140 Stine, Jay C, MD I Internal Medicine 608 Ingraham Ave 10; 00000214427 006 11# Ill Premium Care Physician HAINES CITY INTERNAL MED Hal no, City, FL33844 A 1 865422-9562 Accepting All Patients Allende, Guillermo F, MD I Internal Medicine 608 1 ig raham Ave ID: 00000214411 005 Premium Care Physician HAINES CITY INTERNAL MED Haines City, FL 32844 ,I 863A22-9562 Accepting All Parents Nelson -James, Cara R, DO I Family Practice IUl I E Main St ID: 00002674099 020 Premium Care Physician CENTRAL FLORIDA HEALTH CARE Haines City, FL 33844 +1 8a422-0924 Accepting All Patients Melldiona, Frank J, DO � Farnfly Practice 1575 Santa Barbara Blvd ID: 00000763842 016 Premium Care Physician VILLAGES HEALTH SYSTEM The Villages, FL 32159 +1 352�674-1740 Accepting AX Patients . ........... Plead, Christop1heir S, MD � FarnHy Practice 1575 Santa Barbara Blvd ID: 00002114 181 011 4W Premium Care Physician VII (ACES I IEALTH SYSTEM The Villages, FL 32159 ,l 352-674-1740 Accepting All Patients ZeIaya-Aragon, Sheyla K, MD I Internal Medicine, Nephrology 1580 Sdf ita Barbara Blvd ID: 00005672755 007 Lady Lake, FL 32159 -1 352-259-2159 Accepting All Patients Tafur, Angel, MD Family Practice 1503 Buenos Aires Blvd Ste 160 ID: 00001759275 008 Lady Lake, FL 32159 ,1 352-350-6241 Accepting All Patients f#� qf Prennium Care Physician PREMIER MEDICAL ASSOCIATES 4W #* Premium Care Physician ANGEL E TAFUR MD https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 41 of 140 Luthra, Venu K, MD I Internal Medicine 1710 Wueslhoff Dr ID: Ul 1596 001 V* 011 Premium Care Physician INTERNAL MEDICINE/VIERA Mplbounne, FL 32940 ,1 32 1-255-60K Accepting All Patients Shaktawat, Janmejay, MID I Internal Medicine 13953 NE 86th Ter Ste 101 ID: 00002366364 013N Premium Care Physician HEALTH FIRST INTERNAL MED Lady Lake, FL 32159 ASSOC +1352433-8681 Accepting All Patients Yutani, Fredrick M, MID I Internal Medicine, Internal Medicine Specialist 8550 NE 138th Ln Ste B ID: 00001652528 022 40 4W Premium Care Physician MUNROE HMN HMPN Lady Lake, FL 32159 +1 352-873-2800 Accepting All Patients Hans, Sangeeta, MID I Family Practice 13940 IN Us Highway Bldg 100 ID: 00003041661 005 Premium Care Physician FLORIDA MEDICAL ASSOCIATES Lady Lake, FL 32159 �1 352-350-233C Accepting Existing Patients Only Perez, Tomas, MID I Family Practice 2485 Pinellas PI 1 00D02559587 012 f# q0 Premium Care Physician VILLAGES HEALTH SYSTEM The Villages, FL 32163 -1 352-674-1720 Accepting All Patients Diaz -Mendez, Harry J, MID I Family Practice 7125 Murrell Rd ID: 00001370469 027 111# %* Premium Care Physician HEALTH FIRST MEDICAL GRP Melbourne, FL 32940 -1321-242-8790 Accepting All Patients Spears, Mark Alan, MD I Internal Medicine 7125 Murrell Rd Ste F ID: 00001178366 027 f* W Premium Care Physician Melbourne, FL 32940 ,1 321-242-8790 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 42 of 140 lBerk, Danny P, MD l Internal Medicine, Family Practice W.J57 pyglass Hill nd,',e 104 ID U)00'076660) ± f* Premium Care Physician FLORIDA FAMILY MEDICAL CTR 111rlJbown,,,,, Fi. 1Y2940 , 1 321 24149,7 Arcptin(y All Pafierjt;� MEDICAL ASSOCIATES OF BREVARD Nunes, Christopher S, MD I Adolescent Medicine, internal Medicine, Pediatrics 8667 SqWglass II -II II rid Sin 1% f) 0000089517013 to Premium Care Physician MEDICAL ASSOCIATES OF BREVARD I I-1- 321' Q *1 321 249-467 AJI Pa+iews Marino, Vincent P, MD I Family Practice 333 W Cocoa Beach Cswy Ste D ll): 00000257421 002 f* f# Premium Care Physician Cocoa Beach, FL 32931 ,11321-868-7170 Accepting All Patients Gifte, Sara 1, MD I Internal Medicine 1950 Laurai Manor Dr Ste 150 ID: 0l 004 Premium Care Physician LAKEVIEW INTERNAL MEDICINE The Villages, FL 32162 +1 35&633-5282 Accepting All Patients Gutierrez, Gil F, MD l Internal Medicine, Pediatrics 1950 Laurel Manor Dr Ste 2141 ID: 00000840023 1 111 Premium Care Physician FLORIDA MEDICAL ASSOCIATES The Villages, FL 32162 -1 152,350-8800 Accepting Existing Patients Only Glorgianni, Stephen M, DO I Family Practice 1341 Bedford Or Ste B ID: 00003424680 008 ff f* Premium Care Physician STEPHEN I OlOnCIANNI DO Melbourne, FL32940 11 321622-8031 Accepting All Patients Hernesman, Shane C, MD I Sports Medicine, Family Practice 1980 IN Atlantic Ave Ste 627 ID: 00001972512 009 11# Premium Care Physician SHANE C HERNESMAN ME) 01011Beach, FL 32931 13,121-453-5888 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 43 of 140 Smith, Page Armand, MID I Internal Medicine 1025D SE 167th Place Rd Unit 5-1 ID: 00000903152 015 40 Premium Care Physician LAKEVIEVV INTERNAL MEDICINE Summartleld, FL 34491 352-307-9925 Accepting ig All Palia Ab Jamaleddine, Wael A, MD I Family Practice 33044 Hwy 27 ID: 00001653121003 f* %* Premium Care Physician FAMILY FIRST MEDICAL CTR Haines City, FL 33644 ,I BGS4224977 Accepting All Patients Green, David Justice, MD I Family Practice 6012 State Road 644 ID: 00001419524 003 f# V# Premium Care Physician Winter Haven, FL 33881 f1 863-291-3732 Accepting All Patients Ton, Liem, MD I Emergency Medicine, General Practice I 4 235 N Commonwealth Ave ID: 00001461586 015 Premium Care Physician FIRST FAMILY PRACTICE Polk City, FL 33868 1 863-984-8000 Accepting All Patients Fagan, Teresa S, MD I Internal Medicine 465 Minuteman Csvq Unit 455 ID: 00002109372 016 111 f# Premium Care Physician SUNSHINE HEALTHCARE SOLLMONS Cocoa Beach, FL 32931 +1 866-389-7601 Accepting All Patients Leyte Vidal, Santiago, MD I Internal Medicine 465 Minutemen Cswy ID: 0000 1287879 007 40 Premium Care Physician SANTIAGO LEYTE VIDAL MD Cocoa Beach, FL 32931 +1 321 7B32412 Accepting Existing Patients Only Saladinio, Carl D, MD I Internal Medicine 6420 3rd St Ste 104 ID: 00000836887 006 40 Premium Care Physician SUNTREE MEDICAL ASSOCIATES Rockledge, FL 32955 +1 321-757-9711 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 44 of 140 Wald, Michael Edward, MID I Internal Medicine 8877SE 165th Mulberry Ln ID: 000001039 1# Premium Care Physician VILLAGES HEALTH SYSTEM he, Villages, FL 32162 1 362 674 1750 Accepting All Patents Kennedy, Denise R, MD I Family Practice 8877 SE 165th Mulberry Ln ID; 00002610270 027 IV ## Premium Care Physician The Villages, FL 32162 41 352674-1750 Accepting Existing Patients Only . . . . .. .. ............... Bakshi, Shakti D, MID � Internal Medicine 6550 N Wickham Rd Ste 2 ID: 00001892891 007 Melbourne, rL 32940 11321-255-1947 Accepting All Patients Mckee, Eliana V, MD I Pediatrics 6300 N Wickham Rd Ste 132B [D: 00002647010 018 Melbourne, FLS2940 0 321-622,1097,-1 321-725-1999 Accepting All Patients 111# ff Premium Care Physician MPDI(.,At, ASSOCIATES OF BREVARD f# Premium Care Physician NORTH BREVARD MEDICAL SUPPORT OMNI HEALTHCARE HOARE Cintron, Zu1nna, MD � Internal Medicine 7660 Rod Rug Lake Ric Ste 2080 ff): 00001225259 007 11# Premium Care. Physician Oviedo, FL 32765 -1 407-365-0999 Accepting All Pat�ents Dicristofarol Sharon M, MD I Pediatrics 7455 Pinomire Dr ID: 00002094717 012 Oviedo, FL 32765 -1 407-542-1733,+1 904-6975831 Accepting Existing Patients Only Goodwin, Angela, MD I Pediatrics 7455 Pinerni Or 113: D0003652202 008 Oviedo, FL 32765 +1407-542-1733 Accepting All Patients f# f# Premium Care Physician CHl HEALTH ALLIANCE f# III# Premium Care Physician CHILDREN HEALTH ALLIANCE https:Hconnect.werally.com/searchD!rectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 45 of 140 Tellado, Michelle Pilar, MD I Pediatrics 7465 Pinemire Dr ID: 00006094126 011 Premium Care Physician CHILDREN'S HEALTH ALLIANCE Oviedo, PIL 32765 ,l 407-542-1733 Accepting All Patients . ............ . . . ... ... —11 .............. .................. Rothwell, Gary H, MD I Family Practice 550 E State Road 434 ID: 00001816221 013 f* f# Premium Gets Physician PHYSICIAN ASSOCIATES Longwood, I'L 32750 +1407-381-7367 Accepting All Patients Nagalapadi, Venkatesh P, MD I Geriatric Medicine, Family Practice 11 085 State Road 436 ID: 00002635774 004 q# 4V Premium Care Physician CFP CARE TEAM Ca"""Iberry, FL 32707 41 407,831-5252 Accepting All Patients cr-P PHYSICIANS GROUP Roitman Geller, Gabriela M, MID I Pediatrics I DOD W Broadway St Ste '00 M 00001463219 006 I Premium Care Physician NEW INTERLACHEN PEDIATRICS Oviedo, FL 32765 -1 407-767-2477 Accepting All Pattents, Johnson, Patricia K, MD I Pediatrics 1000 VV Broadway S1 ate 100 ID: 000009133263 011 f# Premium Care Physician NEW INTERLACHEN PEDIATRICS Oviedo, FL 32765 -1 407-767-2477 Accepting All Patients Urclaneta, Javier J, MD I Family Practice 1000 IN Broadway St Ste 102E ID: 00001463252 015 ff V Premium Care Physician Oviedo, FL 32765 -1407,165-9000 Accepting All PaVenis Emmert, Melanie, MID I Pediatrics 1 1000 W Bivadwdy St Ste 100 (D: 00002670299 006 f# f# Premium Care Physician NEW INTERLACHEN PEDIATRICS Oviedo, FL 32765 +1 407-707-2477 Accepting All Patients 0 *as, Flor B, MD I Family Prail- https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 46 of 140 1000 W Broadway St Ste 102B ID: 00005578366 006 f* f# Premium Care Physician Oviedo, FL 32765 -1 407-365-0000 Accepting All Patients Velarcle, Melissa, MD I Pediatrics 1000 W Broadway St Ste 100 10: 0000C104021 007 f# Premium Care Physician NEWATERLACHEN PEDIATRICS Oviedo, Fit. 32765 +1 407-767-2477 Accepting All Patents Marrero, Roger A, MD I Family Practice 1410 W Broadway St Ste 108 ID: 0000,186965 010 10 Premium Care Physician OVIEDO PRIMARY CARE Oviedo, FL 32765 -1 407-359-5098 Accepting &I Patients . . . . . . . . . . . ...................... Marrero, Guillermo, MD I Internal Medicine 1600 Executive Dr Ste 1 ID: 00001962275 002 4 111 Premium Care Physician OVIEDO HEALTHCARE Oviedo, FL 32765 ,1 407-971-1970 Accepting All Patients Mireles, Alfonso, MD I Pediatrics 8300 Red Bug Lake Rd ID; 00000I 032 Premium Care Physician CHILDREN'S HEALTH ALLIANCE Oviedo, FL 32765 d 1 407-890-2273 Accepting Existing Patients Only Pothuraju, en of K, MD I Family Practice ' 120 State? Road 436 Ste 1200 ID: 00003054933 032 1# f# Premium Care Physician CFNTRAI, FL MlGRjCOMM HLTH CTR Casselberry, FL 32707 ,I 407-322-8645 Accepting All Patients Senors, Leidee IKarenna, MD 6 Family Practice 1120 Slate Road 436 Ste 1200 ID: 00002750291011 11# Premium Care Physician CENTRAL FL MIGR/COMM FILTH CTR Casselberry, FL 32707 +1 407-322-8645 Accepting A1 Patients Almeyda-Gomez, Juan R, MD I General Practice 1120SIate Road 436 ID: 00002490657 015 1' 40 Premium Care Physician CENTRAL FL MICR/COMM HLTH CTR Casselberry, Fit. 32707 ,1 407-322-8645 Accepting All Patients 1141111111 ji, Print Search Directory I Find Care Page 47 of 140 Moraflores, Manuel Fernando, MID I Pediatrics 1120 State Roac 436 Ste 1200 ID: OODOI 851821 02D Premium Care Physician CENTRAL FL IVIGR/COMM FILTH CTR Ca'selberry, FL 32707 +1 41 Accepting All Patients lr;l��IlIllplrl�ll�llli 1 120 State Road 436 Ste 1200 11100001829188 010 f* * Premium Care Physician CENTRAL FL MICR/COMM HILTH CTR CaTfiderry, FL 32707 +1 407-322 8645 Accepting All Patients Vemulapalli, Anitha, MD I Family Practice 1120 State Road 436 Ste 1200 ID: D0002787626 034 40 40 Premium Care Physician CENTRAL FL Il4 HILTH CTR Cassolbpnry, FL 32707 +1 407-322-B645 Accepting All Patients Jain, Mohit, MD I Family Practice ,915WState Road 434 Ste 110 ID: 00002975839 006 I Premium Care Physician Longwood, FL 32750 +1 407-83D-8600 Accepting Existing Patients Only Azelvandre, Jacqueline, DO I Family Practice 301 3 Milwee St ID: 00001023026 007 Premium Care Physician L-Cngwood, FL 32750 +1 407-339-106C Accepting All Patients Mosch, David P, DO I Family Practice IPA) Alexandra Blvd Ste, 1 ID: 00001238588 (107 11# IV Premium Care Physician Oviedo, FL 32765 ,1 407-359-7997 Accepting All Patients DAVITA MEDICAL FLORIDA AZELVANDRE DO& ASSOCIATES OVIEDO FAMILY MEDICAL CENTER Shokoohi, Ahmad, MD I Gynecology, Obstetrics and Gynecology, Family Practice 7480 Aloma Ave ID; 00000435040 001 f# 0* Premium Care Physician ALOMA WALK iN CLINIC Winter Park, FL 32792 +1 407-657-7799 Accepting All Patients Beltre, Magdalena G, MD I Internal Medicine https://connect.werally,com/searchDirectory/32708/page-1?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 48 of 140 745 Oriente Ave Ste 1251 ID: 0000 1815860 022 f#� 10 Premium Care Physician PRIMARY HEALTHCARE ASSOC Altamonte Springs, FL 32701 1 407-239-2910 Accepting All Patients Christensen, Marie L, MD I Urgent Care Medicine, Family Practice 249Maitland Ave Ste 1000 [D: 0000',857837 011 ff f# Premium Care Physician ALTAMONTE FAMILY PRACTICE Altamonte Springs, FL 32701 1 40 l-&Q-B366 Accepting All Patients Khan, Vaj1h M, MD I Internal Me6cine . .... . . . . . . . .................... . . . .......... 585 Maitland Ave ID: 00000339140 013 IF IV Premium Care Physician VAJIH M KHAN MD Altamonte Springs, FL 32701 -1 407-265-3801 Accepting All Patients Stern, Stephen N, MD I Internal Medicine 631 Palm Springs Or Ste 117 ID: 00001854592 012 1l1t f* Premium Care Physician ALTAMONTE MEDICAL ASSOC Altamonte Springs, FL 32701 +1 407-339-5S00 Accepting All patients Harris, Brian E, MID 9 Pediatrics 101 N Country Club Rd Ste 115 ID: 00001080619 007 1# f# Premium Care Physician ALTAMONTE PEDIATRIC ASSOCIATES Lake Mary, PL 32746 ,1 407-831-6200 Accepting All Patients Seven, Wayne D, MID I Pediatrics 10 1 N Country Club Rd ID: 00000604289 004 fo Premium Care Physician ALTAMONTE PEDIATRIC ASSOCIATES Lake Mary, FL 32746 +1 407 831-6200 Accepting All Patients Good, Katherine, MD I Pediatrics 101 N Country Club Rd Ste 115 ID: 00005121034 003 f# If Premium Care Physician ALTAMONTE PEDIATRIC ASSOCIATES Lake Mary, FL 32746 +1 407-831-16200 Accepting All Patients Nguyen, Gina 0, MD I Pediatrics 101 N Country Club Rd Ste 115 ID: 00005507896 003 Premium Care Physician ALTAMONTE PEDIATRIC ASSOCIATES Lake Mary, F1 32746 +1 407-831-6200 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Chan, Pedro Y, DO I Family Practice 101 Lake Hayes Rd Ste 105 ID: UOD001 73584 003 Oviedo, FL 32765 ,1 407-365-9010 Accepting All Patients Belton, Janet M, MID I Pediatrics 475 Osceola St Ste 1100 ID: OODO 1764866 015 Allamonto Springs, FL 32701 +1 407-831-6200 Accepting Alt Patients Page 49 of 140 111# 11# Premium Care Physician V III* Premium Care Physician ALTAMONTE PEDIATRIC ASSOCIATES Marathe, Shriram S, MID I Geriatric Medicine, Internal Medicine, Nephrology 3 460 C Altamonte Dr Ste 2200 ID: 00000596658 042 111 V Premium Care Physician MEDICAL SPECS OF NE FLA Altamonte Springs. FL 32701 +1 407-767-0009 Accepting All Patients Patterson, Neil A, MD I Family Practice 2984 Aiafayd Tri Ste 2000 ff): 0000 1203020 604 Premium Care Physician Oviedo, FL 32765 -1407-366-2020 Accepting All Patients Landis, Miles M, MD I Pediatrics 410 Waymont Ct ll): 00DO0216317 009 Lake Mary, FL 32746 +1 4073233550 Accepting All Patients Roque, Mark D, MD I Pediatrics 410 Waymont Ct ID: 00002095742 005 Lake Mary, FL 32746 ,1 407-323-3550 Accepting All Patients Alber, Thomas J, MID I Pediatrics 410 Waymont C1 ID: 00001154403 002 Lake Mary, FL 32746 ,I 407-3233550,,1 407-1233550 Accepting All Patients Derrow, Martin H, MID I Internal Medicin( qP f# Premium Care Physician LAKE MARY PEDIATRICS %* 0# Premium Care Physician * 4P Premium Care Physician LAKE MARY PEDIATRICS https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 50 of 140 800 N Maitland Ave Ste 103 ID: 000010638540 014 f# Premium Care Physical PHYSICIAN ASSOCIATES Maitland FL 32751 11 �401 Accepting All Patients Stanish, Ronald J, MID I Family Practice 2304 Atoms Ave Ste 100 ID: 00000459096 005 q# f# Premium Care Physician WINTER PARK FAMILY HEALTH CTR Winter Park, FL 32792 '1 407-679-9222 Accepting All Patients Priska, Rudina, MD I Family Practice 2304 Aicma Ave Ste IOU ID: 00002809955 LOS 40 IF Premium Care Physician DAVITA MEDICAL FLORIDA Winter Park, FL 32792 ,1 407-679-9222 Accepting All Patients Oostwouder, Peter, MID I Geriatric Medicine, Family Practice 40O W Xrport Blvd ID: 00001829756 010 IV Premium Care Physician CENTRAL FL MIGFI/COMM HLT11 CTR Sanford, FL 32773 -1 407-322-8645 Accepting All Patients Ferguson, Julie, MID p Family Practice 9964 University Blvd ll): 00001816032 013 Premium Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32817 ,1407-261-2962 Accepting All Patients ...... . . . ........ . ........... Burns, Ronald R, DO I Family Practice 10055 University Blvd ID: 00001238391 001 1b Premium Care Physician UNIVERSITY FAMILY MEDICINE Orlando, FL 32817 CENTER �1 407 679 4800 Accepting All Patients Tomsa, Anca, MID I Pediatrics 18$4 W County Road 419 Ste 1000 1 D: 00005685353 006 f# 11W Premium Care Physician FIRST CHOICE PEDIATRICS Oviedo, Fl. 32765 11 407-249-1234 Accepting All Patients Imp, Janet J, MID I Pediatrics, Urgent Care Medicine FRI Print Search Directory I Find Care Page 51 of 140 1884 W County Road 419 Ste 1000 ID: 00002305707 027 V qP Premium Care Physician rmsT a ioicl: PEDIATRICS Oviedo, FL 32765 -1 407-249-1234 Accepting All Patients Mota-Aquino, Orlando, MD I Pediatrics 1884W County Road 419 Ste 1000 ID'000036N937 010 of V Premium Care Physician FIRST CHOICE PEDIATRICS Oviedo, FL 32765 +1 407-249-1234 Accepting All Patients Valay, Durgabhavani, MD I Family Practice II 109 Timbellaolren Cir ID: 00001917047 012 f# Premium Care Physician DAVITA MEDICAL FLORIDA Lake Mary, FL 32746 +1 407-133-9877 Accepting All Patients Simpson, Helen E, MD I Family Practice 109Timbarlachen Cii ID! 00001622617 016 f# f# Premium Care Physician DAVITA MEDICAL FLORIDA Lakr, Mary, FL 32746 ,I 407-333-9877 Accepting All Patients Mashkourl, Morteza G, MD I Family Practice 255 N Lakemant Ave Ste 101 ID: 00002416611 005 Winter Park. FL 32792 +l 407 647-6070 Not Accepting Patients Pham, Lac H, MD I Pediatrics 17 IIIIIII, Premium Care Physician FAMILY PHYSICIANS OF WINTER PARK 157 N LakLmont Ave ID: 00000421094 003 Premium Care Physician Winter Park, FL 32792 +l 407-644-6618 Accepting All Patients Oh, Cheryl 1, MD I Sleep Study Medicine, Family Practice 125 W Prieview St Ste 1001 ID: 0000 1332328 006 f* Premium Care Physician Altamonte Springs, FL 32714 +1 407-8623400 Accepting All Patients Pacheco, Rosa M, MD I Family Practice LAC H PHAM MD 829 Douglas Ave ID! 00001056084 030 1# Premium Care Physician ORLANDO FAMILY PHYSICIANS Altamonte Springs, FL 32714 https://connect.werally.com/searchDirectory/32708/page-I?coverageType=medic... 5/7/2018 Print Search Directory I Find Care ,l 407332-0003 Accepting All Patients Nieves -Cruz, Nancy, MID I Internal Medicine Page 52 of 140 829 Douplas Ave 11000001518226,00,5 1110, W Premium Care Physician ORLANDO FAMI, y PHYSiGWNS, AlFarnitlate ',Slni l� r1s, 1-1. 32 M 4074,20003 °',cccptirqq At P,,Aenls ............ Sanchez Avila, Maria Del P, MD � General Practice 829 Douglas Ave ID: 00003344218 007 4 Premium Care Physician ORLANDO FAMILY PHYSICIANS Altamonte Springs, FL 32714 +1 407�332-0003 Accepting All Patients Maza, Jose G, MD I General Practice 829 Douglas Ave ID: 00005233077 010 Premium Care Physician ORLANDO FAMILY PHYSICIANS Altamonte Springs, FL 32714 ,1 407332-0003 Accepting All Patients Monroy-Avella, Jorge E, MDp General Practice 829 Douglas Ave ID! 00005133678 008 nor 4 Premium Care Physician ORLANDO FAMILY PHYSICIANS Altamonte Springs, FL 32714 -1 407-$32-0003 Accepting All Patients Nieves Perez, Glenda M, MD General Practice 829 Douglas Ave 10:00003344810 005 41# 4# Premium Care Physician ORLANDO FAMILY III IYSICIANS Altamonte Springs, FL 32714 -1407-332-0003 Accepting All Patients Ortiz Valentin, Nanette, MD I General Practice $29 Douglas Ave ID: 00003513429 206 4 40 Premium Care Physician ORLANDO FAMILY PHYSICIANS Altamonte Springs, FL 32714 ,I 407-332-D003 Acnepfing All Patients Moldoveanu, Dain, MD � Internal Medicine 133 Benmore Dr ID: 00001957720 012 4# (# Premium Care Physician ADVENTIST FILTH SYS SUNBELTELT Winter Park, FL 32792 ,1407-646-7070 Accepting All Patients Ralssi-Fard, Ehterann, MID I Adolescent Medicine, Pediatrics 768 N Sun Dr Ste 108 ID: 00001352811 007 Premium Care Physician SUNSTATE PEDIATRICS Lake Mary, FL 32746 ,I 407�333-2809 Acropting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Molhandas, Usha K, MD I Internal Medicine, Family Practice 360 Douglas Ave ID: 00001560137 005 Premium Care Physician Altamonte Springs, FL 32714 +1 407-788-8200 Accepting All Pallente, Williams, Michelle F, MD I Pediatrics 735 Primers Blvd Ste 135 ID: 00003040767 003 f# Premium Care Physician Lake Mary, FIL 32746 ,365-917-0450, 1 40-1-321-0085 Accepting All Patients Page 53 of 140 FAMILY PHYSICIANS OF WINTER PARK CENTRAL FLORIDA PEDIATRICS Rasmussen, Yekatherine, MD I Internal Medicine, Pediatrics 1051 Winderley PI Ste 400 ID: 00002805874 019 Premium Cafe Physician FLORIDA HOSPITAL MEDICAL GROUP Ml FI-32751 ,I 407-43�7-1923 Accepting All Patients Daniel, Meureen 0, MD I Internal Medicine 2105 8 Park Ave 113: 00002282984 008 11# f# Premium Care Physician MAGNUS MEDICAL CENTER Sanford, FL 32771 +1407-330-9082 Accepting Existing Patients Only Meyer, Steven A, MD I Family Practice 4098 Libra Dr ID: 00001325685 010 1* V# Premium Care Physician UNIVERSITY OF CTRAL FL HEALTH S Orlando, FL. 32816 ,1407-823-2701 Not Accepting Patients Coblan, Laritssa P, MD I Pediatrics 8701 Maitland Summit Blvd ID: 00002274639 0040 f# Premium Cam Physician REV SPORTSPLEX PEDIATRICS Orlando, FL 32810 114 07_91 &4520 Accepting All Patients Tran, Phuong-Thi N, DO I Family Practice 434 W Kennedy Blvd ID! 00002435761 01 B qf f* Premium Care Physician CHC/APOPKA FAM FILTH CTR Orlando, FL 32810 r1 407-660-1667 Accepting All Patients Law, Robert K, DO I Internal Medicine, Pediatrics https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 54 of 140 3151 N Alafaya Trl Ste 101 ID: 00001816103 008 %* Premium Care Physician ROBERT LAW DO Orlando, FL 32826 +1 407-207-5000 Accepting All Patients Rivera Irizarry, Miriam L, MID I Internal Medicine 280 S State Road 434 Ste 1049 ID: 00002162483 015 NP f# Premium Care Physician Altamonte Springs, FL 32714 +1 407-267-8823 Accepting All Patients Martinkus, Kelly L, MD I General Practice 7900 Forest Chy Rd ID: 00006138221 009 ` `# Premium Care Physician CHO/VVINTER GARDEN FAMILY Orlando, FL 32810 +1 407-905-8827 Accepting All Patients Pillal, Aravind N, MD 0 Internal Medicine, Family Practice 810 E let St Ste 3 ID: 00001206364 001 + Premium Care Physician Sanford, FL 32771 +1 407-32MOOB Accepting All Patients Brouillette, Christopher J, MD I Family Practice 891 Outer Rd Ste A ID: 00001917020 008 JP IV Premium Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32814 +1 407-895.4737 Accepting All Patients Tra I , Joshua M, MID II Internal) Medicine 2501 N Orange Ave Ste 235 ID: 00002939421 010 1 fo Premium Care Physician FLORIDA HOSPITAL MEDICAL GROUP Orlando, FL 32804 +1 407-303-7270 Accepting All Patients Hsu, Vincent IP, MID l Infectious Disease Medicine, ➢ sterna➢ Medicine 2501 N Orange Ave Ste 235 ID: 00002523685 004 f# ## Premium Care Physician ADVENTIST HLTH SYS SUNBELTELT Orlando, FL 32804 +1 407-303-7270 Accepting All Patients FLORIDA HOSPITAL MEDICAL GROUP MEDICINE SPECIALISTS OF FLORIDA HOSPITAL Verges -Bonet, Enrique, MD I General Practice https://connect.weral ly.com/searchDirectory/32708/page-1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 55 of 140 431 N Seniaran Blvd ID: 00003424393 005 d# Premium Care Physician PRIMARY I 1EALTHCARE ASSOC Orlando, FL 32807 -1 407-894-5054 Accepting All Patients Elio, Florencio V, MD I General Practice 172 S Semoran 91W ID: 00001776457 009 Orlando, FL 32807 +1 407-380-1951 Accepting All Patients Dellwala, Pallavi 13, MD I Pediatrics 7975 Lake Underhill Rd Ste 200 ID: 00000529385 010 Orlando, FL 32822 +1 407-303-6830 Accepting All Patients -.eddy, Ram—,ITID I Internal Medicine Op 4P Premium Care Physician ALPHA MEDICAL f# f# Premium Care Physician ADVENTIST HLTH SYS SUNBELTELT FLORIDA HOSPITAL MEDICAL GROUP 7824 Lake Underhill Rd Ste H ID; 00001419405 010 00 40 Premium Care Physician FAMILY INTERNAL MEDICINE Orlando, FL 32822 41 407-384-1718 Accepting All Patients Dapaah, Michael K, MD I Internal Medicine 12 506 S Chickasaw TrI Ste 200 ID: 00001038276 003 f# Premium Care Physician Orlando, FL 32825 ,1 407-282-9390 Accepting All Patients Hardy, Philip T, MD I Family Practice 11602 Lake Underhill Rd Ste 119 10: 00002541576 005 4' Premium Care Physician LEGACY FAMILY MEDICINE Orlando, FL 32825 ,1 407-781-1000 Accepting All Patients Donis -Silva, Mildred, MD I Family Practice, General Practice 11616 Lake Underhill Rd Ste 205 ID: 00001844940 007 I %* Premium Care Physician FAMILY CARE MEDICAL CENTER Orlando, FL 32825 ,1 407 273 7399 Accepting All Patients Prieto, Jose L, DO I Internal Medicine 11050 Lake Underhill Rd ID: 00004824387 004 f# Premium Care Physician BOND &STEELE CLINIC Orlando, FL 32825 https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care +1 863-293-1191 Accepting All Patients Page 56 of 140 2 Kovats, Christian A, DO I Family Practice 12780 Waterford Lakes Pkwy Ste 135 ID: 00001020469 022 V# f# Premium Care Physician PHYSICAN ASSOCIATES Orlando, FL 32828 +1 407384-1053 Accepting All Patients Antoine, Garry B, MD I Family Practice 5844 44.6uaitluia;9 fllat*t;;;cuirm T"rll llu. 0'000bao2363 CTO0 4# Premium Care Physician NOR Ill-RV'4¢', aT FAM l)1 HII'Al..T"G; Oriaan,lo, Fllm 328 12i l,;I,JhI'li'l''@'� -t 1 407,501.:I 100 A.yvccetafing1 Al Ilaflaro'tL rro, Zolia Elizabeth, DO d Family Practice 10967 Lake Underhill Rd Ste 122 ID: 00002699580 007 40 'f# Premium Care Physician iTr,.NILANDO I Ah48!LY If1IPN4::'I1 v'.,°E'. CAf+L Orlando, FL 32825 +1 407-282-3131 Accepting All Patients Acosta, Lorena Merani, MD I Pediatrics 200 E Marks St ID: 00003049821 011 Or ff Premium Care Physician MICHAEL A MIDDLETON MD Orlando, FL 32803 +1 407-284-6460 Accepting All Patients Boor, IPaul E, MD 0 Sports Medicine, Family Practice 10829 Dylan Laren Cir ID: OD001975716 023 111# ## Premium Care Physician FAMILY PHYSICIANS OF WINTER Orlando, FL 32825 PARK +1 407-273-7373 Accepting All Patients Santana, Reinalclo, MD p Family Practice 1OB29 Dylan Loren Cir ID: 00002551433 008 40 ff Premium Care Physician FAMILY PHYSICIANS OF WINTER Orlando, FL 32825 PARK +1 407-273-7373 Accepting All Patients Durnallaog, Maria I, MID S Pediatrics 414 N Mills Ave ID: 00002235680 010 11# 4# Premium Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32803 +1 407-841-7290 Accepting All Patients Yaeger, David B, MD � Adolescent Medicine, Pediatrics https:Hcon nect.wera I ly.com/search Directory/32708/page-1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care 414 N Mills Ave ID: GOD00152608 008 Orlando, FL 32803 ,1407-841-7290 Accepting All Patients Trinh, Iris Lim, MID I Pediatrics 414 N Mills Ave ID: 00002819864 009 Orlando, FL 32803 ,1407-841-7290 Accepting All Patients Page 57 of 140 0# 1#Premium Care Physician PHYSICIAN ASSOCIATES W V Premium Care Physician PHYSICIAN ASSOCIATES Torres, Joseph L, MD I Sports Medicine, Family Practice 30 815 Woodbury Rd Ste 104 M' 00001106421 012 ff V Premium Care Physician FL. SPORTS & FAMILY HLTH CTR Orlando, FL 32828 tl 407-282-3344, t 1 407-93P-1 192 Accepting All Patients Franco, Noris A, MID I Pediatrics, Family Practice, General Practice 1130 S Semoran Blvd Ste S ID: 00001960026 014 ah Premium Care Physician ORLANDO FAMILY PHYSICIANS Orlando, FL 32607 ,1 407-382-1376 Accepting All Patients Torres, Kriselle, MID I General Practice 1130 S Semoran Blvd Ste B ID: OD003343359 014 40 #$ Premium Care Physician ORLANDO FAMILY PHYSICIANS Orlando, FL 32807 w1 407,182-1376 Accepting All Patients Diaz-Barcelo, Carlos $, MID I General Practice 1130 S Semoran Blvd Ste B 10: 00006101253 002 11# f# Premium Cafe Physician ORLANDO FAMILY PHYSICIANS Orlando, FL 32807 ,1 407 382-1376 Accepting All Patients Feliciano Montalvo, Yanlra, IVID I General Practice 1130 6 Semoran Blvd ID: 00006069431 002 111# V Premium Care Physician ORLANDO FAMILY PHYSICIANS Orlando, FL 32907 -1407-382-1376 Accepting All Patients Garcia -Rivera, Leslie K, MD I General Practice 1130 5 Semoran Blvd Ste B It): 00006101182 005 40 %* Premium Cam Physician OHLANUO FAMILY PHYSICIANS Orlando, FL 32807 ,1407-382-1376 Accepting All Patients https:/Iconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 58 of 140 Pichardo, Jesus R, MID q Genera9 Practice 1130 S Semoran Blvd Ste B ID: 00002491398 007 40 40 Premium Care Physician ORLANDO FAMILY PHYSICIANS Orlando, FL 32807 +1 407-382-1376 Accepting All Patients l s Lej, Chantal IM, MD q Pediatrics 5142 Curry Ford Rd ID: 00001862213 002 1i q# Premium Care Physician DOS PEDIATRICS Orlando, FL 32812 +1 407-381-5533 Accepting All Patients De Cubas, James J, MD I Pediatrics 5142 Curry Ford Rd ID: 00000678506 002 q# 4# Premium Care Physician DOS PEDIATRICS Orlando, FL 32812 +1 407381-5533 Accepting All Patients Rodriguez, iil ert ID, MD � General Practice 7200 Curry Ford Rd ID: 00005941783 OD6 Premium Care Physician <„IIRLANIDO IFAMILY PI111'1rFSICCI PIIIMS Orlando, FL 32822 +1 407-587-7552 Accepting All Patients Santiago, I e e, MD d Parrnaiy Practice 2285 S Semoran Blvd ID: 00001734466 007 q' 1V Premium Care Physician FAMILY PHYSICIANS OF WINTER Orlando, FL 32822 PARK +1 407-282-8200 Accepting All Patients Salgado, Yarltza, MD I Brnterrnai Medicine 5554 Clarcona Ocoee Rd ID: 00001855126 013 ff q* Premium Care Physician FAMILY PHYSICIANS OF WINTER Orlando, FL 32810 PARK +1 407-292-0292 Accepting All Patients leites, Norberto, MD 8 Pediatrics, FarnHy Practice 5564 E Grant St ID: 00002213796 007 111P Premium Care Physician UNLIMITED MED SERVICES OF FL Orlando, FL 32822 +1 321-235-6230 Accepting All Patients ape e, Michael, MD � internal Medicine, Parrnily Practice 220 E Gore St Ste 201 ID: 000025355B5 010 +1# ## 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Mcdowell, Tammy, MD I Pediatrics . ... . ............... .. 7243 Delia Or 10: 00001816129 016 4# f# Premium Care Physician PHYSICIAN ASSOCIATES ES Orlando, FL 32819 +1 407-381-7326 Accepting Ali Patients Seecharan, Stephen K, MD I Internal Medicine 54 E Plant St ID: 00002888048 007 f* Premium Care Physician FLORIDA MEDICAL ASSOCIATES Winter Garden, FL 34787 +l 407,287-6363 Accepting All Patients Yedwab Oliver, Beth D, III � Internal Medicine, Family Practice 54 E Plant St ID: 0t1002050071 028 Premium Care Physician FLORIDA MEDICAL ASSOCIATES Winter Garden, FL 34787 * 1 407-287-6363 Accepting Existing Patients Only Frederick, Dexter M, MD U Internal Medicine 319 S Dillard St ID: 00002174490 023 f# f# Premium Care Physician FLORIDA CARE CTRS Winter Garden, FL 34787 +1 407-574-,6969 Accepting All Patients Gonzalez, Richard, DO p Pediatrics https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 69 of 140 13275 W Colonial Dr ID: 00001856709 014 40 q# Premium Care Physician CI-IC./WINTER GARDEN FAMILY Winter Garden, FL 347137 ,1 407-905-8827 Accepting All Patients Vives, Emily, MD I General Practice 11 IB3 S Orange Blossom TH Ste 204D ID: 00002354254 004 V# fp Premium Care Physician Orlando, FL 32837 +1 407-85MI03 Accepting All Patients Raghavan, Vasanthy, MID I Adolescent Medicine, Pediatrics 11183 5 Orange Blossom TrI Ste C ID: 00001775261 002 f# 40 Premium Care Physician Orlando, FL 32837 -1 407857 2816 Accepting All Patients Janarious, Mary K, MD I Adolescent Medicine, Pediatrics 11183 S Orange Blossom TH Ste 0 ID: 00000623526 003 i Premium Care Physician Orlando, FL 32837 +1 401-857-2816 Ac,,epting All Patients .. . . ........... . . . Watane, Archana A, MID I Pediatrics 11183 S Orange Blossom I rl Ste G ID: 00002070765 002 #0 1p Premium Care Physician Orlando, FL 32837 ,1407-857-2816 Accepting All Patients Rich, Rosela J, MD I Pediatrics 11183 S Orange Blossom Tr I Ste C ID: 00000909601 003 40 JP Premium Cam Physician Orlando, FL 32837 +1 407-857-2816,+1 401-8578523 Accepting All Patients Rodriguez, Marta E, MID I Adolescent Medicine, Pediatrics 11183 S Orange Blossom Tri Ste C ID: 0000'868117 006 40 ## Premium Care Physician Orlando, FL 32837 ,1 407-857-2816 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 517/2018 Print Search Directory I Find Care Page 70 of 140 Umeh, Ifelyinwa N, MD I Pediatrics 11 PK3 K Orange bb;mom I1 ',A; U. W: Ul M2 002 f# Premium Care Physician OrIw;du, F- 3283( ,1 4( 7,357-28 16 Accoplkng MI r1qfloOu Salzman, Ignacio J R, MD I Farnily Practice 9430 Turkey Lake Rd Ste 216 ID: 00001463907 007 rr f# Premium Care Physician Orlando, FL 32819 +1407-354-4470 Accepting All Patients Fol Bertrand B, IVID I Surgery 9430 Turkey LakL, Rd iD: 00003216742 054 f# 11# Premium Care Physician BAPTIST BE MED RCH/LFX Orlando, FL'32819 +1 407-767-5808 Accepting All Patients SOUTH SEMINOLE SURGICAL GROUP - . . . . ........................ . . . . . .... . ..... -- Gonzales, Patrick IP, IMD I Farnfly Practice 7350 Sardlake Commons Blvd 0: 00000155466 009 40 IN# Premium Care Physician SOUTH WEST ORLANDO FAM MED Orlando, FL 32819 +1 407-352-9717 Accepting All Patients Moon, Musarrat P, MD I Family Practice 7448 Does Grove Cir Ste 200 ID: 00001 B89523 007 40 f# Premium Care Physician Orlando, FL 32819 -1 407-352-1303 Accepting All Patients ..... ..... Stanley-Brot Odeft R, MD I Pediatrics . .. .............. 7315 State. Road 535 ID, D0002448709 017 11# Premium Care Physician CHILDREN HEALTH ALLIANCE Windermere, FL 34786 +1 407-217-7979 Accepting All Patients Espinal, Carol M, MID I Family Practice 14075 Town Loop Blvd 10; 00006018706 002 Op 11# Prerviurn Care Physician FAMILY PHYSICIANS OF WINTER Orlando, FL 32837 PARK fil 407-438-5858 Accepting All Patients San Antiolinlo Pine, Maria, MD p Family Practice ID: 00002193933 006 DAVIIA MEDICAL FLORIDA Print Search Directory I Find Care 2000 Cypress Grossing Dr Accepting All Patients 4F W# Premium Care Physician Orlando, FL 32837 ,1407-515-1507 Page 71 of 140 JSA MEDICAL GROUP Harnburgh, Monica Elka, MD I Pediatrics 14065 Town Loop Blvd Ste 400 ]D: 00002784624 010 f# #* Premium Care Physician PHYSCIAN ASSOCIATES Orlando, FL 32837 ,1 407-635-3025 Accepting All Paliems Chang, Khal S, MD I internal Medicine 18550 Us Highway 441 Ste A ID: 00002008397 011 40 %* Premium Care Physician LAKEVIEW INTERNAL MEDICINE Mount Dora, FL 32757 11 352-735-3755 Accepting All Patients Hernandez, Giovanni, MD I Internal Medicine 1100 Cypress Glen Gin ID: 00002357663 007 Premium Care Physician HUNTERS CREEK MEDICAL Kissimmee, FL 34741 ASSOCIATES -1 407-943-3883 Accepting All Patients Estevez, Jermania, MD I Internal Medicine 1100 Cypress Glen Cir ID; 00002227519 005 %W 0# Premium Care Physician HUNTERS CREEK MEDICAL Kissimmee, FL 34741 ASSOCIATES 11 407-943-8883 Accepting All Patients Rodriguez Marin, Yornayra, MD I General Practice 1150 Cypress Glen Cir ID: 00006171519 004 ff Premium Care Physician FAMILY TREE MEDICAL GROUP Kissimmee, FL 34741 ,1407-483-3200 Accepting All Patierils Bolufer, Fernando A, MD I Internal Medicine, Urgent Care Medicine, Critical Care Medicine 9 17580 Us Highway 441 ID: 00001797118 030 f# %W Premium Care Physician PREMIER MEDICAL ASSOCIATES Mount Dora, IL 32757 ,1362-259-2159 Accepting All Patients Figueroa, Veronica ID, MD I Obstetrics and Gynecology 21 2622 Simpson Rd ID: 00003197041014 f# f# Premium Care Physician OSCEOLA COUNTY HEALTH DEPT Kissimmee, FL 34744 ,l 407-343-2050 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 72 of 140 Harris, Anna M, DO � Family Practice 2622Smpson Rd ID; 00002165974 013 00 1# Premium Care Physician OSCEOLA COMMUNITY HEALTH Kissimmee, FL 34744 SERVICES I 4C7-943-8600 Accepting Al Patients . ............ Wilson, James B, DO I Family Practice 17325 Pagonia Dr ID: 00002093699 011 Premium Care Physician PHYSICIAN ASSOCIATES Clermont FL34711 +1 4(j7-g(;n.6o0q Accepting All Patients Watson, Jill, MD I Pediatrics 17325 Pagons Dr ID: 00001816212 016 111 f# Premium Care Physician PHYSICIAN ASSOCIATES Clermont, FL 34711 1 407-905-6014 Accepting All Patients Segura, Efrain, MD I Farnily Practice 8216 World Center Dr Ste D ID: 00005218998 005 f# 4# Premium Care Physician J&G MEDICAL GROUP Orlando, FL 32621 -1 407-465-1110 Accepting All Patients Hernandez, Gloria M, MD I Internal Medicine 4635 N Hhjhway 10'a W 00,13 IV %* Premium Care Physician LAKEVIEW INTERNAL MEDICINE Ulowil Doa, FL 327^37 I 31'�'15845N)Q A I PifiertS Perez -Suarez, Jose H, MD I Family Practice 16140 Us Highway 441 ID: 00002007753 015 1# 4I Premium care Physician LAKE COUNTY HEALTH DEPT Eustis, FL 32726 1392-589-6424, i1 352-771-5500 Accepting All Parents OSCDOLA COUNTY HEALTH DEPT Ochol Aluino I., MD I Pulmonary Medicine 3300 Dairy Rd ID: 00001916110 005 Premium Care Physician INDIAN RIVER MEDICAL OFFICE Titusville, Fl. 32796 0 321-269-6530 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Ochoa, Karin A, MD I Internal Medicine 3300 Dairy Rd ID: 00001916105 005 IN# to Premium Care Physician Titusville, Fl. 32796 321 .269-6530 Accepting All Patients Mumtaz, Syed Tariq, MID I Internal Medicine Page 73 of 140 724 W Vine St ID: 00001814891012 40 Premium Care Physician SYED TARIO MUMTAZ MD Kissimmee, FL 34741 +1407-944-4450 Accepting All Parents Blake, Perth, MID I Family Practice 1840 Classique Ln ID: 0000 1831596 004 III Premium Care Physician YOU & YOUR HEALTH FAMILY CARE Tavares, FL 32776 ,1 352 508 5046 Accepting All Patients Silva -Vega, Alexis, MD I Internal Medicine 591 Oak Commons Blvd ID: 00005079725 006 1V 0 Premium Care Physician WELLMED MEDICAL MANAGEMENT Kis5iuiria" FL 34741 OF FLORIDA +1 4U7-343-270U Accepting All Patients Weinberger, Joel M, DO I Family Practice 720 Oak Commons Blvd I D: 00000697680 001 f# %* Premium Care Physician GTR FOR FAMILY PRAC/SPTS Kissimmee, FL 34741 MEDICINE +1407-933-2522 Accepting All Patients Montallvo, Marla-Lorena, MD I Internal Medicine 327 W Oak St ID: 00003480352 002 40 V Premium Care Physician FAMILY PHYS OF KISSIMMEE Kissimmee, FL 34741 +1 4U7-483-2000 Accepting busting Patients Only Torneria, Carlos A, MD I Pediatrics 206 W Oak St Sts A-1 ID: 00003IJ542E5 015 Kissimmee, FL 34741 +1 407-408-5854 Accepting All Patients Piedad, Oscar E, MD I Family Practice ## V Premium Care Physician https:Hconnect.werally.com/searchDirectory/32708/page- 1?coverageType= medic... 517/2018 Print Search Directory I Find Care Page 74 of 140 dfi [ W Oak St Sh, A I 00601400wgom f# 4P Premium Care Physician QsSlfni'*(,,FL347'H ll 4074346-8600 Campbell, Gusev G, MID I Family Practice 461 W Oak St Ste A ID: 00005211070 00(3 f# Premium Care Physician Kissimmee, FL 34741 ,1 407-846-8600 Accepting All Patients Gutierrez, Enrique G, MD I Pediatrics, Family Practice DAVITA MEDICAL FLORIDA DAVITA MEDICAL FLORIDA 907 1 Central Ave Ste A ID: 001)0 1674663 015 f* Premium Care Physician ENRIOUL G GUTIERREZ MID Kissimmee, FL 34741 *1 401-1346-2050 Accepting All Patients . ............ ... ........... Barlml Douglas G, MD I Pediatrics 1653 Jess Parrish Ct ID: 0000078016D 001 1' Premium Care Physician NORTH BREVARD CHILDRENS MED Titusville, FL 32796 CTR +1 321-267-5965 Accepting All Patients Fersobe, Saadia, MD I General Practice 1804 Oakley Seaver Dr Ste 0 IC: 00006041526 001 f# 4W Premium Care Physician KIDSVILLE PEDIATRICS III C lermoni, FL 34711 + 1352-242-1021 Accepting All Patients Vanent Lecil W, MD 11 Farl Practice E03 N Washington Ave Ste 101 10: 00001650671 011 Premium Care Physician Titusville, FL 32796 +1 321-268-5008 Accepting All Patients Echavarria, Fablo IL, MD g Mternal Medicine 171 b E Highway 50 Ste C ID: 00001935761015 Clermont, FL 34711 ,11 152-243-7495 Accepting All Patients Aggarwal, Alka, MD I Family Practice 865 Oakley Seaver M D: 00005282321 002 Cl"rmond, FL 34711 -,1 352432-3939 Accepting All Patients 010 40 Premium Care Physician FABIO ECHAVARRIA MD f# ## Premium Care Physician https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 75 of 140 Quintyne, David R, DO I Family Practice 500 N Washington Ave Ste 105 ID: 00001816169 018 f# V Premium Care Physician BREVARD HEALTH ALLIANCE Titusville, FL 32796 1 ,1321-68-0267 Accepting All Patients Weaver, Bruce M, DO I Family Practice 3631 W Baceish Blvd ID: 00003355092 006 1 f# Premium Care Physician CARE FIRST FAMILY PRACTICE Tavares, FL 32778 +1352-742-0025 Accepting All Patients Victoria, Alejandro A, MID I Internal Medicine "IG 235 Hatteras Avg Ste, 100 ID, 000021 B8523 006 f* 1 Premium Cam Physician ALEJANDRO VICTORIA MD Clermont, FL 34711 +1 352-242-0676 Accepting All Patients Verma, Shyam, MID I Internal Medicine, Nephrology 801 Carden St ID: 00000066635 001 110 Premium Care Physician TITUSVILLE DIALYSIS & KIDNEY GTR Titusville, FL 32796 + 1 321-267-1163 Accepting All Patients Anwar, Ghullam M, MD I Internal Medicine 390 S Central Ave ID: 00003307226 011 Premium Care Physician LOUIS J RADNOTHY DO Umatilla, FL 32784 +1352-669-3175 Accepting All Patients Stone, Frank J, MD I Internal Medicine, Pediatrics 400 Celebration PI Ste At 50 ID: 00001323524 018 1# f# Premium Care Physician FLORIDA HOSPITAL MEDICAL GROUP Kissimmee, FL 34747 ,1 407-303-3837 Accepting All Patients Jakob, Cara L, MD I Family Practice 3115 Citrus Tower Blvd ID! 00002286765 011 f# 4# Premium Care Physician TOTAL FAMILY HEALTHCARE Clermont, FL 34711 ,1 352-394-0237 Accepting All Patients Boodhoo, Victor R, MID I Geriatric Medicine, Family Practice https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 76 of 140 260 Harrison St ID: 0000 1238319 028 11f 1# Premium Care Physician NORTH BREVARD MEDICAL Titusville, FL 32780 SUPPORT +1 321.267-1424 Accepting All Patients Boehm, Mary R, MD I Internal Medicine 200 F Highland Ave Ste 2 ID: 00002363972 0138 f# V Premium Care Physician Clermont, FL 34711 ,1 386-427-0558 Accepting A31 Patients Rodriguez, Rodolfo F, MD g hiternal Medicine 2101 13th St ID: 00002535652 009 f* ## Premium Care Physician DAVITA MEDICAL FLORIDA Saint Cloud, FL 34769 '1 407-891,7244 Accepting All Patients Lee, Leslie M, MD internal Medicine 2568 S Ridgewood Ave Ste 5 ID: 00001301148 005 Premium Care Physician EDGEWATER INTERNAL MEDICINE Edgewater, FL 32141 ,'I 386428-4640 Accepting All Patients Lester, Donna S, MD I Family Practice 2902 1711) St ID: 00000791367 012 Premium Care Physician DAVITA MEDICAL FLORIDA Saint Cloud, FL 34769 ,l 407 9570090 Accepting All Patients Powers, Charles K, MD I Family Practice 3100 17th St ID: 00000915726 007 %* Ill Premium Care Physician FAMI LY PRACTICE ST CLOUD Saint Cloud, FL 34769 i I 407-892-O009 Accepting All Patients Weaver, William H, I Emergency Medicine, FaMilY Practice 3631 W Bureigh Blvd ID: 00001459880 017 40 ff� Premium Care Physician CARE FIRST FAMILY PRACTICE Tavares, FL32778 +1 352-742-0025 Accepting All Patients Qayyum, Mahnaz, MD I Family Practice https://connect.werally.com/searchDirectory/32708/page- 1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care 1530 Celebration Blvd Ste 408 ID: 00002553647 008 Celebration, FL 34747 -1 407 566-1600 Accepting All Patients Hole, Susan W, DO I Family Practice Page 77 of 140 40 * Premium Care Physician FAMILY PRACTICE OF CELEBRATION 346 N Ridgewood Ave Ste A C: 00001313633 002 f# q# Premium Care Physician SHORES MEDICAL PA Edgewater, FL 32132 +1 386A23-1888 Accepting All Patients ---- .......... . Samano, Gregory P, DO I Family Practice 912 807 State Road 44 ID: 00000459030 006 f# iii Premium Care Physician HALIFAX HEALTHCARE SYSTEMS New Smyrna Beach, FL. 32168 ,1386-428-5554 Accepting All Patients Appleton, Staci, MD I Internal Medicine 405 Downing St ID: 00001652472 010 f# ili Premium Care Physician APPLE70N INTERNAL MEDICINE Now Smyrna Beach, Fl. 32168 +1 386-957-3999 Accepting All Patients Khan, Jamil H, MID I Adolescent Medicine, Pediatrics 11 1929 Sunrise Plaza Or Ste 1 ID: 00001883247 017 Premium Care Physician DAVLNPOH I PEDIA HRICS CLFHMON I Clermont, FL 34714 +1 352-394-7728 Accepting All Patients liEl7iVElmon, r 7 ---- TT=F 1503 Sunrise Plaza Or ID: 00001734336 008 11 %* Premium Care Physician SOUTH LAKE PRIMARY CARE Clermont, FL 34714 +1 352-24,"800 Accepting All Parents Mercurio, Gregory J, MID I Internal Medicine 22 223 N Causeway ID 00DO1686009005 qr 4V Premium Care Physician CAUSEWAY MEDICAL New Smyrna Beach, FL. 32169 ,1 366427-8008 Accepting All Patients Siddiqui, Rehana M, MID I Family Practice, General Practice https://connect.werally.com/searchDirectory/32708/page-l?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 78 of 140 1690 Dunlamon Ave Ste 120 ID: 00000245472 023 1# Premium Care Physician ADVANCED FAMILY PRACTICE AND Pori Orange, FL 32127 ADVANCED ME ,1 386-271-2273 Accepting All Patients Makary, Wafik F, MD I Internal Medicine 4 690 Clyde Morris Blvd ID: 00001403832 010 ff ?# Premium Care Physician Port Orange, FL 32129 ,1 386 767 7885 Acoopting All Patients Delbakhsh, Fariborz, MD I Internal Medicine 33006 Professional Or Ste 102 ID: 00002377461013 111 Premium Care Physician DELCARE Leesburg, FL 34788 11 352-435-7321 Accepting All Patients Torres, Lela R, MD I Family Practice 8131 Centralia Ct Ste 101 ID: 00003358243 009 If f# Premium Care Physician F1 ORIDA HOSPITAL MEDICAL GROUP Leesburg, 134788 ,1 352-360-0654 Accepting All Patients Moussly, Souhell, MD I Internal Medicine 3890 Turtle Creek DrSte C I D: 00000531403 002 10 Premium Care Physician PORT ORANGE INTERNISTS Port Orange, FL 32127 -1 386-756-4400 Accepting All Patients Patel, Blhadresh 1, MD I Family Practice 802 Dunlawtor Ave Ste 101 ID: 00001665714 004 Premium Care Physician RADHARAJ Port Orange, FL 32127 +1 386-788-9086 ACCepting Emning Patients Only Cheema, Ayesha F, MID � internal Medicine 1801 Us Highway 441 Bldg 1 DO IIJI 00003349501 005 f# 40 Premium Care Physician LAKEViEW INTERNAL MEDICINE Leesburg, FL 34748 -1 352AI Accepting All Patients Cardona, Pablo Doll MD I Family Practice https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care 26540 Ace Ave Ste I DBG ID: 00005143953 001 Leesburg, FL 34748 + 1 352 33&5281 Accepting All Patients Page 79 of 140 f# ## Premium Care Physician TO YOUR HEALTH OF LAKE COUNTY Narain, Bindoo, MD I Adolescent Medicine 1070 Flagler Ave ID: 00000697911 001 00 f# Premium Caro Physician Leesburg, FL 34748 11 352-365-2550 Accepting All Patients Robinson, Jeffrey M, MD I Family Practice 802 E Dixie Ave ID: 0000'080730 009 fo qF Premium Care Physician FLORIDA HEART & VASC MULTI SPEC Leesburg, FL 34748 OFF, ,1 352-787-1324 Accepting All Patients LEESBURG FAMILY MEDICINE Thomas, Jolly, MD I Family Practice 801 E Dixie Ave Ste 101 ID: 00002679660 010 40 40 Premium Care Physician FAMILY PHYSICIANS OF WINTER Leesburg, FL 34748 PARK ,1 352-3264031 Accepting All Pateulb Mcleod, Jamaal A, DO I Family Practice 600 E Dixie Ave ID: 00003823572 014 4# %* Premium Care Physician LEESBURG REGIONAL MEDICAL CTR Leesburg, FL 34748 PHYSICIAN +1 508-475-045C Accepting All Patients Soto, Alfred, MD I Internal Medicine, General Practice 1004 IN 14th St Ste 109 ID: 00000930162 032 Premium Care Physician PREMIER MEDICAL ASSOCIATES Leesburg, FL 34748 ,1 352-259-2159 Accepting All Patients Khanna, Dinesh, MD I Internal Medicine 18 1004 N 1 4th St Ste 109 ID: 00001867815 013Y f# Premium Care Physician PREMIER MEDICAL ASSOCIATES Leesburg, FL 34748 ,1 352-259-215g Accepting Existing Patients Only Aponte-Camacho, lleana, MD I General Practice https://connect.werally.com/searchDirectory/32708/page-I?coverageType=medic... 5/7/2018 =�M 004 IN l48h Sl �:�Iv tOO I D: 00003438429 018 f# Premium Care Physician llee"'�b&(j 11,34T48 1, 1 1,52 259-29519 Accepting All Patients Crossman, Margaret, MD l Family Practice 201 N Clyde Morris Blvd Ste 200 ID: 00001434734 009 Premium Care Physician HALIFAX HEALTHCARE SYSTEMS Daytona Beach, FL 32114 -1 386 425 4165 Not Accepting Patients Santi, Kathleen, MD I Family Practice 201 N Clyde Morris Blvd Ste 200 ID: 00001653189 008 4W 11i Premium Care Physician HALIFAX HEALTHCARE SYSTEMS Daytona Beach, FL 32114 1 386,4254165 Accepting Existing Patients Only Cate, Kenneth L, MID I Family Practice 201 IN Clyde Morris Blvd Ste 200 ID: 00000914497 023 If 11F Premium Care Physician HALIIFAX HEALTHCARE SYSTEMS Daytona Beach, FL'32114 +1386-4254165 Accepting All Patients Howard, Susan W, MID I Family Practice 201 N Clyde Morris Blvd Ste 200 ID: 00001594711 007 Premium Care Physician HAUrAX HEALTHCARE SYSTEMS Daytona Beach, FL 32114 ,1 38642&-4I66 Accepting All Patients Byerly, Kenneth D, MD l Emergency Medicine, General Practice 109 IN Doverplu m Ave ID: 00001676964 025 f# Premium Care Physician OSCEOLA COMMUNITY HEALTH Kissimmee, FL 34758 SEWCES +1 40T9438672 Accepting All Patients ---l-1— ---- ------- — . ....... Mcnish, Karla A, MID p Hyperbaric Medicine (Wound Care), Farnily Practice 311 IN Clyde Morris Blvd Ste 70 10' 00003114656 006 1# Premium Care Physician HALIFAX HEALTHCARE SYSTEMS Daytona Beach, FL 32114 +1 386-4254267 Accepting All Patients Garcia, Pablo, MD I Family Practice, General Practice 1455 Dunn Ave ID; 00001431939 009 f* f# Premium Care Physician RURAL HEALTH CARE Daytona Beach, FL 32114 '1 38(3 f3234)600 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page- 1?cclverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 81 of 140 Slomin, Glenn R, DO I Family Practice 1317 W Point Dr ID; 00D009B3047 029 Premium Care Physician STEWARD MEDICAL GROUP Cocoa, FL 32922 +1 321-638-2621 Arzpr,)tlng All Patients Martin, Richard, MD I Family Practice 250D Citnis Blvd ID 00DO1961242010 00 V Premium Care Physician EXPRESS CARE OF BELLEVIEW Leesburg, FL 34748 +1352-347-5226 Accepting All Patients Yee, Margaret R, MD I Family Practice 102 Park Place Blvd ID: 00001651548 006 f# f# Premium Care Physician MD" PRIMARY CARE MEDICINE Davenport, FL 33837 11 863-422-0032 Accepting All Patients Farach, C Javier, MD I Internal Medicine 1545 Hand Ave Ste 91 ID: 00001461310 011 Premium Care Physician JWCR FARACH Ormond Beach, FL 32174 ,1 386-615-3838 Accepting All Patients Turbay, Tamid A, MID I Internal Medicine 111 Longwood Ave ID: 00006120042 005 f* III# Premium Care Physician STEWARD MEDICAL GROUP Rockledge, FL 32955 ,1321-637-2811 Accepting All Patients Peck, Benjamin J, MD I Family Practice 1400 Hand Ave Ste L D; 00DO1950671 008 Premium Care Physician Ormond Beach, FL 32174 tl 38W(-2018 Accepting All Patients Thiha, San Htut, MD I Hospice and Palliative Medicine, Internal Medicine 4 15 Mcleod St ID: 00002646682 006 f# f# Premium Care Physician MERIT MEDICA:, CARE Merritt lsland, FL 32953 ,1 321 452 2016 Accepting All Patients Torres, Carlos M, MD I Pediatrics https:Hconnect.werally.com/searchDirectory/32708/page- 1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 82 of 140 1007 Pathfinder Way Ste 130 113: 00000R39559 013 fo to Premium Care Physician CT PEDIATRICS Rockledge, Fl. 32955 +1 321�639-8090 Accepting All Patients Nihalani, nill K, MID I Internal Medicine 2209 North Blvd W ID; 00001838144 014 10 4# Premium Care Physician RIDGE MEDICAL ASSOCIATES Davenport, FL 33837 rl 863-67M000 Accepting All Patients Khan, Kashan R, MD I Geriatric Medicine, Family Practice 2231 North Blvd W Ste B ID: 00002969706 012 Premium Care Physician CIF -AMBER OF I Davenport, FL 33837 ,1 863422-1890 Accepting All Patients Kennedy, John C, MID � Pediatrics 134 S Woods Dr ID: 00001918627 005 Rockledge, Fl. 32955 ,1 321-636-3066 Accepting All Patients Tebbe, Paul C, MD I Pediatrics ## ## Premium Care Physician PEDIATRICS IN BREVARD 134 $Woods Dr ID: 00001877612 008 4Premium Care Physician rromnics IN BREVARD Rockledge, Fl. 32955 +1321-636-3066 Accepting All Patients Borowski, Anleia J, MID I Pediatrics 134 S Woods Dr ID: 00001154582 009 Rockledge, FL 32955 -1321-636-2545, +1321-6363066 Accepting All Patients Forcier, Tara A, MD I Pediatrics 134 S Woods Dr ID: OD002440272 003 Rockledge, FL 32955 +1 321a6-3066 Accepting All Patients 4V f# Premium Care Physician PEDIATRICS IN BREVARD 4# f# Premium Care Physician https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Gray, Tashara N, MD I Pediatrics 134 S Woods Dr ID: 00004813843 005 Premium Care Physician Rm;kl(,dg(,, FL 32955 ,1 321-636 3066 Accepting All Patients Herrera Soto, Marta, MD I Internal Medicine 895 Executive Ln Ste 110 10: 00003689261 013 f* Premium Care Physician Rockledge, FL 32955 ,132 1-806-3949 Accepting All Patients Raclu, Mihai S, MD I Pediatrics poviews 255 Fortenberry Rd Ste 36 ID: 00000755220 007 Merritt Island, FL 32952 +1 321-453-1717 Accepting All Patients Raclu, Mloara C, MD I Internal Medicine 255 Fortenbprry Rd Ste B6 ID: 00000823922 004 Merritt Island, FL 32952 +1 32 1-783-6115 Not Accepting Patients Page 83 of 140 PEDIATRICS IN BREVARD RIGHT MEDICAL CARE 40 (# Premium Care Physician ATLAN I IC COAST MEDICAL ## 40 Premium Care Physician ATLANTIC COAST MEDICAL Sweeney, John Nolan, DO I Internal Medicine 1978 Us Highway 1 Ste 108 ID: 00002054927 012 Op f# Premium Care Physician INTERNAL MEDICINE OF BREVARD Rockledge, FL 32955 ,H 321631-092 Accepting All Patients Trevino, David Arnold, MD I Internal Medicine W 255 Borman Or FI 2 10 00002273640 007 Premium Care Physician Moffitt Island, FL 32953 IT 321,134-1640,+1 321-434-1771 Accepting All Patients Cosgrove, Lisa A, MD I Pediatrics, Urgent Care Medicine 270 N Sykes Greek Pkwy Ste 108 10: 00001072598 020 4W Premium Care Physician Merritt Island, FL 32953 +1 321-452-1061 Accepting All Patients Long, John Stephen, MD I Family Practice ID! 00001552466 015 HEALTH FIRST MEDICAL GRP ATLANTIC COAST PEDIATRICS VILLAGES HEALTH SYSTEM https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 84 of 140 280 1 Iawor 11 Accepting All Patients 4# f# Premium Care Physician 1 �M2 671 17 10 Pichardo, Nelson M, MD I Internal Medicine 111 Webb Dr ID: 00001756502 004 f* f# Premium Care Physician PICHARDO CLINIC Davenport, FL 33837 -1 863-421-9447 Accepting All Patients D'Souza, Gemma 1, MD I Pediatrics 725 W Granada Blvd Ste 1 ID: 00002337179 007 111# Premium Care Physician ORMOND PrDIATIRICS Ormond Beach, FL 32174 +1 386-673-2770 Accepting All Patients Davis, Christy IL, MID p Family Practice 545 W Granada Blvd ID: 00002083037 017 41# Premium Care Physician ORMOND MEDICAL CENTER Ormond Beach, FL 32174 ,1 386-672-6243 Accepting All Patients Perkins, Seth C, MD p Geriatric IMedicine, Fatuity Practice 929 N Us Highway 441 Ste 501 ID: 00003202839 005 Premium Care Physician REHAB MEDICINE ASSOCIATES Lady Lake, FL 32159 ,1 352-259-2894, -1 352-76M886 Accepting All Patients SIMEDHEALTH Shoemaker, James R, DO � Family Practice 77 W Granada Blvd ID: 00000457773 004 f# Premium Care Physician onimota) MEDICAL. AR VS Ormond Beach, FL 32174 +1 3B"77-0453 Accepting All Patients Lama, Jacobo N, MD p FamNy Practice 101 S Dixie Dr ID: 00001135334 002 1# 4# Premium Care Physician HEART OF FL MEDICAL GEN FER Haines City, FL 33844 ,1863-421-1190 Accepting All Patients Agbo, Felix C, MD I Internal Medicine Print Search Directory I Find Care Page 85 of 140 910 Old Camp Rd Ste 144 ID: 00002832585 007 11# Premium Care Physician SINAI INTERNAL MEDICINE The Villages, FL 32162 SPECIALISTS 1 352-753-2224 Accepting All Patients Gulati, Swenly, MD I Internal Medicine 1050 Old Camp Rd Ste 100 ID: 00006052875 002 1* IV Premium Care Physician The Villages, FL 32162 ,1 352-674-1760 Accepting All Patients Lowenkron, Jeffrey David, MD I Internal Medicine 1050 Old Camp Ad ID: 00005587277 002 4V ff Premium Care Physician THE VILLAGES HEALTH The Villages, FL 32162 +1 352-674-1760 Accepting All Patients Apostol, Jesus M, MID Internal Medicine 1400 N Us Highway 441 Ste 930 ID: 0000 1915783 009 111# #* Premium Care Physician FAMILY PHYSICIANS OF WINTER Lady Lake, FL 32159 PARK +I 352-750-2108 Accepting All Patients Kelley, David A, MD I Internal Medicine it '400 N Us Highway 441 Ste 810 10: G0001 586262 012 4p1 111111111 Premium Care Physician VILLAGES HEALTH SYSTEM Lady Lake, FL 32159 +1 352-674-870C Accepting All Patients Pezzione, Kimberly M, MD I Pediatrics, Pediatrics Specialist 140D N Us Highway 441 Ste 522 ID: OODO 1246835 012 0# f# Premium Care Physician HOMrTOVVN PEDIATRICS Lady Lake, FL 32159 11 352-560-7337, +1 352-674-8700 Accepting All Patients THE VILLAGES HEALTH Camogliano, Romulo J, MD I Internal Medicine 1400 N Us Highway 441 Bldg 900 ID: 00001472442 009 40 f* Premium Care Physician ROMULO J CAMOGLIANO MID The Villages, FL 32159 +1 352-259-3435 Accepting All Patients Vanga, Subba R, MD I Internal Medicine, Interventional Cardiology, Cardiovascular Disease 1400 1 Us Highway 441 Ste 914 ID: 00DO5508062 007 4p Premium Care Physician CITRUS CARDIOLCGY Lady Lake, FL. 32159 CONSULTANTS ,1352-022-7008 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 86 of 140 900 Ingraham Ave ID: 00001466676 018 ti Premium Care Physician DANIEL R RENUART MD Haines City, FL 33844 +1 863-421-6565 Accepting All Patients Glick, Michael Allen, MD I Internal Medicine 1501 N Us Highway 441 Ste 1102 ID: 00000096600 009 `# f# Premium Care Physician FLORIDA HEART & VASC MULTI SPEC Lady Lake, FL 32159 GRP +1 352-753-5222 Accepting All Patients Vasquez, Kimber, MID 3 Family Practice, General Practice 705 Ingraham Ave 10: 00003058541 013 ^ ,. Premium Care Physician CENTRAL FLORIDA HEALTH CARE Haines City, FL 33844 +1 863-03"900 Accepting All Patients Bhatial, Gitashiree, MD � Internal Medicine, Internal Medicine Specialist 705 Ingraham Ave ID: 00000768528 016 lit Premium Care Physician CENTRAL FLORIDA HEALTH CARE Haines City, FL 33844 +1 863449-0898 Accepting All Patients Kraucak, Nelson, MD V Family Practice 1451 El Camino Real ID: 00001162511 017 f} Premium Care Physician HEALTHCARE PARTNERS The Villages, FL 32159 +1 352-75GA333 Accepting All Patients Swietarski, Robert H, MD I Internal Medicine 1560 Santa Barbara Blvd ID: 00002309528 016 i Premium Care Physician FLORIDA HEART & VASC MULTI SPEC The Villages, FL 32159 CRP +1 352-750-5000 Accepting All Patients Wilemlinger, Lori C, MD � Internal Medicine 1575 Santa Barbara Blvd ID: 00000599797 016 40 Premium Care Physician Lady Lake, FL 32159 +1 352-674-1740 Accepting Existing Patients Only https://connect.werally.com/searchDirectory/32708/page- I?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 87 of 140 Ojha, Ashok K, MD I internal Medicine Re'view.', 1 575 Santa Barbara Blvd ID: 00002138265 010 f# 110� Premium Care Physician VILLAGES HEALTH SYSTEM The Villages, FL 32159 +1 352-674-1740 Accepting All Patients Glovannelli, Kimberly S, MD I Family Practice 1515 Santa Barbara Blvd ID: 00004885217 003 Premium Care Physician VILLAGES HEALTH SYSTEM The Villages, FL 32159 41352-674-1740 Accepting All Patients Villa, Marivic D, MD I Internal Medicine, Pulmonary Medicine 1507 Buenos Aires Olvd ID: 00001110375 010 4W Premium Care Physician The Villages, FL 32159 +1 352,350-1600,+1 352-561-6299 Accepting All Patients ............... --.- . ...... Sudberg, Leonard Allen, MD I Internal Medicine, Nephrology 13940 N Us Highway 441 Ste 102 D. COD00185940 012 Premium Care Physician FLORIDA MEDICAL ASSOCIATES Lady Lake, FL 32159 +1 352-751-9900 Accepting Al Patients Medina, Miguel A, MID I Internal Medicine 701 W Cocoa Beach Cswy ID: COD02691539 012 Premium Care Physician HEALTH FIRST MEDICAL GRP Cocoa Desch, IL 32931 +1 321-264-8644,,l 321-868-5871 Accepting All Patients Khan, Anwar A, MID I Internal Medicine 10969 BE 175th PI Ste 200 ID: 00001984340 008 40 f# Premium Care Physician Surnmeffield, FL 34491 +1 352-307-2112 Accepting All Patients Bimbrahw, Preeti, MD I Pediatrics 8095 Spyglass Hill Rd Ste 104 ID. 00003082251012 Premium Care Physician Me lbou me, FL 32940 +1 321-241-6400 Accepting All Patients Stephenson, David W, MA I Internal Medicine 2351 Clearwater Run ID: 00003440242 005 111 ## Premium Care Physician The Villages, FL 32162 +1 352-812-0579 Accepting All Patients ALLIANCE MEDICAL ASSOCIATES MEDICAL ASSOCIATES OF BREVARD PROMISE MEDICAL GROUP https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 88 of 140 Louisville, Tommy L, MID I Family Practice 2315 N Commonwealth Ave ID: 00002345009 005 40 Premium Care Physician HHSI FANIIILY FIRACIIGE Folk Cky, FL 33868 ,I 663-299-8485, +1 863A52-2980, , 1 Accepting All Ilatlents, I--insi tit -i-p unaur CARL CENII.k 863-937-8886,,-1 863-984-8000 Lopez, Jeronimo, MD I Internal Medicine 848 S Main St ID; 00005239873 005 Premium Care Physician FAMILY INTERNAL MEDICINE OF WildAood, FL 34785 OCALA +1352-748-0283 Accepting All Patients Reddy, Kuchakulla N, MD I Internal Medicine 848 S Main St ID: 00001132026 024 111# V Premium Care Physician FAMILY INTERNAL MEDICINE OF Wilftood, FL 34785 OCALA +1 352AI 4-5320 Accepting All Patients Bhushan, Komala Naga, MID p Pediatrics 1389 S Us 301 ID: OD001424920 007 f# 1# Premium Cam Physician LANGLEY HEALTH SERVICES Surnterville, FL 33585 ,1 352.79M900 Accepting All Patients PROJECT HEALTH Hardonon, Scott, MD � Internal Medicine 6619 N Wickham Rd ID: 00003341152 002 Of f# Premium Care Physician SUNTREE INTERNAL MEDICINE Melbourne, FL 32940 +1 321-759-9500 Accepting All Patients Ustello, Frank, MID I internal Medicine 6300 N Wickham Rd Ste 101 ID: 00001724648 006 Premium Care Physician BADOLATOS FAMILY HLTH AT SUNTR Melbourne, FL 32940 -1 321-253-2169 Accepting Existing Patients Only Kumar, Vinay K, MID I Internal Medicine 2070 Us Highway I Ste 103 ID: 00002257742 004 1# Premium Care Physician VINAY K KUMAR MD Rockledge, FL 32955 +1 321.632-0552 Accepting All Patients VINAYA KUMAR PA https:Hconnect.werally.com/searchDirectory/32708/page- 1?coverageType= medic.. 5/7/2018 Print Search Directory I Find Care Page 89 of 140 Katta, Thomas J, MD I Hematology/ Oncology 21 922 Lucerne Ter ID: 00000626769 010 V V ORLANDO -HYS SPECIALISTS Orlando, FL 32806 407-426-8660, +1 40742FI-8660 Accepting All Patients Not Evaluated For Premium Care Brown, Randy A, MD I Hematology, Hematology/ Oncology, Internal Medicine, Medical Oncology, Bone Marrow Transplant I 1400 S Orange Ave ID: 00000257858 017 FLORIDA CLINICAL PRAC ASSO Orlando, FL 32806 +1 352-273-7832 Accepting All Patients Not Evaluated For Premium Care Safder, Asmal, MD I Pediatrics 2622,Simpson Rd ID: 0000 1265620 008 11# ff Quality Care Physician OSCEOLA COMMUNITY HEALTH Kissimmee, FL 34744 SERVICES ,1 407-943-M600 Accepting All Patients Morgan, Charles A, MD I Family Practice 985 State Road 436 ID: 00000670679 016 41# 4# Quality Care Physician CFP CARE TEAM Cassolberry, FL 32707 +1 407-760-1937, +1 407-831-E252 Annnping At Patients CFP PHYSICIANS GROUP Gutierrez -Santiago, Jessica, MD I Pediatrics 1684 W County Road 419 She 10017) ID: 0000,9707989 009 4P ir Quality Care Physician FIRST CHOICE PEDIATRICS Oviedo, FL 32765 .1 107-249-1234 Accepting All Patients Blanchette, Dennis C, DO I Family Practice 2209 S French Ave ID: 000055BI054 004 Sanford, FL 32771 +1 407-343-1825 Accepting All Patients Go, Gleen J, MD I Internal Medicine I IN* 40 Quality Care Physician HEATHROW INTERNAL MEDICINE 601 E Rollins St ID: 00002301864 009 W# (0 Quality Care Physician CENTRAL FL HOSPITALIST Orlando, FL 32803 PARTNERS ,1407-464-9516 Accepting All Patients https://connect.weral ly.com/searchDirectory/32708/page- I?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 90 of 140 Mirander, Marie, MD I internal Medicine 601 E Rollins St ID: 00002408527 011 1$, Quality Care Physician CENTRAL FL HCSPITALIST Orlando, FL 32803 PARTNERS -1 407-464-9516 Accepting All Patients Auerbach, David A, MD I Pediatrics 83 1 Miller St ID: 00000617408 008 Quality Care Physician PEDIATRX MEDICAL GROUP OF Orlando, F1 32B06 FLORIDA ,1 321-843-9792.,1 407-8415218 Accepting All Patients Bessett, Christine Lee, DO I Pediatrics 83 W Miller St ID: 00005809594 007 f* (%ir Quality Care Physician FIEDIATRIX MEDICAL GROUP OF Orlando, FL 32B06 FLORIDA +1 321-843 9792 Accepting All Patients Alexander, Gregor, MD I Pediatrics 92 W Miller St ID: 00000617432 003 4# OA Quality Care Physician Orlando, FL 321 1 407-64949 111 Accepting All Patients lBurzynski, Christina Elizabeth, MDp Pediatrics 92 W Miller St 10: 00005312967 006 UP Quality Care Physician PEDIATPIX MEDICAL GROUP OF Orlando, FL 32806 FLORIDA 1407-649-9111 Accepting All Patients Lipman, Brian, MD I Neonatology, Pediatrics 92. W Miller St ID: 00000617411008 %V 40 Quality Care Physician PEDIATAIX MEDICAL onoup OF Orlando, FL 32806 FLORIDA +l 407-649-9111 Accepting All Patients Hussain, Ablid, MID I Internal Medicine 1055 Saxon 131vd ID: 00006249469 003 III IV Quality Care Physician SOUTHWEST VOLUSIA HEALTHCARE Orange City, PL 32763 '1 386-917-1108 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 91 of 140 Malta, Irlda, MD I Infectious Disease Medicine, Internal Medicine 9430 Turkey Lake Rd ID: 00003523659 006 f# Or Quality Care Physician BAPTIST HEALTH MED GROUP Orlando, FL 32819 +1 502-489 5730 Accepting All Patients Zaman, Waheeduz, MD I Internal Medicine 1 18650 Us Highway 441 ID: 00002738422 004 f* V Quality Care Physician PHYSICIANS OF CENTRAL FLORIDA MDUnt Dora, FL 32757 +1 352-735-3755 Accepting All Patients ....... . . ..... Romero, Ambrosio, MD I Family Practice 9552 Palm Pkwy ID: (0001084020 050 V# f# Quality Care Physician 33RD ST MFOICA1 CENTER Orlando, FL 32836 ,1407-730419111 Accepting All Patients Schlapper, Brent D, DO I Occupational Medicine, General Practice Rcnd"'m-' 650 W Plymouth Ave ID: 00001652155 02D f# V Quality Care Physician DELANDQUICK CARE Deland, FL32720 ,1 18"734771 Accepting All Patients Becker, Garth G, MID I Internal Medicine, Emergency Medicine 8216 World Cenler Dr Ste D ID! 00002946212 016 40 qP Quality Care Physician J&G MFDICAI GROUP Orlando, FL 32821 ,1 407-465-1110 Accepting All Patients Mason -Gonzalez, Stephanie M, MD I Family Practice, General Practice 301 S Bay St ID: 00002282220 020 f# Quality Care Physician NAUTILUS HEALTH CARE GROUP Eustis, FL 32726 +1 352-357-8108 1352-357-8108 Accepting All Patients Lopez-Cespedes, Juan A, MID I Internal Medicine 1310 N Main St Ste 105 ID! 00002866279 013 f* #* Quality Physician LIPS MEDICAL GROUP Kisminaloo, FL 34744 ,1 407-47C,4011 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 92 of 140 del tar, Emad M, MD I Internal Medicine 1020 Don Wickham Dr Ste 335 ID: 00004442689 005 J# %�� Quality Care Physician ERACARE PHYSICIANS Clermont, FL 34711 ,1 152-38M605, +1 352-7OM211 Accepting All Patients Kandil, Alaa E, MD I Internal Medicine 1920 Don Wickham DrSte 335 ID: 00003556606 010 ff V(�p Quality Care Physician EHAGAHE PHYSICIANS Clermont, FL 34711 11 352-3l)Mi3l 352-7013-8211 Accepting All Patients Jetton, Timothy D, MID I IFamily Practice 200 E Highland Ave Ste 1 ll); 00002027927 030 111 %r Quality Care Physician FLORIDA MEDICAL ASSOCIATES Clermont, FL 34711 , 1 352-432-8989 Accepting All Patients Worley, Rachel L, MD I Pediatrics 317 S Dixie Fwy ID: 00003496006 009 pp Quality Care Physician VOLUSiA PEDIATRICS Now Smyrna Reach, FL 32168 11386-424-1414 Accepting All Patients Larrazaball, Patrick John, MD I Internal Medicine 2089 S Ridgewood Ave 10:00002001652 010 111 %P Quality Care Physician AFERMIN PRIMARY CARE South Daytona, FL 32119 +1 386-767-7533 Accepting All Patients Tolat, Mihir A, MD I Pediatrics 305 Memorial Medical Pky Ste 405 lt7:00006679819 002 40 9 Quality Care Physician MEMORIAL I IEALTH SYSTEMS Daytona Beach, FL 32117 +1 38&231-3420 Accepting All Patients Mointanez, Andres, MD I Internal Medicine 101 memorial Medical Pewy ID: 0000492607 012 1# %0` Quality Care Physician MEMORIAL HOSPITAL FLAGLER Daytona Beach, FL 32 117 +1386-231-1091 Accepting All Patients MEMORIAL HSP PENINSULAIPROF HE https:Hconnect.werally.com/searchDirectory/32708/page-I?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 93 of 140 Jerkins, Oscar H, MD I Family Practice 9 Orange Ave ID: 00DO1902878 002 f# Quality Care Physician ROCKLEDGE MEDICAL CENTER Rockledge, FL 32955 ,I 88P,974-555E, +1 388-974-5556 Accepting Alt Patients Brown, James, MD I Family Practice 1180 W Granada Blvd ID: (X)002209615 005 40� Quality Care Physician LENA MEDICAL Ormond Beach, FL 32174 f 1 386-677-2608 Accepting All Patients Ward, Martha S, MID I Internal Medicine, Emergency Medicine 1 298 S Yonge St ID: 00000010086 028 V 4V Quality Care Physician SOUTH GFORGIA EMER MED ASD Ormond Beach, FL 32174 ,1 386-274-7800 Accepting All Patients Patel, Bhargav, MD I Internal Medicine 8715 N Wickham Rd ID: 00005670715 022 Ill 0V Quality Care Physician HEALTH FIRST MEDICAL GRP Melbourne, F! - 32941) +1 321-434-9358 Accepting All Pallets Patel, Deep, MD I Internal Medicine 8745 N Wickham Rd Q: 00005637322 013 Quality Care Physician HEALTH FIRST MEDICAL GRP Melbourne, FL 32940 +1 221-434-9358 Accepting All Patients Shawkat, Tarek A, MD I Internal Medicine 8745 N Wickham Rd ID: OD001323913 026 f* Quality Cars Physician HEALTH FIRST MEDICAL GRP Melbourne, FL 32940 ,,1321434-9358 Accepting All Patients Nwamu, Ndidi N, DO I Internal Medicine, Nephrology 8745 IN Wickham Rd ID; 00003466566 013 f# ail Quality Care Physician HEALTH FIRST MEDICAL GRP Melbourne, FL 32940 -1321-434-9358 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-1?coverageType:--medic... 5/7/2018 FITATOW-W Vargas, Victor M, IMD I Far Ay Practice 7W W Co,a '"it"acfi cvvvy iD 0000476267 00/ 440Quality Care Physician HEALTH FIRST MEDICAL GRP ("nr;08 learJl, FI '2,,"Wfl 1 321 8b8 5P I ArCOPThq Ali ]%Ilents Earley, Brian Eliot, DO I Family Practice 1389 S Us 301 ID: 00002338239 034 f# iijLP Quality Care Physician LANGLEY HEALTH SERVICES Surnterwille, FL 33585 , 1 886-298-5510 Accepting All Patients THOMAS E LANGLEY MED CTRI Mantecon-Mateos, Yolanda, MD I Pediatrics 445 Pireda Ct ID: 00000939704 011 f# aid Quality Care Physician SUNSHINE PEDIATRICS Melbourne, FL 32940 +1321.234-8400 Accepting All Patients M agar! no-L! flano, Janette, MD o PediaMcs 7455 Pinomire Dr ID: 00003272214 019 Quality Care Physician CHILDREN'S HEALTH ALLIANCE Oviedo, FL 32765 1 407.542-1733 Accepting Existing Patients Only ......... . . ...... Moto ski, John H, DO I Geriatric Medicine, lnternai Medicune, General Practice 985 Stste Road 436 1 D: 00000779254 014 f# Quality Care Physician GFP GAR E I EAM Cas6elberry, rL 32707 ,1 32IA46-5893 Accepting Ail Patients CFP PHYSlUANS C1:10UP Behani, Majda Ahmedmurnin, MD I Pediatrics 1120 State Road 436 ID: 00003564963 014 of Quality Care Physician CENTRAL FL MICR/COMM HLTH CTF1 Casselberry, FL 32707 11 407-322-8645 Accepting All Patients Roman, Clara, MD I Family Practice 460 Raccoon St ll): 00003199227 003 %W3 Quality Care Physician ROMAN MEDICAL Lake Mary, FL 32746 . 1 407-79"452 Accepting All Patients Rosario Robles, Anibal, MD u internal Medicine ID: W002136722 007 PRIMARY HEALTHCARE ASSOC https://connect.werally.com/searchDirectory/32708/page- 1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 95 of 140 745 Oriente Ave Ste 1251 Accepting All Patients 4P Quality Care Physician All Springs, FL 32701 ,1407-339-2910 Tahbub, Imad, MID I Internal Medicine I 483 IN Sennoran Blvd Ste 210 10: 00005663598 010 ff ff Quality Care Physician DOCTORS OF CLINICAL SPECIALTIES Winter Park, FIL. 32792 'l 4n7-500,3627 Accepting All Patients Simpkins, Jennifer F, MID I Family Practice 400 W Airport Blvd ID: 00005644909 022 f# 40 Quality Care Physician CENTRAL FL MIGR/COMM HLTH CTR Sanford, FL 32773 +1 407-322-8645 Accepting All Patients Kim-Lu, Grace, MD I Pediatrics 1884 W County Road 419 Ste 1000 ID; 00006072807 006 11# 4V Quality Care Physician FIRST CHOICE PEDIATRICS Oviedo, I'll 32765 ,1407-249-1234 Accepting All Patients Castro, Melrelys, MID I Family Practice 3400 Quadrangle Blvd IS: 00002797489 012 Quality Care Physician UCF PEGASUS HEALTH Orlando, FL 32817 +1 407-882-4814 Accepting All Patients Cattier, Celine Marie, MD I Pediatrics 119 Hodel Cv ID: 00005471160 009 4W Ir Quality Care Physician ORLANDO HEAL]I H PHYSICIAN LakeMary, FL 32745 GROUP 11321-041-2245 Accepting All Patients Behal, Joseph Jerry, MID I Family Practice 1834 N Alafaya Tri Ste A ID: 00001114! 95 027 Quality Care Physician 'A I MARY CARE OF CENTRAL FL Orlando, FL 32826 +1321-235-0692 Accepting All Patients Kazim, Haseeb B, MID I Internal Medicine 601 E Rollins St ID! 00002408524 013 IV Ir Quality Care Physician CENTRAL FLHOSPITALIST Orlando, FL32803 PARTNERS +1 407-464-9516 Accepting All Patients Weprin, Ryan, MID I Internal Medicine I Dn 00002019363 020 https:Hconnect.werally.com/searchDirectory/32708/page-1?coverageType=medic... 5/7/2018 Print Search Directory I Find Care 601 111 tolllns' Sil Accepting All Patients V# (lo Quality Care Physician OrIa ir qk)1: 11 12803 41 1014EW456 Page 96 of 140 CENTRAL FL HOSPITALIST PARTNERS Shaikh, Munilma R, MD I Geriatric Medicine, Hospice and Palliative Medicine, Internal Medicine 25c1 N Orange Ave Ste 235 ID: 00003292492 012 IIw Quality Care Physician ADVENTIST HILTH SYS SUNDELTELT Orlando, FL 32804 fl 407-303-2906 Accepting All Patients Cruz, Dan 0, MID I Family Practice 1707 N Mills Ave ID! 00003683691018 f# IW Quality Care Physician INFECTIOUS DISEASE CONSULTANTS Orlando, FL 32803 +1 407-6473960 Accepting All Patients Rios -Sanchez, Valerie M, MID � Pediatrics 7848 1 Underhill Rd ID: W003280678 007 f# %6r, Quality Care Physician PEDIATRIC CARE GROUP Orlando, FL 32822 ,1 407-275-2676 Accepting All Patients Collon, Sara 1, MID p Internal Medicine 601 E Colonial Dr ID: 00006227071005 f# 10 Quality Care Physician PRIMARY HEALTHCARE ASSOC Orlando, FL 32803 -1 407-895-9255 Accepting All Patients Arca, Nicanor C, MID I Family Practice 300 E Church St ID: 00D02719924 008 1# 14P, Quality Care Physician Orlando, FL 32801 +1 407-233-1844 Accepting All Patients Cooke, Arnanda, MD I Pediatrics 83 Columbia St ll): DOD052858,39 ODS f# W Quality Care Physician OH INPATIENT MEDICINE GROUP Wand,,.a, FL 32.806 � 1 321-643-3220 Accepflng Alf I lalieots Kahn, Lindsay Beth, DO I Neonatology, Pediatrics 83 W Miller St ID: 00005152698 006 Quality Care Physician PEDIATRIX MEDICAL GROUP OF Orlando, FL 32806 FLORIDA -1 321.843-9792 Accepting All Patients Orsini, Anthony J, DO I Neonatology, Pediatrics 83 W Miller St ID: 00001537114 014 Quality Care Physician PEDIATRIX MEDICAL GROUP OF Orlando, FL 32806 FLORIDA ,1 321-843-9792 Accepting All Patients Rao, Laximi D, MD � Neonatology, Pediatrics Print Search Directory I Find Care Page 97 of 140 82 W Miller St ID: 00003093861 006 IN# V# Quality Care Physician PEDIATIRIX MEDICAL GROUP OF Orlando, FL 32806 FLORIDA 1-1 321-84,3-9792.+l 407-841-5218 Accepting All Patients ... . . ............... ..... . ...... Lakshmi, Rajkurnar, MID I Maternal & Fetal Med / Perinatology, Neonatology, Pediatrics 83 W Miller St ID: U0004361521 005 Quality Care Physician PFDIATRIX MEDICAL GROUP OF Orlando, I'll 32806 FLORIDA -1 321-843-9792 Accepting All Patients Dennard, Susan Marie, MD I Pediatrics, Critical Care Medicine 92 W Miller Sit ID: 00002800193 012 1W qV Quality Care Physician PLDIATRIX MEDICAL GROUP OF Orlando, FL 32806 FLORIDA 0 407-649-6960, 1 407-649-9111 Accepting All Patients Hardy, Douglas E, MD I Pediatrics 92 W Miller St 0; 00000425045 003 q# qp Quality Care Physician PEDIATRIX MEDICAL GROUP OF Orlando, FL 32606 FLORIDA +1 407-649-9111, +1 407-841-6111 Accepting All Patients Mcmahan, Michael J, MD I Pediatrics 92 W Miller St 10: 00001364023 002 Quality Care Physician PIDATRIX MEDICAL GROUP OF Orlando, FL 32806 f-LOHIDA +1 407-649-9 V 1, +1 407-841 -3111 Accepting All Patients Pera, Angelina De La Caridad, MD I Maternal & Fetal Med / Perinatology, Pediatrics 92 W Miller St ID: 00001874770 002 f# 4V QuaIIV Care Physician Orlando -L 32806 +1 407-64",l I I Accepting All Patients Perez, Jose A, MD I Pediatrics 92 W Miller St 10: 00001309745 002 f# qP Quality Care Physician PEDIATFUX MEDICAL GROUP OF Orlando, FL 32806 FLORIDA ,1 407 64M1 11, +1 407-Ml -5111 Accepting All Patients Brown Work, Shannon, MID I Neonatology, Pediatrics 92 W Miller St ID: 00003039738 003 IV 41# Quality Care Physician Orlando, FL 32806 ,1 407-649-9111 Accepting All Patients Zavala, Walter Alejandro, MD I Internal Medicine Il I D: 00002597876 002 SUNCOAST MEDICAL ASSOCIATES https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 517/2018 Print Search Directory I Find Care Page 98 of 140 W I DaItc,na Clvr.iSle Kll A(,cejInq Afl Pafleros f# V Quality Care Physician l„J:��[tona, I'L 32725 YFi 71160, 1 P Ajaz, Bushra, IMD � internal Medicine V16 Entcrprls,?, Rd Ste 100 ID: 00006073266 003 1[PS Quality Care Physician MID RL HEMATOLOGY/ONCOLOG Orangn City, FI- 32763 C; T R 1-I 3� 7 71,, �'223 Accepting All latleriv.� Ortiz, Nancy D, MID I General Practice 2555 S Volusia Ave ID: 0000589176E 002 1# %W Quality Care Physician CENTRAL FLORIDA MEDICAL ASCS Orange City, FL 32763 A 1 386-774-040I Accepting All Patients Rivera Bobe, Elizabeth M, MD I Family Practice 2160 Howland Blvd Ste 110 ID: 00001167042 009 04p Quality Care Physician NORTI EAST FLORIDA HEALTH Doliona, FL 32738 SERVICES ,138&532-0515 Accepting All Patients Mohamed, Khale d A, MID l Family Practice 10437 Moss Park Rd ID: 00001834811023 40 lqp Quality Care Physician SIGMA MEDICAL GROUP Orlando, FL 32832 +1 407-802-1100 Accepting All Patients Stanica, Alina, MID I Pediatric Emergency Medicine, Pediatrics 85DO Commodity Cir ID: G0003195624 027 111$ 1l0 QUalty Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32819 11407-354-0717 Accepting All Patients 1� I 8500 Commodity Cir 10: 00002152997 007 IJP Quality Care Physician ALL ABOUT KIDS PEDIATRICS Orlando, rL 32819 ,1 407-354-0717 Accepting All Patients Behan1l, Aida, MD I lntemal Medicine 36 S Main St On 00005347571001 411# ?1# Quality Care Physician CELEBRITY MEDICAL SPA Winter Garden, 134787 ,1 401,347-9886 Accepting All Patients Rodriguez, Alexander, MID I General Practice 790 Buenaventura Blvd ID: 00004987507 008 ff V Quality Care Physician ORLANDO FAMILY PHYSICIANS Kissimmee, FL 34743 -1 407-344-9959 Accepting All Patients Javed, Sannia, MD � lnternal Medicine =NM1109111111 =�111115' Print Search Directory I Find Care Page 99 of 140 18550 Us Highway 441 Ste A 10:00005465378 001 40 V Quality Care Physician PHYSICIANS OF CENTRAL FLORIDA I Dora, FL 32757 ,1 352 307 9D25,,l 352 7353755 Accepting All Patients Kyrillos, Ramona, MID I Internal Medicine 10550 Us Highway 441 Ste A 10: 00005465382 001 111 f# Quality Care Physician PHYSICIANS OF CENTRAL FLORIDA Mount Dora, FL 32757 ,1352-735-3755 Accepting All Patients Gonzalez, Frances Enid, MD I Pediatrics 1144 Cypress Glen Cl r ID: 00005769744 001 f# If Quality Care Physician LOOP PEDIATRICS Kissimmee, Ft_ 34741 ,1 4C7-Q3-5900 Accepting All Patients Gallardo, Salvador A, MD I Family Practice, General Practice 650 W Plymouth Ave ID: 00002962979 016 f# 0* Quality Care Physician DELAND QUICK CARE Deland ' FL32720 +1 386-873A771 Accepting All Patients Acosta Camacho, Martha 1, MD I Pediatrics 201 Hilda St Ste 15 10: C0002402960 030 41 f* Quality Care Physician YOUR HEALTH PEDIATRICS Kissimmee, FL 34741 +1 407-,5744848 Accepting All Patients Mercado, Ronniel, MID I Internal Medicine 2450 1 Orange Blossom I rl ID! 00003319337 022 111 jp Quality Care Physician PIONEER MEDICAL GROUP Kissimmee, FL 34744 ,1 813-779-6303 Accepting All Patients La Roe, Cynthia A, MID I Internal Medicine 1840 Classique Ln ID: 00002185606 004 f# Quality care Physician YOU & YOUR HEALTH FAMILY CARE Tavares, FL 32778 ,I 352-50l Not Accepting Patients Glerbolini, Jose Ismael, MD I Neonatology, Pediatrics 700 W Oak St ID: 000020446315 016 111 11 Quality Care Physician PEDIATRIX MEDICAL GROUP 0- Kissimmee, FL 34741 FLORIDA -1 407-846-2266 Accepting All Patients Longhl, Juan Alfredo, MD I Neonatology, Obstetrics and Gynecology, Pediatrics 700 W Oak St ID: 00001702261020 f# fo Quality Care Physician PEDIATRIX MEDICAL GROUP OF Kissimmee, rl FLORIDA ,-I 407-846-2266 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Lopez, Astrid J, MID I Pediatrics Page 100 of 140 B16W Oak St ID: 00002736',86 004 111 qV Quality Care Physician MEDICAL VILLAGE HFALTHCARE GRP Kissimmee, FL 34741 ,1 407-944-9777 Accepting All Patients Rankin, Trevan M, MD I Family Practice 836 Century Medical Dr ID: 00006039680 005 Quality Care Physician MILLENNIUM MEDICAL Titusville, FL 32796 MANAGEMENT ,1 321-383-8092. -1 321-751-3389 Accepting All Patients Mageau, Diane, DO I Pediatrics 500 N Washington Ave Ste 105 ID: 00005224079 006 VVI, Quality Care Physician BREVARD HEALTH ALLIANCE Titus0le, FL 32796 +I 321,241-6800,-1 321-26M267 Accepting All Patients .............. . . . . . . . ...... . ...... .............. Cunanan, Antonio, MID I Internal Medicine 400 Celebration PI ID: 00002442993 011 40 jIVO Quality Care Physician CENTRAL FL HOSPITALIST Kissimmee, FL 34747 PARTNERS +1 407-200-2355 Accepting All Patients Ahmad, Musaddeque, MID I internal Medicine 3105 Citrus Tower Blvd Ste B ID; 00001421394 057 f#i ## Quality Care Physician PREMIER MEDICAL ASSOCIATES Clermont, FL 34711 ,1362-259-2159 Accepting All Patients Pere z-Astacio, Ramon A, MID l internal Medicine, Medical Oncobigy 107 W Contra[ Ave ID: 00003277500 006 (idp Quality Care Physician CLARK CLINIC Ho.Gy In The Hills, Fl. 34737 41 352324JJ504 Accepting All Patients Glerut, Lukasz, IDO I Family Practice 1600 Budinger Ave Ste D D* 01)006251397 003 V# fe, Quality Care Physician STCLOUD MEDICAL GROUP Saint Cloud, FL 34769 , 1 407-892-3387 Accepting All Patients Bentinganan, Oscar, MD I Internal Medicine 130 Wallace Rd ID: 00002251177 005 Quality Care Physician QUICK CARE MEDICAL TREATMENT New Smyrna Beach, FL 32168 CENTER https://connect.werally.com/searchDirectory/32708/page-I?coverageType=medic... 5/7/2018 Print Search Directory I Find Care + 1 386 426-8600 Accepting All Patients Vasser, Elizabeth C, MD I Family Practice 7227 N Highway 1 Ste 100 [D: 00DO3257131 009 40 ir Quality Care Physician FL 32927 �0 l 1Za637-1595 Accepting All Patients Page 101 of 140 HEALTH FIRST MEDICAL GRP Rosselot, Angela M, DO I Family Practice 109 Lake Davenport Blvd ID; 00005955364 OUT 0* ff Quality Care Physician CITRUS RIDGE MEDICAL CENTER Davenport, FL 33897 +-1 863-256-6030 Accepting All Patient-, Hwang, Do Y, MD I Family Practice 3641 Clyde Morris Blvd Ste 100 ID: 00003325879 009 4F Quality Care Physician METCARE OF FLORIDA Port Orange, FL. 32129 ,I 386�675-4410 Accepting All Patients Jorge Flores, Jaime, MD I General Practice 3358 W Southport Rd ID: 000D2205557 009 Quality Care Physician HEALTH GROUP CENTER Kissimmee, FL 34746 ,1 407 201-7918 Accepting All Patients Dejesus, Juan A, MD I General Practice 1004 N 14th St Ste 109 ID: 00003344114 006 1* Quality Care Physician PREMIER MEDICAL ASSOCIATES Leesburg, FL 34748 +1 352-259-2159 Accepting All Patients Zakiullah, Zubalr, MD I Pediatrics 109 N Doverplum Ave I D: 00005290014 01D 1 Quality Care Physician OSCEOLA COMMUNITY HEALTH Kissimmee, FL 34758 SERVICES *1 407-943-8672 Accepting All Patients Garg, Rajan, MD I internal Medicine, Critical Care Medicine 303 N Clyde Morris Blvd 113: 00005607720 004 #0 Quality Care Physician HALIFAX HEALTHCARE SYSTEMS Daytona Beach, FL 32114 ,1 386-254-4152 Accepting All Patients Lajara, Reyna 1, MD I General Practice 127 Ridge Center Dr ID: 00002983430 013 Y10 Quality Care Physician JAY CARE MEDICAL CENTER Davenport, FL 33837 ,1 863-421-7400 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 102 of 140 Johnson, Lena, MD I Family Practice 24110 N C',curtpnRy Pkwy Ste 100 ID: 000060' 39852 004 OF Quality Care Physician Merritt island, FL 32953 11321-985-9097 Accepting All Patients Heart, Rami J, DO I Internal Medicine, Intetventional Cardiology 40100 Highway 27 ID: 00003438637 009 10P Quality Care Physician HEART & VSCLR INSTITUTE FL Davenport, FL 33837 +1863-4243278 AncPpIng All Patients Vazquez -Maldonado, Lilliam, MD I Pediatrics 2201 North Blvd W M 00006020895 006 ff Quality Care Physician KIDSVILLF PEDIATIRIGS Davenport, FL 33837 +1 863A19,0688 Accepting All Patients Ibrahim, Therese A, MID I Internal Medicine, Family Practice 420 S Nova Rd Ste 4 ID: 00002864130 007 Quality Care Physician METGARF OF PALM COAST Ormond Beach, FL 32174 f 138&506-0111, 1 386-615-8122 Accepting All Patients Fallestiny, Ma Nassif, MID I Internal Medicine 929 IN Us Highway,141 Ste 503 ID: 00001896276 021 1Quality Care Physician Lady Lake, FL 32159 '1352-751-0890 Accepting All Patients Aggarwal, Preyanka, MD I Family Practice 36246 Hwy 27 ID: 00003224206 006 V# VP Quality Care Physician DAYCARE MECICAL GROUP Halnes City, FL 33844 +1 863.421-980II Accepting All Patients Sy, 4n. . , Alfredo P, MD I Family Practice 910 Old Camp Rd ID: OU000484918 018 10 00 Quality Care Physician LEAVITT MED ASCS OF FLORIDA Lady Lake, FL 32162 ,1407,375-2080 Accepting All Patients Meelynn, Kenneth R, MD I Family Practice 390 Challenger Rd I D: 00002250663 023 4W 11 Quality Care Physician NORTH BREVARD MEDICAL Caine Canaveral, FL 32920 SUPPORT +1 321-633-,8640 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 103 of 140 Hsu, Stephen I -Hong, MD I Internal Medicine, Nephrology 1580 Santa Barbara Blvd ID: 00002597748 023 lip ill Quality Care Physician PREMIER MEDICAL ASSOCIATES Lady Lake, FL 32159 ,1 352-259.2159 Accepting All Patients Toledo, Ernesto L, MID I General Practice 1560 Santa Barbara Blvd 10: 00000540767 005 11V V Quality Care Physician WELLN ESS ON WHEELS The Villages, FL 32159 0 352-259-2159 Awpinfing All Patients Toro Galarza, Jennifer Marie, MD I Internal Medicine 8550 NE 138th Ln Bldg 400 D' 00006125326 002 Ill V Quality Care Physician MUNROE HMN HMRN Lady Lake, FL 32159 1 352-674-4, 36 Accepting All Patients Hashmi-Alikhan, Saira, MID I Internal Medicine 8745 N Wickham Rd ID! 00002403994 006 qp f* Quality Care Physician HEALTH FIRST MEDICAL GRP Melbourne, FL 32940 1 321434 1771, +1 321-434 9358 Accepting All Patients Martinez, Ruben A, MD Internal Medicine 701 W Cocoa Beach Cswy ID: 00003274089 010 q1 Quality Care Physician HEALTH FIRST MEDICAL GRP Cocoa Beach, FL 32931 11 321434-1771, +1 321-868-5811 Accepting All Patients Hazelwood, Senator K, MD I Internal Medicine 701 W Cocoa Beach Csvvy ID: 00003103025 012 11V qp Quality Care Physician HEALTH FIRST MEDICAL GRP Cocoa Beach, FL 32931 11 321-868-5871 Accepting All Patients Stainaker, Jeffrey, MD I Internal Medicine, Emergency Medicine 7125 Murrell Rd Ste D ID: 00001259381 011 40 V Quality Care Physician HEALTH FIRST MEDICAL GRP Melbourne, FL 32940 fl 321-434-9562 Accepting All Patients Hunt, David W, DO I Family Practice R,n v l e &s 1950 Laurel Manor Dr Ste 210 ID* 00001411039 046 q Quality Care Physician The Villages, FL 32162 +1 352-350-8800 Accepting All Patients Jordan, Jeffrey Paul, MD I Internal Medicine https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 104 of 140 1389 S Us 301 ID: 00001601353 024 10 16P Quality Care Physician LANG LEY HEALTH SERVICES Surnterville, FL 33585 ,11888-298-5510 Accepting All Patients THOMAS F LANGLEY IVIED CTR Mazzella, Louis, MID I Family Practice, General Practice 165N SE 86th Belle Meade Cir 0: 00003438947 021 A# iV Quality Care Physician NAUTILUS HEALTH CARE GROUP The Villages, FL 32162 ,l 727-544-4646 Accepting All Patients Treharne, John W, MD I Family Practice 1340 Tuskawilla Rd Ste 101-105 ID: 000004813112 007 1# V Quality Care Physician FLORIDA HOSPITAL MEDICAL GROUP Winter Springs, FL 32708 +1 407-699-1160 Accepting Existing Patients Only Schamberger, Robert A, DO 1I Family Practice, General Practice 5745 Canton Cv Ste 121 ID: 00000172830 004 #* TQuality Care Physician AHMAD AMIAWI MID Winter Springs, FL 32708 -1 407 647 2550 Accepting All Patients Voirin, James A, DO I Family Practice 7408 Red Bug Lake Rd ID: 00001816190 012 %V Quality Care Physician PHYSICIAN ASSOCIATES Oviedo, FL 32765 41 407-38I-7387 Accepting All Patients Lauridsen, Deborah 1, MID � Family Practice 7408 Red Bug Lake Rd 10: 00002656490 016 I sit Quality Care Physician PHYSICIAN ASSOCIATES OvIeco, FL 32765 ,1 407-381-7387 Accepting All Patients Nguyen, Nam-Phuong N, MD � Pediatrics 7455 Pine-rilre Dr ID: 00002946762 018 4# to Quality Care Physician CHILDREN'S HEALTH ALLIANCE Oviedo, FL 32765 +1 407-542-1733 Accepting All Patients Mcrae, Chad E, MID 8 Pediatrics, Urgent Care Medicine I D: 00002318769 010 CHILDREN'S HEALTH ALLIANCE https://connect.werally.com/searchDirectory/32708/page-l?coverageType=medic... 5/7/2018 Print Search Directory I Find Care 7455 Pinemire Dr Accepting All Patients Or V Quality Care Physician Oviedo, FL 32765 '1 407-542-1733 Thint, Monica W, MD I Pediatrics 7455 Pinennire Or ID; 0000 1690443 026 Oviedo, FL 32765 41 407-542-1733 Accepting Existing Patients Only Burns, Andrea D, MD I Pediatrics I I RewiAw, 7455 Finennire Dr ID: 00003432719 009 Oviedo, FL 32765 ,-1 4C7-542-1733 Accepting All Patients Johnson, Laura L, MD I Pediatrics 7450 Pinei nine Dr ID: 00001973012 017 Oviedo, FL 32765 ,1407-542-1733 Accepting All Patienti, Ragno, Joseph, MD I Family Practice Page 105 of 140 %* V Quality Care Physician CLIILI)n1N S HEALTH ALLIANCE ffQuality Care Physician f# q# Quality Care Physician CHILDREN'S HEALTH ALLIANCE 550 E State Road 434 ID: 0000 1816219 013 0# V* Quality Care Physician PHYSICIAN ASSOCIATES Longwood, FL 32750 ,1407-381-7367 Accepting All Patients Selznick, Steven H, DO I Family Practice 965 State Road 436 10: 000006041CO 006 f# f# Quality Care Physician CFP PHYSICIANS GROUP Casselperry, FL 32707 +1 407-831-5252 Accepting All Patients Balasubramanian, Akila, MD I Family Practice 9455 State Road 436 ID: 00003350869 004 f$ 4p Quality Cafe Physician CrP CARE TEAM Cassefhprry, FL 32707 ,1 407-831-5252 Accepting All Patients CFP PHYSICIANS GROUP Thomas, Hugh '11, DO I Family Praction. 9 https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care 5J05 5161vRaod 4430 ID: 00001481605 007 1 Qual'ty Care Physician Ge,m>rau=84'sr-my, Fl.. S12107 +'ti 4V.i7-R3: "xdh"5 Accepting All Patients Page 106 of 140 CFP CARE TEAM CFP PHYSICIANS GROUP Martinez -Angel, Rosario I<,,,,, D � Pediatrics 1120 State Road 436 Ste 1200 ID: 00002275083 009 IF f1p, Quality Care Physician CENTRAL FL MIGR/COMM HLTH CTR Casselberry, FL 32707 +1 407322-8645 Accepting All Patients Scalzo, Lawrence J, MD I Family Practice 212 W Bay Ave ID: 00001984876 013 Quality Care Physician LONGWOOD PREVENTIVE MED Longwood, FL 32750 GROUP +1 407-265-1888 Accepting All Patients Kim, Paul, MD I Family Practice 225 W State Road 434 Ste 203 ID: 00003408477 012 q# °%P Quality Care Physician ORANGE AVE CONSULTING Longwood, FL32750 +1 407-459-4360 Accepting All Patients Magee, lEdward mil, MD I Family Practice 225 W State Road 434 Ste 102 ID: 0000250623E 011 4# Ij? Quality Care Physician INTEGRATIVE PHYS VIED OF LAKE Longwood, FL 32750 MARY LLC 11 407-792-0705 Accepting All Patients Dawson, VilirgH L, MID � Family Practice 515 W State Road 434 Ste 301 ID: 00000777144 005 s Quality Care Physician LONGWOOD FAMILY MEDICINE Longwood, FL 32750 +1 407-786-0004 Accepting All Patients Wong, Cristy A, MID I Pediatrics 521 W State Road 434 Ste 101 ID: 00003084633 005 iP Quality Care Physician CHILDREN'S HEALTH ALLIANCE Longwood, FL 32750 +1 407-830-6i347, +1 407-830.5437 Accepting Existing Patients Only Todd, Kathleen L, DO I Neuromuscular Disease, Osteopathic Manipulative Medicine, Family Practice https:Hconnect.werally.com/searchDirectory/32708/page- 1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 107 of 140 406 Lake Howell Rd ID: U0002096524 004 %V III Quality Care Physician Maitland, FL 32751 -1 407-691.3960 Accepting All Patients Dube, Debra A, MD I Internal Medicine 901 W Warren Ave Ste 1001 10:00001868284 004 Op 4V Quality Care Physician DEBRA A DU13E & ASSOCIATES Longwood, FL 32750 1 407-834-0860 Accepting All Patients Hirt, John B, DO I Family Practice, General Practice 5542 Lake Howell Rd ID: OD000957160 006 f^ Quality Cam Physician Winter Park, FL 32792 ,1 407-675-5554 Accepting Existing Patients Only Ziaika, Paul E, MID I Internal Medicine, Internal Medicine Specialist 28213 Gasa Abri Way Ste 600 ID: 00000217243 005 VQuality Care Physician FLORIDA LIPID INSTITUTE Winter Park, FL 32792 +1407-671-9598 Accepting All Patients Aillin, Ben D, MD I Family Practice 7221 Alorna Ave Ste 200 ID: 00002887280 004 r* Quality Care Physician BIN D ALILIN MD Winter Park, FL 32792 ,1 407-657-2111 A(;txpling All Patients Belsare, Devyani, MID I Pediatrics 261 Maitland Ave Ste 104 ID: 00003161424 001 ill Quality Care Physician DEVYANI BELSARE MD Altamonte Springs, FL 32701 407-557-2165 Accepting All Patients Panucclo, Denise, MD I Internal Medicine 1200 W Slate Road 434 Ste 112 ID: 00001877683 01B f# 4V Quality Care Physician ALTAMONTF MEDICAL GROUP Longwood, FL 32750 ,l 407-869-8747 Accepting All Patients Shay, Samuel P, MID I Family Practice https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 108 of 140 (if, tl LA karinr me 4 Me11 & ID: WtuOt)'14bbE§W 002 Quality Care Physician Atan,00,ir9 iw p6'i(p , 1t„ 2701 asse, Elizabeth B, MD � Family Practice 661 E Altamonte Dr Ste 115 ID: 00003515461 002 tit tlV � Quality Care Physician Altamonte Springs, FL 32701 +1 407-831-4D40 Accepting All Patients Phillips, Maryam, MD I Family Practice 661 E Altamonte Dr Ste 120 ID: 00003688486 008 Quality Care Physician Aftamonte Springs, FL 32701 +1 407-960-1465 Accepting All Patients Rangainathan, Sannanalcker, MD I Internal Medicine 1250 W State Road 434 Ste 1004 ID: 00000056479 008 f 6tVP Quality Care Physician Longwood, FL 32750 +1 407-2608227 Accepting All Patients Ahmad, Aneesa B, MD I Pediatrics 608 Maitland Ave ID: 00000126483 001 ASV' Quality Care Physician Altamonte Springs, FL 32701 +1 407-331-5437 Accepting All Patients an elorl, Jaime E, MID 0 Pediatrics 101 N Country Club Rd Ste 115 ID: DOD02796057 002 Quality Care Physician Lake Mary, FL 32746 +1 407-831-6200 Accepting All Patients Ambwani, Jagdish C, MD I Pediatrics 1385 W State Road 434 Ste 206 ID: 00003249435 005 Quality Care Physician LONGWOOD PEDIATRICS Longwood, FL 32750 +1 407-644-9970 Accepting All Patients Von Bargen, William F, DO I Family Practice https:Hconnect.weral ly. com/searchDirectory/32708/page-1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care 7163 University Blvd ID; 00003313051 012 Winter Park, FL 32792 ,1 32 1 -4414944 Accepting All Patients Marcelin, Prudent, MD I Family Practice R'evirmq' 070 N Orlando Ave Ste 1,012 ID; 00003205664 004 Maitland, FL 32751 , 1407-790-7870 Accepting All Patients Page 109 of 140 f# qP Quality Care Physician PHYSIGIANS MED AND INJURY GRP EAST ORLAN 10 Quality Care Physician DOCTORS ASSOCIATES OF ORLANDO Nicolas, Guy E, MD I Family Practice 800 N Maitland Ave Ste 101 ID: 00001415122 012 ll Quality Care Physician PHYSICIAN ASSOCIATES Mainland, FL 32751 ,1 407-660-7000, 1 407-6607011 Accepting All Patients Summers, Andrew G, MID I Pediatrics 800 N Maitland Ave Ste 102 ID; 00001391700 017 f# fo Quality Care Physician PHYSICIAN ASSOCIATES Maitland, 132751 ,1407-650-7010,+1 407-66117062 Accepting All Patients Janmeja, Milan, MD I Infectious Disease Medicine, Internal Medicine 400 W Airport Blvd ID: 00003415380 014 Quality Care Physician CENTRAL FL MICR/COMM HILTH CTR SEntord, FL 32773 +1 407-322-8645 Accepting All Patients Virdi, Manjit Junei MID I Pediatrics 2340 Glenwood Or ID; 00000497674 006 f# Quality Care Physician MID-FLORIDA PEDIATRICS Winter Park, FL 32792 +1407-975-0681 Accepting All Patients Morales, Sandra D, MD I Pediatrics 9954 University Blvd ID: 00001647075 015 Quality Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32817 +1 407-381-5888 Accepting All Patients Eyma, Rachel M, MD I Emergency Medicine, Family Practice https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 110 of 140 9964 University Blvd 11): OD002670902 006 Quality Care Physician M llAIL:lA N A330(,A rES , Orlando, FL 32817 +1 407-261-2923 Accepting All Patients Deluca, Joseph N, MD I General Practice 378 Centerpointe Cir Ste 1280 ID: 00001916310 004 aV Quality Care Physician JOSEPH IN DELUCA Altamonte Springs, FL 32701 -1 407-862-5959 Accepting All Patients Song, lEsther Shinyoung, MD I Pediatrics 1884 W County Road 419 Ste 1000 ID: 00002920143 008 4# 9,F6 Quality Care Physician I a 00111 PF!sWrRICS Oviedo, FL 32765 -1407-249-1234 Accepting All Patients Muhumuza, Jean Plierre B, MD I Pediatdcs 1854 W County Road 419 Ste 1000 ID: 00004631116 002 f# fo Quality Care Physician FIRST CHOICE PEDIATRICS Oviedo, FL 32765 +1 407-249-1234 Accepting All Patients Khan, are rya R, MID I Adoflesceint Medicine .................... - ------- 201 N Lakemont Ave Ste 500 ID: 00002064101 003 Quality Care Physician WINTER PARK PEDIATRICS Winter Park, FL 32792 -1 407-644-7400 Accepting All Patients Oureshl, Kashi1f, MD I Family Practice 125 W Pineview St Ste 1001 ID: 00003561341 DD2 f# r Quality Care Physician LONGWOOD FAMILY HEALTH Altamonte Springs, FL 32714 +1 407-8623400 Accepting All Patients Guthrie, George E, MD g Preventive Medicine, Family Practice 133 BLnmore Or Ste 200 ID: 00001711951013 f# SW Quality Care Physician ADVENTIST HILTH SYS SUNBELTELT Winter Park, FL 32792 ,1407-646-707[) Accepting All Patients Cook, Barry A, MD I Family Practice https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page Ill of 140 600 Northlaka Blvd Ste 260 ID: 00DO0836133 021 4V ?* Quality Care Physician WALTER A CONLAN Ill MID Altamonte Springs, FL 32701 ,1 407 3394490 Accepting All Patients Finer, Howard 1, MID I Pediatrics 2135 W State Road 434 ID: 00000636776 003 111 qr Quality Care Physician Lon9l FIL 32779 1 407-602-9020 Accepting All Patients ... ....... — ...... Monette, Daniel Raymond, MD Sports Medicine, Family Practice 63 2209 S French Ave ID: 00002206342 003 f# f# Quality Care Physician HEATHROW INTERNAL MEDICINE Sanford, FL 3277' ,1 407-3214230 Accepting All Patents Gill, Manpreet K, MD I Family Practice 2209 S French Ave ID: 00002549583 012 111 Quality Care Physician HEATHROW INTERNAL MEDICINE Samford, FL 32771 +1407-3214230 Accepting All Patients — . . . . . ....... Madden, Mitchell, MD Pediatrics fR 725 Racial Cv ID: 00001816214 011 V# IF Quality Care Physician PHYSICIAN ASSOCIATES Lake Mary, FIE 32746 , 1407-302-3130 Accepting All Patients Nerness, David L, MD I Family Practice iewGnvs 755 Rinehart Rd ID: 00001413501 007 111 V Quality I Physician FLORIDA HOSPITAL MEDICAL GROUP Lakc Mary, FL 32746 +1 407-333-1550 Accepting All Patients Soh-Urbano, Jin Y, MD I Family Practice 75.5 Rinehart Rd ID: 00002365782 007 4V Quality Care Physician FLORIDA HOSPITAL MEDICAL GROUP Lake Mary, FL 32746 +1 407-333-1550 Accepting All Patients Berger, Kristina H, MD I Family Practice https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care 755 Rinehart Rd ID: 00003503859 007 Lake Mary, FL 32746 +1 407-333-1550 Accepting All Patients Roberts, Kelly A, MD � Fam lly Practice Page 112 of 140 I# I, Quality Care Physician FLORIDA HOSPITAL MEDICAL GROUP 4098 Libra Dr ID: 00002279622 008 111 V Quality Care Physician UNIVERSITY OF CTRAL FL HEALTH S Orlando, FL 32816 +1 407-823-2701 Accepting All Patients Chander, NMI, MD i Pediatrics, Pediatrics Specialist 6701 Makland Summit Blvd ID: 00003101917 012 '* f,rl Quality Care Physician ROV SPORTSPLEX PEDIATRICS Orlando, FL 32810 +1 407-9164520 Accepting All Patients Aran -Serrano, Frank, MD I Family Practice 434 W Kennedy Blvd Ste D ID: 00003047883 006 4W �#Quality Care Physician CHC EATONVILLE FAMILY HEALTH Orlando, FL 32810 CTR +1 407-905-8827 Accepting All Patients Patel, Varesh R, DO 0 Farm y Practice 1400 S Orlando Ave Ste 204 ID: 00002304389 004 r# 16Quality Care Physician WINTER PARK FAMILY PRACTICE Winter Park, FL 32789 +1 407-58&0596 Accepting All Patients aaf r, Fatan, MD U Pediatrics 340 N Wymore Rd Ste B ID: 00003503536 005 ail. Quality Care Physician SAFARI PEDIATRICS Winter Park, FL 32789 +1 401-813-2473 Accepting All Patients Albers, Debra S, DO I Family Practice 3120 Corrine Dr ID: 00000861453 001 1# f4ft Quality Care Physician JACK T WEAVER DPM DO MD Orlando, FL 32803 +1 407-395,4707 Accepting All Patients to so, Lug A, MD I Internal Medicine i:, ; Print Search Directory I Find Care Page 113 of 140 1090 W State Road 436 ID: 00002415911 011 fo Quality Care Physician ALONSO MEDICAL AND WELLNESS Altamonte Springs, FL 32714 CENTER ,I 407-869-1030 Accepting All Patients Oni, Hafusat A, DO I Family Practice 7900 Forest City Rd ID: 00002944491018 Quality Care Physician CHC EATONVILLE FAMILY HEALTH Orlando, FL 32810 CTR ,I 407-905.3827 Accepting All Patients Doshi, Neha, MD I Internal Medicine, Family Practice 942 Lake. Baldwin Ln ID'00F)0239B166 007 f# f# Quality Care Physician WINTER PAHK PRIMARY CARE Ortardo, FL 32814 ,1 321-285-6363 Accepting All Patients Serrao, E John, MID I Obstetrics and Gynecology fleviewf"' 2905 Mcrae Ave ID: 00000891199 008 f# V Quality Care Physician Orlando, FL 32803 +1 407-897-2230 Accepting All Patients Tarnbunan, Daniel J, MD I Internal Medicine 2501 N Orange Ave Ste 235 ID' 00001796400 006 4W W Quality Care Physician Orlando, FL .32804 +1 407-303-7270 Accepting All Patients Everett, George D, MD I Internal Medicine 2501 N Orange Ave Ste 235 ID: 00000620565 015 f# 4V Quality Care Physician Orlando, FL 328D4 ,1 407-303-7270 Accepting All Patients Echeverria-Beltran, Karen A, MD I Internal Medicine ADVFNTIST FIFTH SYS SUNBF1 TFI T FLORIDA HOSPITAL MEDICAL GROUP ADVENTIST FILTH SYS SUNBELTELT FLORIDA HOSPITAL MEDICAL GROUP MEDICINE SPECIALISTS OF FLORIDA HOSPITAL 2501 N Orange Ave Ste 235 10:00002315615 015 f* Quality Care Physician MEDICINE SPECIALISTS OF FLORIDA Orlardo, FL 32804 HOSPITAL ,1 407-303-7270 Accepting All Patients Suarez, Juan P, MD I Internal Medicine https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 114 of 140 1900 IN Mills Ave Ste 103 ID: 00000619600 004 ff Quality Care Physician JUAN PSUAREZ LOPEZ MID Orlando, FL 32803 +1 407.843-0151 Accepting All Patients . .......... — — --------- .................... . ........... . . ........... ...... Maharaj, Priya, DO I Family Practice 1040 Woodcock Rd Ste 200 11): 00002674654 001 40 f1 U Qually Care Physician BALDWIN PARK FAMILY PRACTICE Orlando, FL 32803 ,1407-898-4550 Accepting All Patients Patel, Ramesh M, MID I Family Practice 1910 IN Orange Ave ID; 00000420446 005 1I fV Quality Care Physician ADVANCE FAMILY PRACTICE Orlando, FL 32804 -1407-898-1451 Accepting All Patients Magee, Kris ty J, MD I Family Practice 6300 W State Road 46 Ste 2 10: 00002512257 004 q$, Quality Care Phi HEATHROW INTERNAL MEDICINE Sanford, FL 32771 +1 407-321-4230 Accepting All Pattenis .............. ........... Browning, Brian L, DO I Neurol-TiUSICUlar Disease, Osteopathic Manipulative Medicine, Family Practice 7975 Lake Underhill Rd Ste 200 ID: 00002932659 005 111# IV, Quality Care Physician ADVENTIST FILTH SYS SUNBELTELT Orlando, F1 32322 ,1 407-303-6830, 0 407-303-8012 ftcepting All Patients FLORIDA HOSPITAL MEDICAL GROUP Timoshkin, Elena M, DO I Family Practice Specialist 7975 Lake Underhill Rd Ste 200 ID: 00003642111 007 41 Quality Care Physician FLORIDA HOSPITAL MEDICAL GROUP Orlando, FL 32822 -1 407 303 6830 Accepting All Patients Elliziondo Vega, Heather L, MD I Adolescent Medicine, Pediatrics 7075 Lake Underhill Rd Ste120 ID: 00003620724 013 Quality Care Physician ADVENTIST HILTH SYS SUNBELTELT Orlando, FL 32822 +1 407-31),"830 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 115 of 140 Attermann, Steven L, DO I Internal Medicine 7915 Lake Underhill Rd Ste 220B ID: 00000816644 009 f# qp Quality Care Physician FLORIDA HOSPITAL MEDICAL GROUP Orlando, Fl- 32822 0 407-309-C2135 Accepting All Patients Gans, Barbara J, MD I Adolescent Medicine, Pediatrics 414 N Mills Ave ID: 00001237953 007 ff V Quality Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32803 1 407-841-7290 Accopling All Patients Coffman, Gregory J, MD I Adolescent Medicine, Pediatrics 414 1 Mills Ave ID: 00001239320 008 f# f# Quality Care Physician PHYSICIAN ASSOCIATES Orlando, 132803 -1 407-841-7290 Accepting All Patients Britton, Brooke C, MD I Pediatrics 414 N Mills Ave ID, 00002158833 009 Quality Care Physician PHYSICIAN ASSOCIATES Odando, FL 32803 +1 407-841-7290 Accepting All Patients Didea, Mark B, MD I Adolescent Medicine, Pediatrics 414 N Mills Ave ID, 00000152600 008 Quality Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32803 +1 407-841-7290 Accepting All Patients Ryan, Susan L, MD I Adolescent Medicine, Pediatrics 414 N Mills Ave ID: 00001323526 008 4# ir Quality Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32803 ,1 407-841-7290 Accepting All Patients Haber, Tanya, DO I Internal Medicine 4011 Mills Ave Ste C ID: 0001011 f# III Quality Care Physician Orlando, FL 32803 ,1 407-893-6225 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-1?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 116 of 140 Ansarl, 14,11mus S, MID 11 Pediatrics 7037 Rose Ave ID: 00002899369 007 40 4f Quallrty Care Physician NAJMUS SEVIR ANSARI Orlando, FL 32810 +1 407-286-2965 Accepting All Patients Kivett, Gerald, MD I Farnfly Practice 4711 Curry Ford Rd ID: OD000079118 006 4V 40 Quality Care Physician PRIMARY CARE SPEC ORLANDO Orlando, FL 32812 -1 407-275-9014 Accepting All Patients Mohamed, Mohamed G, MID 11 Geriatric Medicine, Family Practice 5554 Clarcona Ocoee Rd ID: 00003001691012 #0 IV Quality Care Physician FAMILY PHYSICIANS OF WINTER Orlando, FL. 32810 PARK +1 407-292-0292 Accepting All Patients Stine, Sandra R, MD I Internal Medicine 5540 E Grant St Ste A 11):00000792007 013 Quality Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32822 +1 407-361-4715 Accepting All Patients Frank, Catherine A, MD I Family Practice 5540 E Grant St Ste A ID: 00001472255 008 11# 1r Quality Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32822 +1 407-367A709 Accepting All Patients Mestre, Arsenio A, IMID I Family Practice 5540 E Grant St Ste A ID: 00000926637 011 IV ii Quality Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32822 +1407-367-4712, +1 407-65MB66 Accepting All Patients Smith -Gonzalez, April R, DO I Family Practice 5555 E Michigan St Ste 103 D: 00003498855 001 4# 40, Quality Care Physician APRIL SMITH GCN7ALEZ Orlando, FL 32822 +1 407-456-2977 Accepting All Patients https://connect.weraIly.com/searchDirectory/32708/page-I?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 117 of 140 Nguyen Min, Caroline N, MID I Internal Medicine 6 21 Columbia St Ste 201 ID: 00005158163 003 f# V Quality Care Physician ORLANDO PHYSICIANS NETWORK Orlando, FL 328D6 11 321-,6416600 Accepting All Patients Harris, Ryan K, MD I Internal Medicine 21 Columbia St ID* 00005180432 005 %V Quality Care Physician ORLANDO PHYSICIANS NETWORK Orlando, FL 32806 ,1 321-841-6600 Accepting All Patients .... . ....... — Chen, Christina Hanfod, MD I Internal Medicine 21 Columbia St Ste, 201 ID: 00002800622 011 0# (f Quality Care Physician ORLANDO PHYSICIANS NETWORK Orlando, FL 32806 'l 321-841-6600 Accepting All Patients Smuckler, David T, MD I Internal Medicine, Internal Medicine Specialist 21 Columbia St ID: C0002323634 010 Quality Care Physician Orlando, FL 32806 ,l 321-8416,300 Accepting All Patients Oxford, April L, MD I Internal Medicine 21 Columbia St Ste 201 ID: M005131809 004 f# fe Quality Care Physician Orlando, FL 32806 ,1 321-841-6600 Accepting All Patients Tsai, Li Chen C, MD I Pediatrics 1 83 Columbia St ID: 00001460468 009 1M Quality Care Physician Orlando, FL 32806 ,1 404-897-5931 Accepting All Patients Reguero, Lillian, MD I Pediatrics 94 W Underwood St ID: 00000989702 005 40 fo Quality Care Physician Orlando, FL 32806 ,l 407-122-0373 Accepting All Patients ORLANDO PHYSICIANS NETWORK NCIVIOURS DUPONT PEDIATRICS https://connect.werally.com/searchDirectory/32708/page- 1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 118 of 140 Prete, Rachel Brooke, DO � Pediatrics 92 W Miller St 10:00003192079 006 41(1, Quality Care Physician PEDIATRIX MEDICAL GROUP OF Orlando, FL 32806 FLORIDA +1 407-649-9111, 1 8E6-230 1802 Accepting All Patients ..... ......... — Garcia, Cristina P, MID I Family Practice 2863 Dell Ave ID: 00002667031001 qW JI0, Qualty Care Physician JANOVITZ PARILLO & DELGADO ME Orlando, FL 32806 ,11407-843-1620 Accepting All Patients Figueroa -Gordian, Jeannette M, MD I General Practice 2840 IN Hlawassee Rd Ste 428 IS: 00003347554 003 W# Quality Care Physician FLORIDA FAMILY PHYSICIANS Orlando, FL 32816 +1 407-292-2200 Accepting All Patients Azmat, Hiiina, MID I lnternai Medicine, Urgent Care Medicine 770 Dohona Blvc Ste A D; 00002621207 006 11# f,�VV Quality Care Physician Doltera, FL 32725 +1 386-259-9902 Accepting All Patients Pritchett, Bernice A, IMD l Family Practice 3701 Avalon Park West Blvd Ste 205 W: 00002502633 028 f4^ 11q Quality Care Physician FLORIDA HOSPITAL MEDICAL GROUP Orlando, FL 32828 ,-1 407-306-0982 Accepting All Patients Mathura, Shiva A, MD I Farnfly Practice 190 N C Richard Beall Blvd # 103 ID: W003799993 009 4# �(W, Quality Care Physician SW VOLUSIA MEDICAL ASSOCIATES Il FL 32713 +I 386-W 7-7670 Accepting All Patients Caron, Raymond F, MID I Pediatrics 453 N Kirkman Rd Ste 103 ID: 00000759569 013 qW Quality Care Physician Orlando, FL 32811 +1 407-292-4453, -1 407-292-4453 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 119 of 140 Anterior, Kattya, MD I Pediatrics 5 164 Conway Rd ID: 00DO5779076 001 f* 8# Quality rare Physician GROWING TOGETHER PED7RICS Orlando, FL 32812 ,1 407 770 1414 Accepting All Patients 71 rig uez-Fernandez, Sheydy F, MD I Pediatrics 1 5164 Conway Rd ID: 00ON844546 003 f# V Quality Care Physician GROWING TOGETHER PEDT[91CS Orlando, FL 32812 fl 407-770-1414 Accepting All Patients Dominguez, Humberto A, MD I Family Practice 70 Fox Ridge Ct ID: 00000448863 001 Debary, FL 32713 ,1 36&6684411 Accepting All Patients Elfaki, Saima H, MD I Pediatrics 8236 Lee Vista Blvd Ste I ID: 00002945755 010 Orlando, FL 32829 11 407-809-5562 Accepting All Patients Rosales, Jose J, MD I Family Practice ## f* Quality Care Physician HUMBERTO DOMINGUEZ MID f# 1p Quality Care Physician NONA PEDIATRIC CENTER 1035 Town Center Dr D: 00D01 407401 007 110 qp Quality Care Physician SW VOLUSIA MEDICAL ASSOCIATES Orange City, FL 32763 1 386-775-8229 Accepting All Patients Varghese, Vinny M, MD I Internal Medicine 2720 Rebecca Ln Ste 102 ll): 00002214892 006 to q# Quality Care Physician VINNY M VARGHESE MID Orange City, FL 32763 t1 386-228-1234 Accepting All Patients Weigand, Frederick J, MID I Family Practice 1565 Saxon Blvd Ste 102 ID: 00000,970067 010 to V Quality Care Physician SW VOLUSIA MEDICAL ASSOCIATES Deltona, FL 32725 + 1 386-917-7395 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page- 1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Terwilia ger, John IE, MD p Pediatrics Page 120 of 140 1666 Saxon Blvd Ste 202 ID: 00000112898 010 f# qP Quality Care Physician SANFORD PEDIATRIC ASSOCIATES Dellona, FL 32725 +1 386.851-0644 Accepting All Patients Narahari, Revati, MID I Pediatrics 1507 S Hiawassee Rd Ste 105 ID: 00001780619 006 40 dIt Quality Care Physician PRIMARY CARE PEDIATRICS Orlando, FL 32835 -1 407-445-9224 Accepting All Patients Lindor- Antoine, Nirva M, MD I Family Practice 6101 Lake Ellerior Dr Ste 105 ID: 0000 1909909 017 Quality Care Physician Orlando, FL 32609 +1 407-322-8645 Accepting All Patients Hunter, Patrick K, MD I Pediatrics 9 145 Narcoossee Rd Ste 103 ID: 00002446588 005 I%9 Quality Care Physician CHI LDRZN'S HEALTH ALLIANCE Orlando, FL 32827 ,1 407-243-2040 Accepting Existing Patients Only Guyton, Ginny, MID g Pediatrics 7635Ahlay Pno,, Ot Slebt) I ID: 000001042l2 W3 fo 14P Quality Care Physician WINDERMERE PEDIATRICS Oranct, ` L 328,35 ,1 40 ?iP VM0 Accopflnq All PlitivrrtG Bra in, Denise, MD I Pediatrics, 7635 Ashley Park Ot Ste 501 ID; 00002226872 005 Orlando, 132835 +1 407-297-0080 Accepting All Pnfients, ran Orin, Gene IR, MID I Family PracfiCE 10 125 IN Colonial Dr Ste 206 ID: 0000 1736664 007 Ocoee, 134761 ,1 407-523-7666 Accepting All Patients q# 4IIP Quality Care Physician WINDERMERE PEDIATRICS qk 40 Quality Care Physician GENE P ARANGORIN MID https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 121 of 140 10131 WGolonlal Dr Ste 1 ID: 00002433723 01D Quality Care Physician Ocoee, FL 34761 " 407-447 9596 Accepting All Patients Nathanson Md, Richard P, MD I Internal Medicine 10000 W Colonial Or Ste 380 ID: 00000924398 003 fo Quality Care Physician Ocoee, FL34761 +1 407-247-0526, +1 40t-29M210 Accepting All Patients - ------ ---------- Brooks, Mark G, MD I Internal Medicine 10000 W Colonial Or Ste 187 ID, 00001782464 005 q# 010 Quality Care Physician MARK G BROOKS MD Ocoee, FL 34761 ,1 407-3213-9010, +1 407-57",610 Accepting All Patients Marsell, Scott D, MD I Internal Medicine 10000 W Colonial Or Ste 487 ID; 00001482544 007 4P Quality Care Physician ORLANDO CTR INT MED/PRIM CARE Ocoee, FL 34781 -1 401-296-1922, l 407-296-1923 Accepting All Patients PHYSICIAN ASSOCIATES Middleton, Robert C, MD I Pediatrics 1132 Kelton Ave ID: 0000234D978 025 %V Quality Care Physician PHYSICIAN ASSOCIATES Ocoee, FL 34761 ,I 407-381-7360 Accepting All Patients Hernandez, Aparna, MD I Internal Medicine 6979 Vineland Rd Ste 310 ID: 00002185349 003 4p Quality Care Physician SOUTHWEST INTERNAL MED SPCI-TS Orlando, FL 32819 +1 407-345-0005 Accepting All Patients Alatriste, Anthony, MD I Family Practice I W Citrus Medica Ct ID: 0000 1463857 027 Quality Care Physician ST ANTHONYS FAMILY MEDICAL Ocoee, FL 34761 PRACTICE 1407-512-6401 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 122 of 140 Khan, Adnan A, MD 8 Internal Medicine 2716 Row Cir Ste 100 ID: 00002831932 022 1p fP Quality Care Physician ADNAN A KHAN Ocoee. FL 34761 +1 407-347-0666 Accepting All Patients PREMIER INTERNAL MEDICINE OF OCOEE Mills, William L, MID y General Practice 801 Marshall Farms Rd ID: 00000655004 003 f 1Quality Care Physician Ocoee, FL 34761 +1 407-8776280 Accepting All Patients Bolourian, Houman M D, MD I Family Practice 8014 Conroy Windermere Rd Ste 10 ID: 00002088016 022 Ift Quality Care Physician ADVENTIST HEALTH SYSTEM Orlando, FL 32835 SUNBELT +1 407-291-8975 Accepting All Patients Buswell-Char1kow, Doinald R, MD I Internal Medicine 11140 W Colonial Dr ID: 00000654245 019 %0, Quality Care Physician PHYSICIAN ASSOCIATES Ocoee, FL 34761 +1 407-677-2111 Accepting All Patients ent ell, 'Thomas H, IMD p Internal Medicine 11140 W Colonial Dr Ste 1 ID: 00000654247 013 Quality Care Physician PHYSICIAN ASSOCIATES Ocoee, FL 34761 +1 407-8776500 Accepting All Patients olas, Gerardo A, MD 1I internal Medicine 8751 Commodity Cir Ste 15 ID: 00002421222 008 ,i Quality Care Physician GLOBAL HEALTH CARE FOR ADULTS Orlando, FL 32819 +1 407-517-4827 Accepting All Patients Meares, Michael J, MD I Family Practice 8793 Commodity Cir ID: 00000029715 012 ff Quality Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32819 +1 407-351-8200 Accepting All Patients https:Hconnect.werally.com/search Directory/32708/page-1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 123 of 140 10743 Nar000ssee Rd Ste A 13 ID: 00002527335 010 Quality Care Physician TREE HOUSE PEDIATRICS Orlando, FL 32832 ,1 407-736-873.3 Accepting All Patients Javier, Kristina Maria, MD I Pediatrics 10743 Narcoosses, Rd Ste At 3 ID: 00003232173 001 %9 Quality Care Physician TREE HOUSE PEDIATRICS Orlando, FL 32832 ,-1 407-736-8733 AuceptiPig All Patients Visser, Gary C, MD I Family Practice 2658 Maguire Rd ID: 00003350925 007 f# Quality Care Physician PREMIER FAMILY & SPORTS MED Ocoee, FL 34761 ,1 407-681-9066 Accepting All Patients Langley, Adam W, MD I Family Practice 2658 Maguire ' Rd 10: 00003354072 004 1 Quality Care Physician PREMIER FAMILY & SPORTS MED Ocoee, FL 34761 ,1 407-581-9065 Accepting All Patients Francisco, Sue Ann, MD I Pediatrics 8500 Commodity Cir ID: 00003058244 015 4W sill Quality Care Physician ORLANDO HEALTH PHYSICIAN Orlando, FL 32819 GROUP +1 407-636-3200 Accepting All Patients PHYSICIAN ASSOCIATES Duany, David IM, MD I Pediatrics 8500 Commodity Cir D' OD000624885 014 Ill ff Quality Care Physician PHYSICIAN ASSOCIATES Odando, FL 32819 ,1 407-354-0717 Accepting All Patients Gonzalez, Gonzalo, MD I Internal Medicine 8958 Conroy Windermere Rd D: 00002474701 021 to f# Quality Care Physician PREMIER MEDICAL ASSOCIATES Orlando, FL 32835 +1 352-25g-21159 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 124 of 140 Blockson, Tiffany L, MD I Pediatrics 6900 Turkey Lake Rd Ste 1-5 ID: 00003184103 003 frJP Gustily Care Physician NAZIM MERCHANT MD Orlando, FL 32819 +1 407-351-5437 Accepting All Patients Robbins, Marla A, MD I Pediatrics 7051 Dr Phillips Blvd Ste 1 ID: 000001 D4273005 4# aWP Quality Care Physician PERSONAL PEDIATRICS Orlando, FL 32819 +1 407-345-9929 Accepting All Patients Baligabatiov, Eldar B, MD I Internal Medicine, Emergency Medicine 36 S Main St ID: 00002833448 017 4#, �MP Quality Care Physician CELEBRITY MEDICAL SPA Winter Garden, FL 34787 +1 407-347-9886 Accepting All Patients Velez, Tania E, MD I Family Practice 7575 Dr Phillips Blvd Ste 120 ID: 00003506114 012 Orlando, FL 32819 +1 407-530-8591 Accepting All Patients e Leon, Maria V, MID � Family Practice 7350 Sandlake Commons Blvd ID: 00002287420 006 Orlando, FL 32819 +1 407-352-9717 Accepting All Patients odic r, Luis A, MD � Family Practice 40 FV Quality Care Physician VE'_EZ FAMILY HEALTH LLC 1# �01, Quality Care Physician SOUTH WEST ORLANDO FAM IVIED 9975 Tavistock Lakes Blvd Ste 120 ID: OD001847718 014 f# ff Quality Care Physician UNIVERSITY OF CTRAL FL HEALTH S Orlando, FL 32827 +1 407-266-3627 Accepting Existing Patients Only an iolo, Mariana B, MID p Geriatric Medicine, Family Practice 9975 Tavistock Lakes Blvd Ste 160 ID; 00003376732003 ° Quality Care Physician UCF PEGASUS HEALTH Orlando, FL 32827 +1 407-266-3627 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page- I?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 125 of 140 Desal, Arnit D, MID I Urgent Care Medicine, Family Practice 9975 Tavistock Lakes Blvd Ste 220 ID: 00005169013 008 Quality Care Physician rLon]DA LIOSPITA. MEDICAL GROUP Orlando, FL 32827 ,1 407.930-7800 Accepting All Patients Falk, Ashley J, MD I Family Practice 2000 Fowler Grove Blvd R 3 ID: 00002956301017 40 f# Quality Care Physician FLORIDA HOSPITAL MEDICAL CROUP Winter Garden, Fl. 34787 +1 407-614-0528 Accepting All Patients Bendel, Sarah E, DO I Family Practice 2000 Fowler Grove Blvd rl 3 ID: CW03342556 009 10 Quality Care Physician Winter Garden, FL 34787 +1 407-614-0528 Accepting All Patients Morales, Santiago, MID I Family Practice, General Practice 6675 Westwood Blvd Ste 475 ID: 00001411284 009 4P V Quality Care Physician Orlando, FL 32821 ,1 508-475-0450 Accepting All Patients Cruz, Frances F, MD I Internal Medicine 12200 MentaSt Ste 107 ID: 00003348190 008 1# V Quality Care Physician INTERNAL MEDICINE HEALTH GROUP Orlando, FL 32837 +1 407Jr30-0787 Accepting All Patients Gonzalez -Florin, Ruben A, MID I Pediatrics 13848 Tilden Rd Ste 230 ID: 00002391556 008 W# Quality Care Physician KIDMD PEDIATRICS Winter Garden, FL 34787 ,.I 407-347-6144, 11 407.697-8500 Accerrlirjp All Rdtiei its Miller, Mandel B, MD I Family Practice 4137 Hunters Park Ln ID: 00000623365 014 f# fe Quality Care Physician PHYSICIAN ASSOCIATES Orlando, FL 32837 +1 407-856-1603 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 126 of 140 11 1111 L1111 1 11 yril 16106 1 Rd Ste 102 fa 00005151264 008 ilj1 Quality Care Physician ORLANDO PHYSICIANS NETWORK Winter Garden, FL 34737 +1 107-347-0600 Accepting All Patients Trevett, Mildred, MD I internal Medicine 2000 Cypress Crossing Dr ID: 00001846159 013 f# 10I Quality Care Physician DAVITA MEDICAL FLORIDA Orlando, FL 32837 +1 407-515-1607 Accepting All Patients JSA MEDICAL GROUP Eckert, Darlene M, MD I Pediatrics 1 e[)65 I own 1, ocid Blvd SIP, 400 ID: 00002494350 015 111# 04P, Quality Cam Physician PHYSICIAN ASSOCIATES Orlando, FL 32837 +1 407-241-5554 Accepting All Patients Lopez, Jose A, MD I internal Medicine, Family Practice 30 Remington Rd Ste 2 ID: 00002293388 1 011 V Quality Care Physician Oakland, FL 34787 +1 07-392-1919, r-I 407-483-5257 Accepting All Patients Bhattarai, Bilrendra, MD I Internal Medicine 185,90 Us Highway 441 Ste A iD: 00002957994 017 111 040 Gustily Care Physician LAKEVIEW INTERNAL MEDICINE Mritirit Dorn, FL 32757 ,1 352-735-3755 Accepting All Patients fee a, Tasneern, MD I internal Medicine 18550 Us Highway 441 Ste A ID: 00003222905 009 111* Ig§j, Quality Care Physician LAKEVIEW INTERNAL MEDICINE Mount Dora, FL 32757 +1 352 735 3755 Accepting All Patients ANeyne, Diahann M, MD I Family Practice 3264 Greenwald Way N ID: C)0D01997710 022 f# 14n Quality Care Physician Kissiri FL 34741 11 407-539-0312 Accepting All Patients https:Hconnect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 127 of 140 Gonzalez-Cortes, Glenda E, MD I Internal Medicine, Internal Medicine Specialist, Emergency Medicine 1000 E Osceola Pkwy lt):00001869258 012 qr fo Quality Care Physician PRIMARY HEALTHCARE ASSOC Kissimmee.FL 34744 +1 407-847-7910 Accepting All Patients Edwards, Samuel M, MD I Internal Medicine 750 W Plymouth Ave ID: 00000976842 008 f# Quality Care Physician Cleland, FL 32720 +1 38C-736-7244 Accepting Existing Patient,; Only Patel, Bhavna B, MD I Pediatrics 999 N Stone St Ste A ID: 00000506078 002 11# Quality Care Physician DELAND PEDIATRIC ASSOC MID Deland, FL 32720 +1 3811 Accepting All Patients Schutt-Aine, Luc -Marie R, MID I Internal Medicine 1070 N Stojip St Ste A ID: 00001856259 009 40 1# Quality Care Physician MEMORIAL REP WEST Deland, FL 32720 VOLUSIA/PROF +1 38&943-7100 Accepting All Patients Vasquez, Rene Silao, MD I Family Practice 929 N Spring Garden Ave Ste 170 ID: 00000822139 017 4# %* Quality Care Physician METCARF: OF FLORIDA Deland, ILL 32720 +1 38,6-738-9144 Accepting All Patients Denardis, Michael Ronald, DO I Obstetrics and Gynecology H�,Vlevys 2622 Simpson Rd ID: 00002748712 020 Quality Care Physician OSCEOLA COUNTY HEALTH DEPT Kissimmee, FL 34744 ,' 407-343-2050 Accepting All Patients Palazzolo, Mark R, DO I Obstetrics and Gynecology 42. 2622 Simpson Rd ID: 00002339426 032 4# 40 Quality Care Physician OSCEOLA COUNTY HEALTH DEPT Kissimmee. FL 34144 +1 407-343-2D50 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page- I?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Allicea, Teresita, IMD � Pediatrics Page 128 of 140 3070 Dye. r Blvd 10'00001816210 015 41# qR (Duality Care Physician PHYSICIAN ASSOCIATES Kissimmee FL 34741 ,I 407-93�7930 Accepting All Patients Moss, Judith A, DO I Family Practice 17327 Pagonia Dr ID: 00001689635 014 f# tIP Quality Care Physician PHYSICIAN ASSOCIATES Clermont, FL 34711 +1 407-905-6000 Accepting All Patients Martinez-Solls, Carlos, MD I internal Medicine 2577 Simpson Rd ID: 00001466826 027 f# Vp Dually Care Physician Kissimmee, FL 34744 +1 407-34"338 Accepting All Patients Davina, Eleanor F, DO I internal Medichie 3619 Lake Center Or 10: 00001360930 006 I4F Quality Care Physician ADULI MEDICINE OF LAKE COUNTY Mount Dora, FL 32757 ,1 352-383-8222 Accepting All Patients Cuevas-Bocanegra, Harry R, MD I Pediatrics ',050 W Carroll St I0:00001135221 007 0# Quality Care Physician KIDSVILLE PEDIATRICS 11 Kissimmee, FL 34741 1 407-51MO78 Accepting All Patents . . .......... Lesmes, Lilliane K, MD d Pediatrics 4880 N Highway 19a Ste 200 ID: 00000896736 005 1# ff Quality Care Physician LAKE PEDIATRICS Mount Dora. FL 32757 ,1352-589-8111 Accepting All Patients Carlson, E Thomas, MD I Pediatrics 4880 N Highway 19a Ste 200 ID: 00000494328 006 f* 401 Quality Care Physician LAKE PEDIATRICS Mount Dora, FL 32757 ,1 352-58M Ill Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 129 of 140 201 Hilda 5t Ste 14 ID: 00000624182 001 4V ff Quality Care Physician Kissimmee, FL 34741 +l 407-846-8288 Accepting All Patients Elallaoui, Sidi A, MD I Internal Medicine 505 W Vine St Ste 303 ID: 00001807602 009 #0 V Quality Care Physician Kissimmee, FL 34741 ,1 407-343-1284 Accepting All Patients Gonzales, Pillar R, MD I Pediatrics 841 E Oak St ID: 00000672483 003 Ill 1p Quality Care Physician CHILDREN'S HEALTH ALLIANCE Kissimmee, FL 34744 ,-1407-847-2050 Accepting All Patients Finlayson, William D, MD I Internal Medicine 801 N Bay St ]D: 00000385031006 Vp f# Quality Care Physician FL.CRIDA HOSPITA- MEDICAL GROUP Eustis, FL 32726 , 1352-589-6367 Accepting All Patients Nguyen, Hanson V, MD I Family Practice 2037 E No Bronson Memorial Hwy ID: 00002829225 026 40 Quality Care Physician ST CLOUD MEDICAL GROUP Kissimmee, FL 34744 ,1 407-4994911 Accepting All Patients Crouse, Roger L, MD I Internal Medicine 8()(3WOak St ID: 00001157330 028 tWqr Quality Care Physician OSCEOLA SURGICAL ASSOCIATES Kissimmee, FL 34741 +1 407-4833376 Accepting All Patients Nordquist, Clay E, MD I Family Practice 2470 E Highway 50 ID: 00003060324 012 f# Quality Care Physician NORDQUIST FAMILY MEDICAL Clermont, FL 34711 CENTER MID ,1 352-404-9940 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-I?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 130 of 140 Basfar, Sujaffia V, MD � internal Medicine 1866 Mayo Dr ID! 00002574098 007 f# V, Quality Care Physician LAKE COUNTY PRIMARY MEDICAL Tavares, FL 32778 CAPE ,1 352-508-5171 Accepting All Patents Khaznadar, Samer R, MD I Pediatrics 800 N Rose Ave ID; 00002406128 010 q# a10 Quality Care Physician Kissimmee, -L 34741 -1 407-183-7925 Accepting All Patients Mohan, Kumaran K, MD I Family Practice 1879 Nightingale Ln Ste 03 ID: 00002141250 011 4# eq7 Quality Care Physician Tavares, FL 32778 +1 952589-9090 Awepting All Patients ......................... Unyon, Cesar A, MD I Internal Medicine . 1879 Nightingale Ln Ste B1 ID: 00003480254 002 if 11P Quality Care Physician FLORIDA HOSPITAL MEDICAL GROUP Tavares, FL 32778 +1352-343-5722 Accepting All Patients Fernandez, Jose R, MD I Family Practice 300 IN John Young P"y ID: 00001764068 008 0# Quality Care Physician JMJ FAMILY PRACTICE Kissimmee, FL 34741 ,1 407-935-9012 Accepting All Patients Nguyen Casado, Kathy N, MD I internal Medicine 1920 Don Wickham Dr Ste 300 ID: 00002796172 006 40 qV Quality Care Physician JSA MEDICAL GROUP Clermont, FL 34711 ,1 352-243-0206 Accepting All Patients Thomas, Khannia E, MD I Family Practice 212 E main St ID: 00003298875 010 111# 1W Quality Care Physician Tavares, FL 32778 . 1 401 Accepting All Patients https://connectwerally, com/searchDirectory/32708/page-1?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 131 of 140 212 E Main St ID: 0000'734332 011 r Quality Care Physician CHC INC/1-EESDURC Tavares, FL 32778 '1 50"36-3663 Accepting All Patents Hernandez-Montaivo, Myriam, MD I Pediatrics 1804 Oakley Seaver Dr Ste 0 ID: 00002157341009 1* IV OLJaIItY Care Physician KIDSVILLE PEDIATRICS III Clermont, FL 34711 ,1 352-242-1021 Accepting All Patients Hameed, Ayesha, MD I Urgent Care Medicine, Family Practice 603 N Washington Ave Sle 101 ID: 00003678124 026 Quality Care Physician HEALTH FIRST MEDICAL GRP Titusville, FL 32796 ­rl 321-264-7388 Accepting All Patients Hari, Aashiv N, MD I Family Practice 825 Oakley Seaver Dr ID: 00002326042 007 f# Quality Care Physician Clermont, FL 34711 ,1 352-530-1764 Accepting All Patients Aroca, Estuardo E, DO I Family Practice 1735 E Highway 50 Ste B ID: CM02164316 022 40 4* Quality Care Physician Clermont, FL 34711 -1 352-241.0549 Accepting All Patients Thomas, Valerie 13, MD I Pediatrics 1603 Banning Beach Rd ID: 00001741684 007 Tavares, I-L 32T78 ,1 352-343-2167 Accepting All Patients Lockhart, Wendy, MD I Pediatrics SOON Washington Ave Ste 105 ID: 0000 1817337 009 TII FL 32796 ,1321-268-0267 Accepting Ali Patients fp 9 Quality Care Physician PHYSICIANS MEDICAL GROUP f# ff Quality Care Physician EREVARD HEALTH ALLIANCE https://connect.werally.com/searchDirectory/32708/page-l?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 132 of 140 63 Ailey Rd ID! 00002076684 015 f* a%p Quality Care Physician PHYSICIAN ASSOCIATES 1 8 is ljornee, FL 34747 ,I 407-9I08900 Accepting All Patients Bennett, Lorna 0, MD I Pediatrics 365 Citrus Tower Blvd Ste 104 ID: 00002524944 006 Ill tV¢ Quality Care Physician Clermont, FL 34711 11 352404-7728 Accepting All Patients Kinsella, Anthony, MID I Family Practice, General Practice 1855 Knox Mcrae Dr ID: 000016.%873 011 Quality Care Physician ROYAL OAKS MEDICAL GROUP Titusville, FL 32780 ,l 321-269-2028 Accepting All Patients Torres, Riodolfol A, MD Q Farnfly Practice 155 <,nox Wise l�Dr 10: 00001993568 W4 Quality Care Physician ROYAL OAKS MEDICAL GROUP 'Iffd:rsviile, FIL 32780 32' 2619202P Accepting All Patients Fischer-Carne, 'Tina L, MD b FarnHy Practice 126 Florida Memorial Pkwy Ste 2700 10: 00001950861 011 Ill f# Quality Care Physician MEMORIAL HEALTH SYSTEMS Now Smyrna Beach, FL 32168 +1 38&409-6871 Accepting All Patients 125 Florida Memorial Pkwy Ste 2500 113: 00003616708 005 if 4f, Quality Care Physician MEMORIAL HEALTH SYSTEMS Now Smyrna Beach, FL 32168 -1 386-409-6850 Accepting All patients Keller, Kimberly Anne, DO I Internal Medicine f 1 1 125 Florida Memorial Pkwy Ste 260D IS: 00002088153 021 1# %* Quality Care Physician MEMORIAL HEALTH SYSTEMS New Smyrna Beach, FL 32168 +1 386�4096864 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 133 of 140 Bransdorf, Richard E, MID I Internal Medicine 400 Celebration PI Ste A350 ID. 00DO1939946 015 1# 9 Quality Care Physician CELEBRATION INTERNAL MEDICINE Kissimmee, FL 34747 41 407-303-4901 Accepting All Patients Hitawala, Salma, MD I Internal Medicine 255 Citrus Tower Blvd Ste 205 ID: 00001889465 023 f* Quality Care Physician SALMA HITAWALA MID Clermont, FL 34711 ,1 352-404-7874, +1 352-988-6460 Accepting All Patients Mays, Wendellenna S, MID I Internal Medicine Hevjew', 3175 Citrus Tower Blvd Ste B ID: 00002099992 011 q# Quality Care Physician WFNDFt. LENA S MAYS MD Clermont, FL 347-11 'l 352 404 6900 Accepting All Patients Campo, Lawrence J, MD I Internal Medicine 3135 Citrus Tower EiNd ID: 00001758791 016 q# Quality Care Physician rLORIDA MEDICAL ASSOCIATES Clermont, FL 34711 ,l 352-988-620C Accepting Existing Patients Only ......... . .. . .............. . . . . — — — ------ Raguindin, Rhu-Jade M, MID I Internal Medicine 250 Harrison St ID: 00D03275766 006 111V f* Quality Care Physician NORTH BREVARD MEDICAL Titusville, FL 32780 SUPPORT '1 321 267 1424 Accepting All Patients Masid, Elba E, MID I Family Practice 4513 Old Canoe Crock Rd ID: 00003099413 001 4V Quality Care Physician CENTRAL FLORIDA FAMILY Saint Cloud, FL 34769 PRACTICE ,I 407A9B-0461 Accepting All Patients Aragon -Lopez, Martha Catalina, MD I Family Practice 1700 E Irlo Bronson Memorial Hwy ID: 00004671616 004 Yf# Quallity Care Physician ST CLOUD MEDICAL GROUP Saint Cloud, FL 34771 +1 407-891-2926 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-1?coverageType=medic... 5/7/2018 Print Search Directory I Find Care Page 134 of 140 Gonzalez, Jaime C, MD � Internal Medicine 265 tN Highway 50 ID: 00000076994 009 4P Quality Care Physician Clermont, FL 34711 +1 352394-5535 Accepting All Patients Morrow, Peter'T, MID 0 Geriatric Medicine, Internal Medicine 1600 Budinger Ave Ste D ID: 00000718427 012 tit 1VP Quality Care Physician ST CLOUD MEDICAL GROUP Saint Cloud, FL 34769 +1 407-ag2-3387 Accepting All Patients O'Malley, Martin J, MD I Internal Medicine 1600 Budinger Ave Ste D ID: OD000672811 009 qdd° Quality Care Physician lS]I- G1ILCU) miY-INCAL.. 4' F11:)@, P Saint Cloud, FL 34769 +1 407-892-3387 Accepting All Patients Meredith, James R, MD I General Practice 502 Palmetto St ID: 00003509355 009 to Quality Care Physician MDPA SOLUTIONS New Smyrna Beach, FL 32168 +1 386-957-1854, +1 386-9573810 Accepting All Patients Pejic, Branko D, MD ! Family Practice 63D5 Pleasant Ave ID: 00001901289 010 1 Quality Care Physician Cocoa, FL 32927 +1 321-638A199 Accepting Existing Patients Only Nettleton, Benjamin R, DO K Family Practice 5005 Pod St John Pkwy Ste 2200 ID: 00003061225 021 41# 0,F Quality Care Physician NORTH BREVARD MEDICAL Cocoa, FL 32927 SUPPORT +1 321-504-0556 Accepting All Patients arr sco, J s 1ph L, MD 6 Internal Medicine 26540 Ace Ave Ste 108C ID: 00001811014 014 Quality Care Physician TO YOUR HEALTH OF LAKE COUNTY Leesburg, FL 34748 +1 352-326-6281 Accepting All Patients Print Search Directory ( Find Care Diaz, Tanya 1, MD I Family Practice 511 Medical Plaza Dr Ste 101 ID: 00002435163 004 Leesburg, 134748 M1 352 728-6806 Accepting Existing Patients Only Ankoh, Peter A, MD I Internal Medicine IV V Quality Care Physician Page 135 of 140 FLORIDA HEART & VASC MULTI SPEC of 1107 W I Ave 10; 0000 1830093 014 f# 1p Quality Care Physician PETER A Al I Leesburg, FL 34748 f-I 352-728-2999 Accepting All Patients Ecklind, Jerrold R, DO I Family Practice 1004 1 14th St Ste 109 lDz 00001913412 010 f# 4P Quality Care Physician WELLNESS ON WHEELS Leesburg, 134748 ,1 352-314-6992, -1 352 508-1125 Accepting All Patients Ombogo, Anthony A, MD I Family Practice 201 N Clyde Morris Blvd Ste 240 ID: 00003411332 009 irc1110 Quality Care Physician HALIFAX HEALTHCARE SYSTEMS Daytona Beach, FL 32114 +1 386-425-4B22 Accepting All Patients Vey, Carrie G, MD I Hospice and Palliative Medicine, Family Practice 201 N Clyde Morris Blvd Ste 200 ID: 00D02825052 005 Quality Care Physician HALIFAX HEALTHCARE SYSTEMS Daytona Beach, 132114 .11 386-425-4165 Accepting All Patients Altenburg, Ellen M, MD I Adolescent Medicine, Pediatrics 1317 W Point I ID: 00001541086 019 f# li Quality Care Physician STEWARD MEDICAL GROUP Cocoa, FL 32922 +1 321636-2621 Accepting All Patients Baez, Raymond C, MD I Internal Medicine 1317 W Point Dr It): U0001 238905 016 40 %9 Quality Care Physician STEWARD MEDICAL GROUP Coma, FL 32922 +1 321-636-2621 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page-l?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 136 of 140 Quirguis, Hany S, MID U lnternal Medicine 1317W Point Dr I D: 00002335890 009 f# 1�q Quality Care Physician S1 i 1 W Dl('AGROUP Cocoa FL 32922 ,1 3211i3Cr2621 Accepting All Patients IPsarakis, Mark S, MD I Internal Medicine 1317W Point Dr ID: 00001157590 017 Quality Care Physician STEWARD MEDICAL GROUP Cocoa, FL 32922 +1 321-636-2621 Accepting All Patients Atkinson, Andrew M, MID � lnternall Medicine 1317 W Point Dr ID: 00000490424 023 ff ltP Quality Care Physician C"I"[WAi1l) VIED11,',AL G 8GLV Cocoa FL 32922 +1 321'�36-2621 Accepting All Patients Hernandez, Gabriel A, MD I Pediatrics 1317 W Point Dr ID: 00000486105 017 t Quality Care Physician STEWARD MEDICAL GROUP Cocoa, FL 32922 +1 321-636-2621 Accepting All Patients . . .............. —.— Wasil, Bushra Irarn, MD I Family Practice 1317 VV Point Dr ID: 00002916594 015 �IV Quality Care Physician S]J EWARD JADINCAL 13RC11)l1 Cocoa, FL32922 -1321-63&2621 Accepting All Patients Cohen, Hezi, IMD � Family Practice 305 Memorial Medical Pkwy Ste 207 ID: 00002097299 013 Quality Care Physician MEMORIAL HEALTH SYSTEMS Daytona Beach, FL 32117 ,11386-231-3525 Accepting All Patients Fischer, James IP, MD I internal Medicine 305 Memorial Medical Pkwy Ste 201 ID: 00001648014 022 Quality Care Physician POLIN RUTLEDGE & FISCHER MD Daytona Beach, FL 32117 ,1 38&231-3414 Accepting All Patients Print Search Directory I Find Care Page 137 of 140 Niewaid, Andrew J, MD I Family Practice 305 Memorial Medical Pkwv Ste 502 ID: 00002810038 011 111# W# Quality Care Physician MEMORIAL HEALTH SYSTEMS Daytona Beach, -L 32117 +j 38C,231 3570 Accepting All Patients Son!, Ambica, MD I Family Practice 106 Park Place Blvd Ste C ID: 00003382184 013 f# Quality Care Physician BONI FAMILY PRACTICE Davenport, FL 33837 ,1 863-588-4775 Accepting All Patients Kahlon, Harpreet, MD I Pediatrics 12 101 Park Place Blvd Ste A ID: 00001683243 010 11# 4V Quality Care Physician RAINBOW PEDIATRICS Davenport, FL 33837 -1 863-4212799 Accepting All Patients Ahmed, Saiman, IVID I Adolescent Medicine, Infectious Disease Medicine, Pediatric Infectious Disease Medicine, Pediatric Rheumatology, Pediatrics, Emergency Medicine 200 Booth Rd Ste A ID: 00001885479 029 Quality Care Physician HALIFAX HEALTHCARE SYSTEMS Or mend Beach, FL 32174 0 38C,42&1212 Accepting All Patients Henriques, Ricardo A, MD I Internal Medicine 503 Delannoy Ave I D! 00000407179 005 1# f# Quality Care Physician R A i-ENRIQUES MID Cocoa, FL 32922 +1 321-631-6995 Accepting Existing Patients Only Siddharthan, Renuka, MD I Hospice and Palliative Medicine, Internal Medicine 1688 W Granada Blvd Ste 2A ID; 00000870593 006 40 IV Quality Care Physician HA[.)FAX HEALTHCARE SYSTEMS Ormond Brach, FL 32174 , I 38CA254460 Accepting All Patients Arnold, Arthur A, MID I Aerospace Medicine, General Practice ID: 00002999205 003 MILARN CORP https://connect.werally.com/searchDirectory/32708/page-1?coverageType=medic... 5/7/2018 ""�rint Search Directory I Find Care '__ 138 of 141 l395 114 t'.doultle ay Hwy y Pura :Wl Ancxi,pting AU Rwtler)s Quality Care Physician Nler1tt N: and, I-tl... A.91?^53 +13 V 33 5u"715, B i 1005,aV8,+1 31 V fi1d-0150 Aziz, Nabil W, MD I Internal Medicine 1257 Florida Ave S ID: 00001274833 004 4# 44y Quality Care Physician Rockledge, FL 32955 +1 321-631-1007 Accepting All Patients Gandhi, Drashti M, MD I Family Practice 410 Lionel Way ID: 00005977006 002 f# f#� Quality Care Physician Davenport, FL 33837 +1 86&419-2420 Accepting All Patients Perez, Ruben E, MID � Internai Medicine 410 Lionel Way Ste 320 ID: 00000147057 013 f# 1# Quality Care Physician HAINES CITY HMA PHYSICIAN Davenport, FL 33837 MANAGEMENT +1 863-419-2420 Accepting All Patients Townsend, ichael E, MID I Internal Medicine 335 Clyde Morris Blvd Ste 290 ID: 00001036872 019 ff Quality Care Physician MEMORIAL HEALTH SYSTEMS Ormond Beach, FL 32174 +1 33E672,3219 Accepting Existing Patients Only shiie, (Francis A, MID g Farn lly Practice 1007 Beverly Dr Ste C ID: 00002031677 004 MP Quality Care Physician Rockledge, FL 32955 +1 321-636-1834 Accepting All Patients ahedi, Mina B, MID d Internal Medicine 1050 W Granada Blvd Ste 2 ID: 00001969042 007 4V V Quality Care Physician MEMORIAL HEALTH SYSTEMS Ormond Beach, FL 32174 +1 386-231 3050, +1 386-676-4410 Accepting All Patients MINA B 7AHEDI MD Scheerer, Rachel G, MD I Family Practice https://connect.wera I ly.com/searchDirectory/32708/page-1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 139 of 140 1050 WCranacla Blvd Ste 2 ID: 00005140658 007 40 4p Quality Care Physician MEMORIAL HEALTH SYSTEMS Ormond Beach, FL 32174 +1 386-231-3050 Accepting All Patients Kanellophoulos, Nikolaos, III I Family Practice Hrrviewp 255 Borman Or F1 2 ID, 00003488098 004 f# V Quality Care Physician HEALTH FIRST MEDICAL GRP Merrill Island, FL 32953 +1321-434-1640 Accepting All Patients Rigdon, Randall B, MD I Internal Medicine 270 N Sykes Creek Pkwy Ste 202 ID: 00002036260 005 f# f* Quality Care Physician RANDALL B HIGDON MD Morrill Island, FL 3295�3 +1 321-454-2468 Accepting All Patients Burress, John D, DO I Family Practice 607 Highway 466 1 D: 00002097061 011 10 V Quality Care Physician FAMILY HEALTH ENTERPRISES Lady Lake, FL. 32159 -1 362-259-7994 Accepting All Patients Philips, Lyudmila, MD I Family Practice W Commerce Pkwy Ste 120 ID: 000036'708'3 005 Quality Care Physician HEALTH FIRST MEDICAL GRP Rockledge, FL 32955 ,1 321-4346555 Accepting All Patients Brandes, Wayne S, DO I Family Practice 389 Commerce Pkwy ID: 00005918922 002 0# qP Quality Care Physician HEALTH FIRST MEDICAL GRP okledge, FL 32955 121-242-8790 Accepting Al I Patients Escandon, Juan Carlos, MD I Sleep Study Medicine 111 Webb Dr ID: 00003163702 006 Quality Care Physician PICHARDO CLINIC Davenport, FL 33837 -1 863-421-9447 Accepting All Patients https://connect.werally.com/searchDirectory/32708/page- 1?coverageType= medic... 5/7/2018 Print Search Directory I Find Care Page 140 of 140 U.) J 15p[ wapti% Ste 113- 10 11 I D 00(WW1378"dH f# 14V Quality Care Physician NORMAN 8 NOVIS MD Lady Lako, r1. 321154 1 11 7619 Ar,Cepiwg AV Patients Farmer, Danny M, MD I Internal Medicine 570 Memorial Cir Ste 110 ID:00000458081 011 4W %Y Quality Care Physician Ormond Beach, FL 32174 +1 385-676-3959 Acrepling All Patients Turner, John B, MD � internal Medicine, FarNil' Practice, General Practice 41 Rosewood Ave ID: 00000501990 004 f# JIF Quality Care Physician Ormond Beach, FL 32174 +1 38656"400 Accepting Existing Patients Only The choice of provider is yours. This site is for informational purposes only. It is not a substitute for rnedical, behavioral health, or health care advice. This directory does not recommend a particulair provider or type of behavioral health, medical or health care. IIf you believe YOU are experiencing a medical ernergency, please call 911 Before scheduling an appointment or receMng services, please check with YOUr provider to confirm available ser0ces, and if the, provider its participating. The directory is up&-ited weekly. If you -think any information in the directory is inaccurate, let us know by clicking on 'Report Incorrect Information'ori that provider's page, or calling the number orl your health plan member I[) card. 'The cost estimates on this page are based on average charges for in --network providers within a specific geographic market.Your actual costs may be higher or cower than these cost estimates as a result of changes in the provider's contract or, status, additional services that arise during the course of treatment, or for other reasons. Check with your provider and health plan details -to confirrn the costs that you may be charged for a service or procedure. You are responsible -for costs that are not covered and for getfing any pre-authodzations or referrals required by your health plan. Neither payments nor benefits are guaranteed. The network of doctors, facilities and medical groups is always changing. Before making an appointrrient, please check that the doctor, -facility, or rnedicat group is in your network. https://connect.werally.com/searchDirectory/32708/page-1?coverageType=medic... 5/7/2018 Print Search Directory I Find Care UnitedHea th Results for Hospitals 41 In -Network Facilities found within 50 miles of 32708 Selected Sort/Filters Tier 1 Hospitals Page 1 of 6 05.07.2018 Choice Plus Our network of doctors and facilities is always evolving. Before making an appointment, please check that the doctor, facility, or medical group is in your network. To find out, you can ask your doctor or facility or you can check on myuhc.com Oviedo Medical Center I General Hospital 8300 Red Bug Lake Rd Accepting All Patients Oviedo, FL 32765 +1 407-890.2273 Orlando Health South Seminole Hospital I General Hospital 555 W State Road 434 Accepting All Patients Longwood, FL 32750 +1 407-767-1200 Orlando Health Uf Health Cancer Ctr I General Hospital 555 W Slate Road 434 Accepting All Patients Longwood, FL 32750 +1 407-767-1200 Arnold Palmer Hsptl Pdiatrc Rehab Srvc I General Hospital 1555 Howell Branch Rd Ste B1 Accepting All Patients Winter Park, FL 32789 +140764"111 Florida Hosp Altamonte I General Hospital 601 E Altamonte or Accepting All Patients Altamonte Springs, FL 32701 ,1 407303-2200, + 1 407-897-1969 Winter Park Memorial Hospital I General Hospital 200 N Lakemont Ave Accepting All Patients Winter Park, FL 32792 -,1 407-646.7000 https://connect.werally.com/facilitiesDirectory/32708/page-1?coverageType=medi... 5/7/2018 Print Search Directory I Find Care Florida Hospital Lake Mary I General Hospital 950 Rinehart Rd Accepting All Patients Lake Mary, FL 32746 +1 321.363-0400 Central FI Regional Hospital I General Hospital 1401 W Seminole Blvd Accepting Ail Patients Sanford, FL 32771 +1 407-321-4500 Florida Hosp Med Center I General Hospital 601 E Rollins St Accepting All Patients Orlando, FL 32903 +1 407-303-6611 Select Specialty Hospital Orlando North I General Hospital 2250 Bedford Rd Accepting All Patients Orlando, rL 32803 +1 407303-7869 Florida Hospital East I General Hospital 7727 Lake Underhill Rd Accepting All Patients Orlando, FL 32822 +1 4073038110 Orlando Health Heart Institute I General Hospital 1222 5 Orange Ave Accepting All Patients Orlando, FL 32806 +i 407 650.3800 Orlando Health Orlando Regional Med Cntr I General Hospital 52 W Underwood St Accepting All Patients Orlando, FL 32806 +1 321-8415111 Orlando Health Arnold Palmer Hospital Fo I General Hospital 50 Sturtevant St Accepting All Patients Orlando, FL 32806 +1 407-65D3800 Orlando Hlth Winnie Palmer Hsp For W & B I General Hospital 83 W Miller St Accepting All Patients Orlando, FL 32806 -1 407-6503800 Page 2of6 https://connect.weraIly.com/faciIitiesDirectory/32708/page-1?coverageType=medi... 5/7/2018 Print Search Directory I Find Care Florida Hospital Apopka I General Hospital 2100 Ocoee Apopka Rd Accepting All Patients Apopka, FL 32703 +1 407-609.7000 Florida Hospital Fish Memorial I General Hospital 1055 Saxon Blvd Accepting All Patients Orange City, FL 32763 +1 386-851.5090, +1 386-917-5000 Orlando Health -Health Central Hosp I General Hospital 10000 W Colonial Dr Accepting All Patients Ocoee, FL 34761 +1 407-29F 1000 Halifax Health I General Hospital 3300 E Halifax Crossing Blvd Accepting All Patients Deltona, FL 32725 +1 38&. 54-4000 Orlando Health Dr P Phillips Hosp I General Hospital 9400 Turkey Lake Rd Accepting All Patients Orlando, FL 32819 +1 407-351-8500 Nemours Childrens Hospital I General Hospital 13535 Nemours Pkwy Accepting All Patients Orlando, FL 32827 +1 407-567.4000 Florida Hospital Winter Garden I General Hospital 2000 Fowler Grove Blvd Accepting All Patients Winter Garden, FL 34787 +1 407-614-0500, +1 407-614-1527 Florida Hospital Deland I General Hospital 701 W Plymouth Ave Accepting All Patients Deland, FL 32720 +1 386-9434670 Florida Hosp Kissimmee I General Hospital Page 3of6 https://con nect.wera I ly. com/faci l itiesDi rectory/32708/page-1?coverageType= med i ... 5/7/2018 Print Search Directory I Find Care 245D N Orange Blossom Trl Accepting All Patients Kissimmee, FL 34744 +1 40-1-8464343, +1 407-897.5550 Osceola Regional Medical Center I General Hospital 700 W Oak St Accepting All Patients Kissimmee. FL 34741 +1 407-845.2266 Florida Hospital Waterman I General Hospital 1000 Waterman Way Accepting All Patients Tavares, FL 32778 +1 352-2533333, +l 8OM33-2243 Parrish Medical Center I General Hospital 951 N Washington Ave Accepting All Patients Titusville, FL 3279B +1 321-268-6111, +1 321-268-6333 Orlando Health South Lake Hospital I General Hospital 1900 Don Wickham Dr Accepting All Patients Clermont, FL 34711 +1 352394.4071 Florida Hosp Celebration I General Hospital 400 Celebration PI Accepting All Patients Celebration, FL 34747 +1 407303-0500, +1 407.303.4000, +1 407-894-4405 St Cloud Regional Medical Center I General Hospital 2906 17th St Accepting All Patients Saint Cloud, FL 34769 +1 407-892-2135 Leesburg Regional Medical Ctr I General Hospital 3631 W Burleigh Blvd Accepting All Patients Tavares, FL 32778 +1 352-343-1811 Florida Hospital New Smyrna I General Hospital 401 Palmetto St Accepting All Patients New Smyrna Beach, FL 3216E +1 386-4245000, +1 386-424-6540 Page 4of6 https: //connect.wera I ly. com/faci I itiesDi rectory/32708/page-1?coverageType= med i... 5/7/2018 Print Search Directory I Find Care Poinciana Medical Center I General Hospital 325 Cypress Pkwy Accepting All Patients Kissimmee, FL 34759 +1 407-53D-2000 Florida Hospital Memorial Medical Center I General Hospital 301 Memorial Madical Pkwy Accepting All Patients Daytona Reach, FL 321 V +1 386.6766000, +1 888676.2219 Heart Of Florida Regional Medical Center I General Hospital 40100 Highway 27 Accepting All Patients Davenport, 7L33637 +1 863-422-4971,+1 B77-834.0010 Steward Rockledge Hospital I General Hospital 110 Longwood Ave Accepting All Patients Rockledge, FL 32955 +1 321-636-2211 Florida Hospital Oceanside I General Hospital 264 S Atlantic Ave Accepting All Patients Ormond Reach, FL 32176 +1 386-586-2000, +1 386672-4161, +1 88"7&2219 Villages Regional Hospital I General Hospital 1451 El Camino Real Accepting All Patients Lady Lake, FL 32159 +1 800.6453055 Winter Haven Hospital I General Hospital 1901 Us Highway 27 N Accepting All Patients Haines City, FL 33844 +1 863-421-9801 Viera Hospital I General Hospital 8745 N Wickham Rd Accepting All Patients Melbourne, FL 32940 +1 321-434-9000, +1 321434-9000 Cape Canaveral Hospital I General Hospital 701 W Cocoa Beach Cswy Accepting All Patients Cocoa Beach, FL 32931 +1 321-799-71 11 Page 5 of 6 https://connect.werally.com/facilitiesDirectory/32708/page-1?coverageType=medi... 5/7/2018 Print Search Directory I Find Care Page 6 of 6 The choice of provider is yours. This site is for informational purposes only. It is not a substitute for medical, behavioral health, or health care advice. This directory does not recommend a particular provider or type of behavioral health, medical or health care. If you believe you are experiencing a medical emergency, please call 911. Before scheduling an appointment or receiving services, please check with your provider to confirm available services, and if the provider is participating. The directory is updated weekly. If you think any information in the directory is inaccurate, let us know by clicking on 'Report Incorrect Information' on that provider's page, or calling the number on your health plan member ID card. The cost estimates on this page are based on average charges for in -network providers within a specific geographic market. Your actual costs may be higher or lower than these cost estimates as a result of changes in the provider's contract or status, additional services that arise during the course of treatment, or for other reasons. Check with your provider and health plan details to confirm the costs that you may be charged for a service or procedure. You are responsible for costs that are not covered and for getting any pre -authorizations or referrals required by your health plan. Neither payments nor benefits are guaranteed. The network of doctors, facilities and medical groups is always changing. Before making an appointment, please check that the doctor, facility, or medical group is in your network. https://connect.wera lly. com/facil itiesDi rectory/32708/page-1?coverageType= medi... 5/7/2018 Florida Municipal Insurance Trust City of Winter Springs Rate Quote for Dental Benefit Coverage Renewal Rates - Delta Dental Employer Paid PPO 1000 10/1/2018 - Contract Type Enrollment 9/30/2019 Monthly Premium Annual Premium Single 59 $29.08 $1,715.72 $20,588.64 EE + Spouse 16 $58.28 $932.48 $11,189.76 EE + Children 6 $61.78 $370.68 $4,448.16 Family 22 $95.29 $2,096.38 $25,156.56 Total 103 $5,115.26 $61,383.12 Renewal Rates - Delta Dental Employer Paid PPO 1500 10/1/2018 - Contract Type Enrollment 9/30/2019 Monthly Premium Annual Premium Single 59 $30.61 $1,805.99 $21,671.88 EE + Spouse 16 $61.35 $981.60 $11,779.20 EE + Children 6 $65.03 $390.18 $4,682.16 Family 22 $100.30 $2,206.60 $26 479.20 Total 103 $5,384.37 $64,612.44 Renewal Rates - Delta Dental Employer Paid PPO 2000 10/1/2018 - Contract Type Enrollment 9/30/2019 Monthly Premium Annual Premium Single 59 $31.83 $1,877.97 $22,535.64 EE + Spouse 16 $63.80 $1,020.80 $12,249.60 EE + Children 6 $67.63 $405.78 $4,869.36 Family 22 $104.31 $2,294.82 $27,537.84 Total 103 $5,599.37 $67,192.44 Renewal Rates - Delta Dental Employer Paid DHMO 10/1/2018 - Contract Type Enrollment 9/30/2019 Monthly Premium Annual Premium Single 59 $14.22 $838.98 $10,067.76 EE + Spouse 16 $24.74 $395.84 $4,750.08 EE + Children 6 $30.43 $182.58 $2,190.96 'Family 22 $38.96 $857.12.....—___ ............. $10,285.44 q^ Total 103 $2,274.52 $27,294.24 Plan Benefit Highlights for: Florida Municipal Insurance Trust(FMIT) Group No: 18430 ($1000 Max) Primary enrollee, spouse (includes domestic partner) and eligible dependent children to the end of the calendar year dependent turns Deductibles waived for Diagnostic Maximums $1,000 per person each plan year D & P counts toward maximum? No I Waiting Period(s) _Bas�ne �nefits Pros I thodontics Orthodontics R None ie one None E1,114 1 11 _1.___­­.­­­­­_ Delta Dental PPO dentists" __ . ... ... ... Non -Delta Dental PPO dentists** Diagnostic & Preventive Exams, cleanim�, Basic Services 80% 80% Covered Under Basic Services Periodontics (gum treatment) 80% 80% Covered Under Basic Services Oral Surgery 80% 80% Covered Under Basic Services Major Services Crowns, inlays, onlays and cast 50% 50% restorations Orthodontic Benefits 50% 50% Orthodontic Maximums $1,000 Lifetime $1,000 Lifetime imitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement isbased onDelta Dental maximum contract allowances and not necessarily each dentist's submitted fees. Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for non -Delta Dental dentists. Delta Dental Insurance Company Customer Service Claims Address 1130 Sanctuary Parkway, Suite 600 800-521-2651 P.O. Box 1809 A|phanatto, G/\3UODB Alpharetta, GA 30023-1809 deltadentalins.com This benefit information is not intended or designed to replace or serve as the plan's Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company's benefits representative. no_oo/C_rp0_2o0L_(nev, 04103n01e) Plan Benefit Highlights for: Florida Municipal Insurance Trust (FMIT) Group No: 18430 ($1500 Max) Primary enrollee, spouse(includes domesticpartner) and eligible dependent children to the end of the calendar year dependent turns ace26 Deductibles $50 per person / $150 per family each plan year _ ..... Deductibles waived for Diagnostic & Preventive (D & P) and Yes Orthodontics? Maximums $1,500 per person each plan year ............ D & P counts toward maximum? No Waiting Period(s) Basic Benefits Major Benefi-ti-I Prosthodontics Orthodontics None t None None None w PPO *.... Non -Delta Dental PPO „T �lJI YNHI NWIY%lN d i1� � ➢IIY ... .� ,.,u„ dentists dentists" Diagnostic &Preventive Services (D a P) 100 % 100 % Exams, cleanin_9s, x-rays and sealants — _ _ ......... ..... Basic Services 80 % 80 % Fillings Endodontics (root canals) 80 % 80 % Covered Under Basic Services Periodontics (gum treatment) 80 % 80 % Covered Under Basic Services m .�..............�.�........ ... ..... ....... ............. Oral Surgery 80 % 80 % Covered Under Basic Services ..............._._._._._._._�WW.._._w,,,............,.___---------- Major Services Crowns, inlays, onlays and cast 50 % 50 % restorations PBndtes.... od..on..... ....tics .......................................................................... ..... .......... 50 % 50 and dentures Orthodontic Benefits 50 % 50 % Dependent children to age 19 Orthodontic Maximums $1,000 Lifetime $1,000 Lifetime Limitations or waiting periods may apply for some benefits; some services may� excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist's submitted fees. Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for non -Delta Dental dentists. Delta Dental Insurance Company Customer Service Claims Address 1130 Sanctuary Parkway, Suite 600 800-521-2651 P.O. Box 1809 Alpharetta, GA 30009 Alpharetta, GA 30023-1809 deltadentalins.com This benefit information is not intended or designed to replace or serve as the plan's Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company's benefits representative. HLT_DDI C_P PO_2C0 L_(Rev. 04/03/2018) v� H TJT V H LL LLI Z W M Plan Benefit Highlights for: Florida Municipal Insurance Trust (FMIT) Group No: 18430 ($2000 Max) �'�� °�"" Prima enrollee, spouse includes domestic partner) and eligible �, � � � r �y rY P (� p ) 9� dependent children to the end of the calendar year dependent turns a, a 26 Deductibles $50 per person / $150 per family each plan year Deductibles waived for Diagnostic & Preventive (D & P) and Yes Orthodontics? Maximums $2,000 per person each plan year D & P counts toward maximum? No Waiting Period(s) Basic Benefits Major Benefits Prosthodontics Orthodontics None None No None ?N 12,41. 111'�=Deltdenttsl Dental PPO *PPONn-Delta dentists**.....__......__ Diagnostic & Preventive _._........___.._.___._.__.._._, __......._,_� Services (D & P) 100 % 100 % Exams, cleanings,_x—rags and sealants Basic Services 80 % 80 % Fillings Endodontics (root canals) 80 % 80 % Covered Under Basic Services ......... ......... - Periodontics (gum treatment) 80 % 80 % Covered Under Basic Services Oral Surgery U 80...�/o....................................................�W�W�W...,�W�W.......�.�.�.�.�._------ - 80 % e der Basic Services m..-..------...----------m�.m.... _m_...,.,�e...m.� _.e.���..���.... �.........� �. � ��....._..�....�� �.�.�.�.� �...e.ee�w_ Major Services Crowns, inlays, onlays and cast 50 % 50 % restorations Prosthodontics 50 % „ 50 % Bridges and dentures,,,,,,,,,,,,,,,m,,,mm.,,,,.,.......,,,.,. �... _ Orthodontic Benefits 50 % 50 Dependent children to age 19 - - - Orthodontic Maximums $1,000 Lifetime .........w__ $1,000 Lifetime Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist's submitted fees. Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for non -Delta Dental dentists. Delta Dental Insurance Company Customer Service Claims Address 1130 Sanctuary Parkway, Suite 600 800-521-2651 P.O. Box 1809 Alpharetta, GA 30009 Alpharetta, GA 30023-1809 deltadentalins.com This benefit information is not intended or designed to replace or serve as the plan's Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company's benefits representative. H LT_D D I C_PPO 2C O L_(Re v. 04/03/2018 ) H Li J r= V_ 2 H U. W Z W m SCHEDULE A Description of Benefits and Copayments The Benefits shown below are performed as deemed appropriate by the attending Contract Dentist subject to the limitations and exclusions of the Program. Please refer to Schedule B for further clarification of Benefits. Enrollees should discuss all treatment options with their Contract Dentist prior to services being rendered. Text that appears in italics below is specifically intended to clarify the delivery of benefits under the DeltaCare USA program and is not to be interpreted as CDT-2017 procedure codes, descriptors or nomenclature that are under copyright by the American Dental Association. The American Dental Association may periodically change CDT codes or definitions. Such updated codes, descriptors and nomenclature may be used to describe these covered procedures in compliance with federal legislation. ENROLLEE CODE DESCRIPTION PAYS D0100-DO999 I. DIAGNOSTIC D0120 Periodic oral evaluation - established patient.................................................................................... No Cost D0140 Limited oral evaluation - problem focused........................................................................................ No Cost D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver ......................... No Cost D0150 Comprehensive oral evaluation - new or established patient................................................................. No Cost D0160 Detailed and extensive oral evaluation - problem focused, by report ....................................................... No Cost D0170 Re-evaluation - limited, problem focused (established patient; not post -operative visit) ................................. No Cost D0171 Re-evaluation - post -operative office visit......................................................................................... $5.00 D0180 Comprehensive periodontal evaluation - new or established patient........................................................ No Cost D0190Screening of a patient................................................................................................................ No Cost D0191 .......................... Assessment of a patient....................................................................... ............. No Cost D0210 Intraoral - complete series of radiographic images - limited to 1 series every 24 months ............................... No Cost D0220 Intraoral - periapical first radiographic image.................................................................................... $4.00 D0230 Intraoral - periapical each additional radiographic image...................................................................... $2.00 D0240 Intraoral - occlusal radiographic image............................................................................................ No Cost D0250 Extraoral - 2D projection radiographic image created using a stationary radiation source, and detector ............. No Cost D0251 Extraoral posterior dental radiographic image................................................................................... No Cost D0270 Bitewing - single radiographic image.............................................................................................. No Cost D0272 Bitewings - two radiographic images.............................................................................................. No Cost D0273 Bitewings three radiographic images.............................................................................................. No Cost D0274 Bitewings - four radiographic images - limited to 1 series every 6 months ................................................. No Cost D0277 Vertical bitewings - 7 to 8 radiographic images................................................................................. $20.00 D0330 Panoramic radiographic image...................................................................................................... $45.00 D0415 Collection of microorganisms for culture and sensitivity....................................................................... No Cost D0425 Caries susceptibility tests............................................................................................................ No Cost D0460Pulp vitality tests....................................................................................................................... No Cost D0470Diagnostic casts........................................................................................................................ No Cost D0472 Accession of tissue, gross examination, preparation and transmission of written report - available only when performed in conjunction with a covered biopsy................................................................................ No Cost D0473 Accession of tissue, gross and microscopic examination, preparation and transmission of written report - available only when performed in conjunction with a covered biopsy ....................................................... No Cost D0474 Accession of tissue, gross and microscopic examination, including assessment of surgical margins for presence of disease, preparation and transmission of written report - available only when performed in conjunction with a coveredbiopsy......................................................................................................................... No Cost D0601 Caries risk assessment and documentation, with a finding of low risk - 1 every 3 years ................................ No Cost D0602 Caries risk assessment and documentation, with a finding of moderate risk - 1 every 3 years ......................... No Cost D0603 Caries risk assessment and documentation, with a finding of high risk - 1 every 3 years ............................... No Cost D0999 Unspecified diagnostic procedure, by report - includes office visit, per visit (in addition to other services) ........... $5.00 D1000-D1999 II. PREVENTIVE D1110 Prophylaxis cleaning - adult - 1 D1110, D1120 or D4346 per 6 month period ............................................. No Cost D1110 Additional prophylaxis cleaning - adult (within the 6 month period).......................................................... $45.00 D1120 Prophylaxis cleaning - child - 1 D1110, D1120 or D4346 per 6 month period ............................................. No Cost D1120 Additional prophylaxis cleaning - child (within the 6 month period).......................................................... $35.00 D1206 Topical application of fluoride varnish - 1 D1206 or D1208 per 6 month period ........................................... No Cost D1208 Topical anplication of fluoride - excludino varnish - 1 D1206 or D1208 ner 6 month nerind .......... ................... No Cost D1310 Nutritional counseling for control mfdental disease ............................................................................. MoCost U1320 Tobacco counseling for the control and prevention o[oral disease .......................................................... MnCost D1350 Oral hygiene instructions ------------------.------------------NoCom D1351 Sealant 'pertonth-linitedbopemanontmolars through age /5 -------------------.. No Cost D1352 Preventive resin restoration in a moderate to high caries riskcatient-permanenthooth-limited to permanent molars through age 15 .-------------.—..--------....----------..NoCom D1353 Sealant repair - per tooth - limited /opermanent molars through age Y5................................................... NoCost D1354 Interim caries arresting medicament application - / per 6month period ................................................... No Cost O1510 Spmc*mpintainav-fixed-unilatend --------------------.----------.. No Cost D1515 Space maintainer - fixed -bilateral ---------------.-----------------NnCoe D1520 Gpaoemaintainer-namovable-umUatem| ............._------.—.---_....--------.NoCoa D1525 Spauamaintainer-mmovobe-bilatem| -----.......................................................................... No Cost D1550 Re -cement or re -bond space maintainer .................. $12.00 D1555 Removal offixed space maintainer ---------.—.---------.............................. $12.00 D2$00-D2999 111.RE8TOR4TPVE Includes polishing, all adhesives and liners and acid etch When there are more than six crowns in the same treatment plan, an Enrollee may be charged an additional S125.00 per crown, beyond the 0hunit. Replacement of crowns, inlays and onlays requires the existing restoration /nDe5+ years old. ~Name brand, labprocessed crowns1pontics producedmmugh specialized*sohn are material upgrades.The Contract Dentist may charge an additional fee not to exceed $325.00 in addition to the listed Copayment. Refer to /m,mammnn/nenenm*wfor onuomva/mm,moxon D2140 Amalgam ' one surface, primary orpermanent ........................................... D2150 Amalgam ' two surfaces, primary orpermanent .......................................... O2180 Amalgam ' three surfaces, primary orpermanent ........................................ D2161 Amalgam ' four or more surfaces, primary o/permanent ----------. D2330 Reon-baoodonmpuahm-onm surface, anterior ........................................... D2331 Resin -based composite - two surfaces, anterior .......................................... D2332 Resin -based composite - three surfaces, anterior ........................................ D2335 Resin -based composite - four or more surfaces or involving incisal angle (anterior) D2390 Resin -based composite crown, anterior ..................................................... D23A1 Resin -based oompuekm-one surface, posterior .......................................... D2392 Resin -based compoahe-k*o surfaces, posterior ......................................... D23S3 Resin -based cnmposite-threeeurfaoea posterior ...... .............................. D2394 Resin -based composite - four o,more surfaces, posterior .............................. D25iO Inlay ' metallic ' one surface ... —.......................................................... Q252O Inlay- metallic - two surfaces --------.._....._......~.--. Q253OInlay ' metallic ' three ormore surfaces ...... ............................................. D25420nlay'metallic - two surfaces ................................. ............................. D2543Onlay-metallic three surfaces ............................................................. D2544Dnlay metallic - four ormore surfaces .................................................... D281O Inlay - - one surface* .................................................... D262OInlay - - two surfaces* ................................................... D2030 Inlay - -thremormore surfaces* ..... ................................ O2642Onlay' - two surfaces* .................................................. D2G43 Onlay' ' three surfaces* ---.---..-----.—.—.. D2644 Onlay'porcelain/ceramic ' four mmore surfaces* ......... ........................... O2650 |nloy-roon-bmood composite -oneaurfaoe ............................................... D2651 |nby-naon-baoadoompooite-twmouMaoee ............................................. V2652 Inlay resin -based composite ' three ormore surfaces ................................. D2662 Onlay- resin -based compuaite-Vwu muManon ............................................ D2663 Onlay-mon-basedoompoaite-dhaeaurfauen --___........................... D2084 Omlay-mnin-bmeodoompovdm-fom,nrmpre surfaces ................................. D2710 Crown 'resin -based composite (indirect) ................................................... D2712 Crown '% resin -based composite (indiroct)......... ..................................... D2720 Crown ' resin with high noble metal -------.......-------. ...................................... NoCost .................................... moCost -—.---------- NuCost ......... .......................... NoCost .......----------$280O —.~----------'$35lN _...`~.._.~._. $45.00 ...-----.----.— $75l* ...... ............................. $SOlN ..................................... $65.00 ..................................... $75.00 --'---------- *90.00 -------.-----*115l0 ............... ..................... $210IN ..~...--------.$22Ol0 .................................... ......................................$31O{N .....----.----.. $325.08 .....................................*335.0O ....------.----*B18.00 --.----'-----.$335.0O ~^--------.---.*300.0O ----------'—..$395.0O ------------.$425.0O ~_--........................ ~......—.-----..$185.0O —... _........... ............. $21O.0U ..........-_--....--.$245.0O ......................................$225.O0 ----.--------.o245.0O --.—.—'-------$27OM ----'--------$145,00 ............---.....$145.0O .....................................$485.0O —............. ------------- --841DDO D2722 Crown - resin with noble metal..................................................................................................... $465.00 D2740 Crown - porcelain/ceramic substrate*.............................................................................................. $485.00 D2750 Crown - porcelain fused to high noble metal*................................................................................... $485.00 D2751 Crown - porcelain fused to predominantly base metal......................................................................... $410.00 D2752 Crown - porcelain fused to noble metal........................................................................................... $465.00 D2780 Crown - 3/ cast high noble metal................................................................................................... $485.00 D2781 Crown - 3/4 cast predominantly base metal....................................................................................... $410.00 D2782 Crown - 3/ cast noble metal......................................................................................................... $465.00 D2783 Crown - 3/ porcelain/ceramic*....................................................................................................... $485.00 D2790 Crown - full cast high noble metal................................................................................................. $485.00 D2791 Crown - full cast predominantly base metal...................................................................................... $410.00 D2792 Crown - full cast noble metal........................................................................................................ $465.00 D2794 Crown - titanium .......................... .............................................................................................. $485.00 D2910 Re -cement or re -bond inlay, onlay, veneer or partial coverage restoration ................................................. $12.00 D2915 Re -cement or re -bond indirectly fabricated or prefabricated post and core ................................................ $12.00 D2920 Re -cement or re -bond crown........................................................................................................ $12.00 D2921 Reattachment of tooth fragment, incisal edge or cusp (anterior)............................................................. $75.00 D2929 Prefabricated porcelain/ceramic crown - primary tooth - anterior............................................................ $125.00 D2930 Prefabricated stainless steel crown - primary tooth............................................................................. $35.00 D2931 Prefabricated stainless steel crown - permanent tooth......................................................................... $45.00 D2932 Prefabricated resin crown - anterior primary tooth.............................................................................. $85.00 D2933 Prefabricated stainless steel crown with resin window - anterior primary tooth ........................................... $125.00 D2940 Protective restoration.................................................................................................................. $12.00 D2941 Interim therapeutic restoration - primary dentition............................................................................... $12.00 D2949 Restorative foundation for an indirect restoration............................................................................... $65.00 D2950 Core buildup, including any pins when required................................................................................. $65.00 D2951 Pin retention - per tooth, in addition to restoration.............................................................................. $10.00 D2952 Post and core in addition to crown, indirectly fabricated - includes canal preparation ................................... $85.00 D2953 Each additional indirectly fabricated post - same tooth - includes canal preparation ..................................... $70.00 D2954 Prefabricated post and core in addition to crown - base metal post; includes canal preparation ....................... $65.00 D2955Post removal............................................................................................................................ $35.00 D2957 Each additional prefabricated post - same tooth - base metal post; includes canal preparation ....................... $30.00 D2960 Labial veneer (resin laminate) - chairside - limited to replacement of significant tooth structure loss due to caries orfracture ..................................... ........................................................................................... $300.00 D2961 Labial veneer (resin laminate) - laboratory - limited to replacement of significant tooth structure loss due to caries orfracture................................................................................................................................ $340.00 D2962 Labial veneer (porcelain laminate) - laboratory - limited to replacement of significant tooth structure loss due to cariesor fracture....................................................................................................................... $400.00 D2971 Additional procedures to construct new crown under existing partial denture framework ............................... $100.00 D2980 Crown repair necessitated by restorative material failure...................................................................... $85.00 D2981 Inlay repair necessitated by restorative material failure........................................................................ $85.00 D2982 Onlay repair necessitated by restorative material failure...................................................................... $85.00 D2983 Veneer repair necessitated by restorative material failure..................................................................... $85.00 D2990 Resin infiltration of incipient smooth surface lesions - limited to permanent molars through age 15 ................... No Cost D3000-D3999 IV. ENDODONTICS D3110 Pulp cap - direct (excluding final restoration).................................................................................... $18.00 D3120 Pulp cap - indirect (excluding final restoration).................................................................................. $18.00 D3220 Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and applicationof medicament........................................................................................................... $25.00 D3221 Pulpal debridement, primary and permanent teeth............................................................................. $80.00 D3222 Partial pulpotomy for apexogenesis - permanent tooth with incomplete root development .............................. $25.00 D3230 Pulpal therapy (resorbable filling) - anterior, primary tooth (excluding final restoration) .................................. $45.00 D3240 Pulpal therapy (resorbable filling) - posterior, primary tooth (excluding final restoration) ................................ $45.00 D3310 ............................ Root canal - endodontic therapy, anterior tooth (excluding final restoration) ............................................... $110.00 D3320 Root canal - endodontic therapy, bicuspid tooth (excluding final restoration) .............................................. $195.00 D3330 Root canal - endodontic therapy, molar (excluding final restoration)........................................................ $245.00 D3331 Treatment of root canal obstruction; non -surgical access..................................................................... $75.00 D3332 Incomplete endodontic therapy; inoperable, unrestorable or fractured tooth ............................................... $65.00 D3333 Internal root repair of perforation defects......................................................................................... $115.00 D3346 Retreatment of previous root canal therapy - anterior.......................................................................... $285.00 D3347 Retreatment of previous root canal therapy - bicuspid......................................................................... $335.00 D3348 Retreatment of previous root canal therapy - molar............................................................................ $425.00 D3351 Apexification/recalcification - initial visit (apical closure/calcific repair of perforations, root resorption, etc.) .......... $80.00 D3352 Apexification/recalcification - interim medication replacement (apical closure/calcific repair of perforations, root resorption, pulp space disinfection, etc.).......................................................................................... $80.00 D3353 Apexification/recalcification - final visit (includes completed root canal therapy - apical closure/calcific repair of perforations, root resorption, etc.).................................................................................................. $80.00 D3410 Apicoectomy - anterior................................................................................................................ $85.00 D3421 Apicoectomy - bicuspid (first root).................................................................................................. $290.00 D3425 Apicoectomy - molar (first root)..................................................................................................... $315.00 D3426 Apicoectomy (each additional root)................................................................................................ $85.00 D3427 Periradicular surgery without apicoectomy........................................................................................ $85.00 D3430 Retrograde filling - per root.......................................................................................................... $60.00 D3450 Root amputation - per root........................................................................................................... $95.00 D3920 Hemisection (including any root removal), not including root canal therapy ............................................... $80.00 D4000-D4999 V. PERIODONTICS - Includes preoperative and postoperative evaluations and treatment under a local anesthetic. D4210 Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant .............. $165.00 D4211 Gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded spaces per quadrant ............... $50.00 D4212 Gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth ...................................... $50.00 D4240 Gingival flap procedure, including root planing - four or more contiguous teeth or tooth bounded spaces per quadrant.................................................................................................................................. $185.00 D4241 Gingival flap procedure, including root planing - one to three contiguous teeth or tooth bounded spaces per quadrant.................................................................................................................................. $110.00 D4245 Apically positioned flap .................... ........................................................................................... $135.00 D4249 Clinical crown lengthening - hard tissue.......................................................................................... $215.00 D4260 Osseous surgery (including elevation of a full thickness flap and closure) - four or more contiguous teeth or tooth bounded spaces per quadrant...................................................................................................... $360.00 D4261 Osseous surgery (including elevation of a full thickness flap and closure) - one to three contiguous teeth or tooth bounded spaces per quadrant...................................................................................................... $285.00 D4263 Bone replacement graft - retained natural tooth - first site in quadrant ..................................................... $190.00 D4264 Bone replacement graft - retained natural tooth - each additional site in quadrant ....................................... $105.00 D4266 Guided tissue regeneration - resorbable barrier, per site...................................................................... $210.00 D4267 Guided tissue regeneration - nonresorbable barrier, per site (includes membrane removal) ........................... $240.00 D4270 Pedicle soft tissue graft procedure................................................................................................. $250.00 D4273 Autogenous connective tissue graft procedure (including donor and recipient surgical sites) first tooth, implant, or edentulous tooth position in graft...................................................................... ......... $300.00 D4274 Mesial/distal wedge procedure, single tooth (when not performed in conjunction with surgical procedures in the same anatomical area)............................................................................................................... $105.00 D4275 Non-autogenous connective tissue graft (including recipient site and donor material) first tooth, implant, or edentulous tooth position in graft................................................................................................... $350.00 D4277 Free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant, or edentulous toothposition in graft.................................................................................................................. $245.00 D4278 Free soft tissue graft procedure (including recipient and donor surgical sites) each additional contiguous tooth, implant, or edentulous tooth position in same graft site....................................................................... $245.00 D4283 Autogenous connective tissue graft procedure (including donor and recipient surgical sites) - each additional contiguous tooth, implant or edentulous tooth position in same graft site .................................................. $180.00 D4285 Non-autogenous connective tissue graft procedure (including recipient surgical site and donor material) - each additional contiguous tooth, implant or edentulous tooth position in same graft site ..................................... $210.00 D4341 Periodontal scaling and root planing - four or more teeth per quadrant - limited to 4 quadrants during any 12 consecutive months................................................................................................................... $50.00 D4342 Periodontal scaling and root planing - one to three teeth per quadrant - limited to 4 quadrants during any 12 consecutive months................................................................................................................... $40.00 D4346 Gophng inpresence o[ generalizedmoUorateoro*vmmginQivminOommnVon-fuUmouth.oftermn|eva|uoUon-/ DY//0\Dy/20orD434Gper 6month period ..................................................................................... NoCost D4355 Full mouth debridement to enable comprehensive evaluation and diagnosis - limited to 1 treatment in any 12 consecutive months ............. ............................ ...................'......................................'........... - $50,00 D4581 Localized delivery ofantimicrobial agents via acontrolled release vehicle into diseased orevou|artissue, per tooth for each ofthe first two tooth treated within oquadrant following root planing orperiodontal maintenance .. $80.08 D4081 Localized delivery ofantimicrobial agents via acontrolled release vehicle into diseased cmviculartissue, per tooth - for an additional tooth treated in the same quadrant following root planing or periodontal maintenance No Cost D4910 Periodontal maintenance - limited /o7treatment each Omonth period .................... ................................ $50,00 D4810 Additional periodontal maintenance (within the 6month period) ............................................................. $00.00 D5000-DS899 V1.PROST ODONTICS(remoshkW For all listed dentures and partial dentures, Copayment includes after delivery adjustments and tissue conditioning, if needed, for the first six months after placement. The Enrollee must continue to be eligible, and the service must be provided at the Contract Dentist's facility where the denture was originally delivered. - Rebases, refines and tissue conditioning are limited to I per denture during any 12 consecutive months. - Replacement of a denture or a partial denture requires the existing denture to be 5+ years old. D5110 Complete denture - maxillary .......................................... ...................... ...................................... $510,0V D5120 Complete denture - mandibular .............................. ................................................................... $51O.UO D513O Immediate denture - maxillary ...................................................................................................... $53&UO D5140 Immediate denture ' mandibular .................................................................................................... $535.00 D5211 Maxillary partial denture - resin base (including any conventional clasps, rests and teeth) ............................. $585.00 D5212 Mandibular partial denture-reainbaaeVndudingmnyoonvenUunaldaopo.nestsundtewth> .......................... $535.00 D5213 Maxillary partial dentum-pon metal framework with resin denture bases (including any conventional clasps, restsand teeth) ......................................... .............................................. ............................. ..$O10.0O D5214 Mandibularpadu|dmntuna-cas metal framework with resin denture bases (including any conventional clasps, restsand teeth) ....................................................................................... ................................. $61O.00 D5221 Immediate maxillary partial denture resin base (including any conventional clasps, rests and teeth) ................ $535.00 D5222 Immediate mandibular partial dantuve-resn base (including any conventional danPe, rests and teeth) ........ *505.00 D5223 Immediate maxillary partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) -----------...........------..-..,...--.---..-.$O1O.OU O5224 Immediate mandibular partial dnntuno-con metal framework with resin denture bases (including any conventional olaapa, rests and teeth) ----'------.---------.-----------.$610.VO D5225 Maxillary partial denture -Uexible base ymJvdin8 any clasps, rests and teeth) ----.----------. $660.00 D5220 Mamdibvlarponia|dantuw-OmxNobaseVndudinganyclmopo rests and teeth) -----------'-- *600.00 D5281 Remuvableunilatera|partia|dantum-onepieceoaa metal (including clasps and teeth) .. $400.00 D5410 Adjust complete denture - maxillary ........................................................................ ....................... $12.00 D5411 Adjust uompletedenture-mandibular ------........................................................................... $12.00 D5421 Adjust partial denture - maxillary ................................... ............................................................... $12.00 D5422 Adjust partial denture -mondibular ....... ............ ........................................................................... $12.00 D5510 Repair broken complete denture base -................-----------..----.---... $68.00 D5520 Replace missing mbroken teeth -onmplete demure (each tooth) .......................................................... o08.00 D5610 Repair resin denture base -------------------.----------------' $68.00 Q5620 Repair cast framework .... $68.00 D5630 Repair or replace broken clasp - per tooth --.--------.------------------- $68.00 Q5040Replaoobmhontenth -per tooth ................................................................ ......... ......................... $08.00 U5650 Add tooth hoexisting partial denture .-.---......._----------_._---------. $68.00 D5060 Add clasp to existing partial denture - per tooth .. $68.00 D5670 Replace all teeth and acrylic oncast metal framework (maxKlary)..................... ................................... $275.00 D5071 Replace all teeth and acrylic oncast metal framework (mmndibu|ar)........................................................ $27s.8O D5710 Rebaoe complete maxillary denture .............................. $175.00 D5711 ReUaao complete mandibular denture ............................................................... $175.00 D5720 Rebaonmaxillary partial denture ----------.-.---.----.-...-----------. $175.00 D5721 Robmmomandibular partial denture ----.------------.-----.-.---------$175.00 D5730 Reline complete maxillary denture (chairoido) -----...-----.---..-.._._--------. s85.00 U5731 Reline complete mandibular denture (chairside) -.....__---.-------__--.------- $9588 D5740 Reline maxillary partial denture (chairside)....................................................................................... $85.00 D5750 Reline complete maxillary denture (laboratory).................................................................................. $125.00 D5751 Reline complete mandibular denture (laboratory)............................................................................... $125.00 D5760 Reline maxillary partial denture (laboratory)...................................................................................... $125.00 D5761 Reline mandibular partial denture (laboratory)................................................................................... $125.00 D5820 Interim partial denture (maxillary) - limited to 1 in any 12 consecutive months ............................................ $210.00 D5821 Interim partial denture (mandibular) - limited to 1 in any 12 consecutive months ......................................... $210.00 D5850 Tissue conditioning, maxillary ....................................................................................................... $16.00 D5851 Tissue conditioning, mandibular..................................................................................................... $16.00 D5900-1315999 VII. MAXILLOFACIAL PROSTHETICS - Not Covered D6000-1016199 Vill. IMPLANT SERVICES - Not Covered D6200-D6999 IX. PROSTHODONTICS, fixed (each retainer and each pontic constitutes a unit in a fixed partial denture [bridge]) - When a crown and/or pontic exceeds six units in the same treatment plan, an Enrollee may be charged an additional $125.00 per unit, beyond the 6th unit. - Replacement of a crown, pontic, inlay, onlay or stress breaker requires the existing bridge to be 5+ years old. Name brand, laboratory processed or in -office processed crowns/pontics produced through specialized technique or materials are material upgrades. The Contract Dentist may charge an additional fee not to exceed $325.00 in addition to the listed Copayment. Refer to Limitation of Benefits #4 for additional information. D6205 Pontic - indirect resin based composite........................................................................................... $145.00 D6210 Pontic - cast high noble metal...................................................................................................... $485.00 D6211 Pontic - cast predominantly base metal........................................................................................... $410.00 D6212 Pontic - cast noble metal............................................................................................................. $465.00 D6214 Pontic - titanium........................................................................................................................ $485.00 D6240 Pontic - porcelain fused to high -noble metal*.................................................................................... $485.00 D6241 Pontic - porcelain fused to predominantly base 'metal......................................................................... $410.00 D6242 Pontic - porcelain fused to noble metal........................................................................................... $465.00 D6245 Pontic - porcelain/ceramic'........................................................................................................... $460.00 D6250 Pontic - resin with high noble metal............................................................................................... $485.00 D6251 Pontic - resin with predominantly base metal.................................................................................... $410.00 D6252 Pontic - resin with noble metal...................................................................................................... $465.00 D6600 Retainer inlay - porcelain/ceramic, two surfaces................................................................................ $335.00 D6601 Retainer inlay - porcelain/ceramic, three or more surfaces................................................................... $360.00 D6602 Retainer inlay - cast high noble metal, two surfaces........................................................................... $270.00 D6603 Retainer inlay - cast high noble metal, three or more surfaces.............................................................. $280.00 D6604 Retainer inlay - cast predominantly base metal, two surfaces................................................................ $220.00 D6605 Retainer inlay - cast predominantly base metal, three or more surfaces ................................................... $230.00 D6606 Retainer inlay - cast noble metal, two surfaces................................................................................. $250.00 D6607 Retainer inlay - cast noble metal, three or more surfaces..................................................................... $260.00 D6608 Retainer onlay - porcelain/ceramic, two surfaces............................................................................... $395.00 D6609 Retainer onlay - porcelain/ceramic, three or more surfaces................................................................... $425.00 D6610 Retainer onlay - cast high noble metal, two surfaces.......................................................................... $360.00 D6611 Retainer onlay - cast high noble metal, three or more surfaces.............................................................. $380.00 D6612 Retainer onlay - cast predominantly base metal, two surfaces............................................................... $310.00 D6613 Retainer onlay - cast predominantly base metal, three or more surfaces .................................................. $330.00 D6614 Retainer onlay - cast noble metal, two surfaces................................................................................ $340.00 D6615 Retainer onlay - cast noble metal, three or more surfaces.................................................................... $360.00 D6710 Retainer crown - indirect resin based composite................................................................................ $145.00 D6720 Retainer crown - resin with high noble metal.................................................................................... $485.00 D6721 Retainer crown - resin with predominantly base metal......................................................................... $410.00 D6722 Retainer crown - resin with noble metal.......................................................................................... $465.00 D6740Retainer crown - porcelain/ceramic'"............................................................................................... $485.00 D6750 Retainer crown - porcelain fused to high noble metal*......................................................................... $485.00 D6751 Retainer crown - porcelain fused to predominantly base metal.............................................................. $410.00 D6752 Retainer crown - porcelain fused to noble metal................................................................................ $465.00 D6780 Retainer crown - 3/4 cast high noble metal........................................................................................ $485.00 D6781 Retainer crown - % cast predominantly base metal............................................................................ $410.00 D0782 Retainer crown '% cast noble metal ............................................................................................ .$465.0O D0783 Retainer crown -%pmmelain/ceemic°............................................................................................ $485.0O DG7BU Retainer crown - full cast high noble metal .......................................................... ........................... $485.0O Q6791 Retainer crown -fuU cast predominantly base metal ......._.._------........---.-.---. $410.08 D8792 Retainer crown full cast noble metal ................ ........................................ ............................. ... $46S.00 D6784 Retainer crown titanium ............................................... ............. .............................................. $485.UD O6930 Re-cement or re -bond fixed partial denture ........... ....................................... ................................. $12.00 DGQ4OStress breaker ............................................................................................. ........... ................ $1OO,00 D7000-D7999 X. ORAL AND MAX|LLOFACkuL SURGERY ' Includes preoperative and postoperative evaluations and treatment under afocal anesthetic. D7111 Extraction, uonma|remnants - deciduous tooth ................................................................................. $45.00 D7140 Extraction, erupted tooth urexposed root (elevation and/or forceps removal) ............................................. $18I0 D7210 Extraction, erupted tooth requiring removal ofbone and/or sectioning oftooth, and including elevation of mucopeUooteo| flap if indicated -----------....--------------------- $30D0 D7220 Removal of impacted tooth - soft tissue ------------------------'-----. $50.00 D7230 Removal of impacted tooth -partially bony ---....--.--------------------' $65.00 D7240 Removal of impacted tooth -nompletely bony --.-...----.-----......---------- $80.00 D7241 Removal o[impootedtooth-onmpletelybony, with unusual surgical complications ......................................a135.UV D7250 Removal ofresidual tooth roots (cutting procedure) ............................................................................ $36.00 U7251 Comnoctomy-intentiono|padia|toothmmova ..................................................... ............................ *135.00 O7270 Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth ...................................... $45.00 D7280Exposure of an unampted tooth --------._........................................................................ $115.00 D7282 Mobilization cferupted ormolponitioned tooth maid eruption ................................................................ $11V.O0 D7283 Placement ofdevice »ofacilitate eruption ofimpacted tooth -------------'--------. No Cost D7288 Incisional hiopoyofuralUowua-snft-doeomot include pathology laboratory procedures .............................. *70.00 D7810 Ahouloplastyinconjunction with extractions ' four or more teeth mtooth spaces, per quadrant ...................... $35.80 D7311 Alveoloplasty in conjunction with extractions - one to three teeth or tooth spaces, per quadrant ............ $35.00 D7320 /Uveooplustymotinuonjunctionwithextractiono-km/ormore teeth ortooth spaces, perquadmnt------ $55.00 D7321 Alveoloplasty not in conjunction with extractions - one to three teeth or tooth spaces, per quadrant ........... $55.00 D7450 Removal ofbenign odontogeniccyst ovtumor - lesion diameter uph/125cm........................................... *60.00 D7451 Removal ofbenign ndontoAam|ccyst ovtumur-lemiondiametergrenua than 125mn.................................. $90.00 D7471 Removal of lateral mxosmea(maxilla ovmandible) -------------------------- $65.00 D7472 Removal nftorus pa|ahnum ..----------.---.------.--....------.---- $65.00 D7473 Removal oftorus mmndibulaha -'------.-.----------'--------------. $65.00 D7510 Incision and drainage ofehooaoe- intraom| soft tissue ----------.-.-.....----.----. $18.00 D7860 Fnmulectomy'also known as frenectomy or frenotomy - separate procedure not incidental to another procedure $90.00 D7970 Excision ofhypemlamhctissue - per arch ----...._..._-......-._.......--------, $115100 D7871 Excision ofparicoumal gingiva -----.....-......------.------..--------' $115l0 Q8000-D8999 XU.ORTHODONTICS The listedcomprehensive) covers upto24months of active treatment Beyond 24 months, an additional monthly fee, not to exceed $125.00, may apply. - The Retention Copayment includes adjustments andlor office visits up to 24 months. Pre and postomhodowticomuomds/no/mde: Thmbone/it for pre-treatment records and diagnostic services includes: ..................... .............................. $2O0.0V D0210 |nUaono|'complete series ofradiographic images n0322 Tomogruphivaurvey D0330 Panoramic radiographic image D0340 2D cephalometric radiographic image - acquisition, measurement and analysis D0350 2Doo|lfaoio|photographic images obtained intmona||yorextmonoUy D0351 3Dphotographic image D0470 Diagnostic casts Thmb*no/it/0rpoat-8watnenrnaoonds/nmbdox:....'........................................—..........—..—............. $70.00 D0210 |mtraona|'complete series ofradiographic images O0470 Diagnostic casts D8010 Limited orthodontic treatment Wthe primary dentition -.....--.---..^..................................... U8020 Limited orthodontic treatment mfthe transitional denUUon-childoradolenonn /oage Y8............................. $1.15O.00 b8030 Limited orthodontic treatment ofthe adolescent denUtion-admleaown to age 19.............—.~—.-. $1.150.00 D8040 Limited orthodontic treatment Wthe adult dentition - adults, including covered dependent adult children .......... $1.350.0O D8050 Interceptive orthodontic treatment ofthe primary dentition .----------_...-.----.--.$1.150.OU D8080 Interceptive orthodontic treatment ufthe transitional dentition ........................................ ..................... $t150.V0 D8070 Comprehensive orthodontic treatment of the transitional dentition - child or adolescent to age 19 ................... $2.100.00 D8080 Comprehensive orthodontic treatment v[the adolescent dentition - adolescent to age 10............................ $2.1OO.00 D8090 Comprehensive orthodontic treatment of the aduhdentition-adults, including covered dependent adult children.��50.00 D8860 Pre -orthodontic treatment examination to monitor growth and development ............................................... $25.00 U8670 Periodic orthodontic treatment visit - included 'ncomprehensive case fee ................................................. NoCost D8680 Orthodontic retention (removal ofappliances, construction and placement of removable retainers).—.----. $300.88 Q8881 Removable orthodontic retainer adjustment --......_......~.,.--.-._..._...--.—...—.. No Cost D8093 Re -bond orre-cement fixed retainer limited 8n2per 6month poriod-----....---------- No Cost D8894 Repair offixed retainers, includes reattachment ' limited /o2per 0month period ....................................... No Cost Q8999 Unmpecifindorthodonticpnoceduna.Uymport-incluoemkea»nen planning session .................................... $100.00 D9000-D9999 X11.ADJUNCTIVE GENERAL SERVICES D9110 Palliative (omargonoy)treatment cddental pain minor procedure .......................................................... NoCost D8211 Regional block anesthesia ....---------...~..---.—............................... No Cost D9212 Trigmmina| division block anesthesia ....------.-----.------------------.. No Cost D9215 Local anesthesia in conjunction with operative or surgical pmoeUuma ..................................................... No Cost U9219 Evaluation for deep sedation or Benma| anesthesia --------.----.—.-----------. No Cost D9223 Deep anmathemia-eaoh 15minute increment ------.--------'-----' $55.00 D9243 Intravenous moderate (conecioum)oedation/anolgesia -oaoh 15 minute increment --------.--... $5&00 D9310 Consultation ' diagnostic service provided by dentist mphysician other than requesting dentist mphysician ....... $25,00 D9311 Consultation with medical health care professional ......................... ................................... ............. .NoCost D8430 Office visit for observation (during regularly scheduled hours) - no other services performed .......................... $5�00 D9440 Office visit ' after regularly scheduled hours ...................................................... $35.00 D9450 Case premontaUon, detailed and extensive treatment planning --.-----~~..._-----............... No Cost D9932 Cleaning and inspection ofremovable complete denture, maxillary ......................................................... NoCost D9933 Cleaning and inspection of removable complete denture, mandibular ...................................................... No Cost D9934 Cleaning and inspection of removable partial denture, maxillary ............................................................. NoCost D9935 Cleaning and inspection ofremovable partial denture, mondibula, .......................................................... moCost O9940 Occlusal 0uand, by report -0nited,n 1 in 3yeam -------'----'-------'------$175.00 D8943 Occlusal guard adjustment ......................................... $10.00 D9951 Occlusal adjustment, |knded .....-------.--------.--............---....., Q25.00 D9852 Occlusal adjustment, complete ------.......__-----.--.._.—.—.-------.. $8600 D9876 External bleaching for home application, per arch; includes materials and fabrication o[custom trays limited to one bleaching tray and gel for two weeks ofself-treatment -------------------'---$125.00 D988$ Missed appointment - without 24hour notice - per /5minutes ofappointment time ..................................... $10.00 D9887 Cenooleduppoimtmeni-withou 24hour notice - per Y5minutes ofappointment time .................................. $10.00 D9981 Dmnta|uosomanagenent-addremnngmppnnknen compliance barriers ................................................. No Cost D9092 Dental omoo management - care coordination ........._.---.----.—....._--------- No Cost If services for a listed procedure are performed by the assigned Contract Dentist, the Enrollee pays the specified Copayment. Listed procedures which require a Dentist to provide Specialist by the assigned Contract Dentist, must beauthorized SCHEDULE B Limitations of Benefits 1. The frequency of certain Benefits is limited. All frequency limitations are listed in Schedule A, Description of Benefits and Copayments. 2. If the Enrollee accepts a treatment plan from the Contract Dentist that includes any combination of more than six crowns, bridge pontics and/or bridge retainers, the Enrollee may be charged an additional $125.00 above the listed Copayment for each of these services after the sixth unit has been provided. 3. General anesthesia and/or intravenous sedation/analgesia is limited to treatment by a contracted oral surgeon and in conjunction with an approved referral for the removal of one or more partial or full bony impactions, (Procedures D7230, D7240, and D7241). 4. Contract Dentists may offer services that utilize brand or trade names at an additional fee. The Enrollee must be offered the plan benefits of a high quality laboratory processed crown/pontic that may include: porcelain/ceramic; porcelain with base, noble or high - noble metal. If the Enrollee chooses the alternative of a material upgrade (name brand laboratory processed or in -office processed crowns/pontics produced through specialized technique or materials, including but not limited to: Captek, Procera, Lava, Empress and Cerec) the Contract Dentist may charge an additional fee not to exceed $325.00 in addition to the listed Copayment. Contact the Customer Service department at 800-422-4234 if you have questions regarding the additional fee or name brand services. 5. Benefits provided by a pediatric Dentist are limited to children through age seven following an attempt by the assigned Contract Dentist to treat the child and upon Authorization by Delta Dental, less applicable Copayments. The Plan will consider exceptions on an individual basis if a child has a physical or mental impairment, limitation or condition which substantially interferes with that child's ability to have Benefits provided by a Contract Dentist. 6. The cost to an Enrollee receiving orthodontic treatment whose coverage is cancelled or terminated for any reason will be based on the Contract Orthodontist's usual fee for the treatment plan. The Contract Orthodontist will prorate the amount for the number of months remaining to complete treatment. The Enrollee makes payment directly to the Contract Orthodontist as arranged. 7. Orthodontic treatment in progress is limited to new DeltaCare USA Enrollees who, at the time of their original effective date, are in active treatment started under their previous employer sponsored dental plan, as long as they continue to be eligible under the DeltaCare USA program. Active treatment means tooth movement has begun. Enrollees are responsible for all Copayments and fees subject to the provisions of their prior dental plan. Delta Dental is financially responsible only for amounts unpaid by the prior dental plan for qualifying orthodontic cases. Exclusions of Benefits 1. Any procedure that is not specifically listed under Schedule A, Description of Benefits and Copayments. 2. Any procedure that has poor prognosis for a successful result and reasonable longevity based on the condition of the tooth or teeth and/or surrounding structures, or is inconsistent with generally accepted standards for dentistry. 3. Services solely for cosmetic purposes, with the exception of procedure D9975 (External bleaching for home application, per arch), or for conditions that are a result of hereditary or developmental defects, such as cleft palate, upper and lower jaw malformations, congenitally missing teeth and teeth that are discolored or lacking enamel, except for the treatment of newborn children with congenital defects or birth abnormalities. 4. Porcelain crowns, porcelain fused to metal or resin with metal type crowns and fixed partial dentures (bridges) for children under 16 years of age. 5. Lost, stolen or broken appliances including, but not limited to, full or partial dentures, space maintainers, crowns, fixed partial dentures (bridges) and orthodontic appliances. 6. Procedures, appliances or restoration if the purpose is to change vertical dimension, replace or stabilize tooth structure loss by attrition, realignment of teeth, periodontal splinting, gnathologic recordings or to diagnose or treat abnormal conditions of the temporomandibular joint (TMJ) with the exception of procedures D9951 and D9952 as shown on Schedule A. 7. Precious metal for removable appliances, metallic or permanent soft bases for complete dentures, porcelain denture teeth, precision abutments for removable partials or fixed partial dentures (overlays, implants, and appliances associated therewith) and personalization and characterization of complete and partial dentures. 8. Implant -supported dental appliances and attachments, implant placement, maintenance, removal and all other services associated with a dental implant. 9. Consultations or other diagnostic services for non -covered benefits. 10. Dental services received from any dental facility other than the assigned Contract Dentist or an authorized dental specialist (oral surgeon, endodontist, periodontist, pediatric dentist or Contract Orthodontist) except for Emergency Services as described in the Contract and/or Evidence of Coverage. 11. All related fees for admission, use, or stays in a hospital, out -patient surgery center, extended care facility, or other similar care facility. 12. Prescription and over-the-counter drugs. 13. Dental expenses incurred in connection with any dental procedure started before the Enrollee's eligibility with the DeltaCare USA Program. Examples include: teeth prepared for crowns, root canals in progress, full or partial dentures for which an impression has been taken and orthodontics unless qualified for the orthodontic treatment in progress provision. 14. Changes in orthodontic treatment necessitated by accident of any kind. 15. Myofunctional and parafunctional appliances andlor therapies. 16. Composite or ceramic brackets, lingual adaptation of orthodontic bands, Invisalign and other specialized or cosmetic alternatives to standard fixed and removable orthodontic appliances. 17. Treatment or appliances that are provided by a Dentist whose practice specializes in prosthodontic services. Florida Municipal Insurance Trust City of Winter Springs Rate Quote for Vision Benefit Coverage Renewal Rates - U n ited Healthcare Vision Coverage 10/01 /2018- Contract Type 09/3012019 Single $6.57 Family $17.65 Vision Benefit Summary Customer Service: (800) 638-3120 Provider Locator: (800) 839-3242 Comprehensive Vision Exam { Materials - Eyeglass Lenses/Eyeglass Frames or Contact fFrequencies - Based on last date of service _. __ $10 Copay ....._-_. $0 Copay' Exam Once every 12 months Lenses Once every 12 months Frames Once every 24 months Pair of Lenses (for Eyewear) • Standard single vision lenses Covered in full after applicable copay' • Standard lined bifocal lenses • Standard lined trifocal lenses Includes standard scratch -resistant • Standard lenticular lenses coating Lens options such as progressive lenses, tints, UV, and anti -reflective coating may be available at a discount at participating providers. Frames You will receive a retail frame allowance toward the $130 Retail Frame Allowance purchase of any frame at a network provider. For frames (after applicable Copay' ) that exceed your allowance, you may receive an additional 30% discount on the overage (available only at participating providers and may exclude certain frame manufacturers). Contact Lenses' • Covered contact lens selection It is important to note the covered contact lens selection may vary by provider but does include the most popular brands on the market today? A complete list can be found by visiting our website www.myuhcvision.com. • Non -selection contacts You receive an allowance which is applied toward the fitting/evaluation fees and purchase of contact lenses outside the covered contact lens selection. Plan V1114 Up to $40 See below Up to $40 Up to $60 Up to $BO Up to $BO Up to $45 Up to 6 boxes of contact lenses plus Up to $150 the fitting/evaluation fees and up to two follow-up visits are covered -in -full (after applicable copay' ) Up to $150 Up to $150 (material copay is waived) • Necessary contact lenses Covered in full after applicable copay' Up to $210 1 The material copayment will apply once if frames and lenses, or contact lenses in lieu of eyewear, are purchased at the same time at a network provider. Z Contact lenses are in lieu of eyeglass lenses and/or eyeglass frames. 3 Coverage for Covered Contact Lens Selection does not apply at Walmart, Sam's Club and Costco locations. The allowance for non -selection contact lenses will be applied toward the fittinglevaluation fee and purchase of all contacts. 4 Necessary contact lenses are determined at the providers discretion for one or more of the following conditions: Fallowing cataract surgery without intraocular lens implant; to correct extreme vision problems that cannot be corrected with eyeglass lenses and/or eyeglass frames; with certain conditions of anisometropia, keratoconus, irregular comeals/astigmatism, aphakia, facial deformity, or corneal deformity. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare concerning the reimbursement that UnitedHealthcare will make before you purchase such contacts. ( UnitedHealtheare"' Vision Benefit Summary Customer Service: (800) 638-3120 Provider Locator: (800) 839-3242 Network Always identify yourself as a UnitedHealthcare customer when making your appointment. This will assist your provider in obtaining a claim authorization before your visit. - Your participating provider will help you determine which contact lenses are available in the UnitedHealthcare selection. Your contact lens allowance is applied to the fittinglevaluation fees, as well as the purchase of non -covered selection contact lenses. For example, if your allowance is $150 and the fitting fee and evaluation is $35, you will have $115 toward the purchase of non -selection contact lenses. Evaluation and fitting fees may vary among providers and type of fitting required. Your material copay is waived when purchasing non -selection contacts. • Patient options, such as UV coating, progressive lenses, etc., which are not covered -in -full, may be available at a discount at participating providers. Choice and Access of Vision Care Providers UnitedHealthcare offers its vision program through a national network including both private practice and retail chain providers. To access the Provider Locator service, visit our Web site at www.myuhcvision.com or call 1-800-839-3242, 24 hours a day, seven days a week. You may also view your benefits, search for a provider or print an ID card online at www.myuhcvision.com. Retain this UnitedHealthcare vision benefit summary which includes detailed benefit information and instructions on how to use the program. Please refer to your Certificate of Coverage for a full explanation of benefits. Network Provider - Copays and non -covered patient options are paid to provider by program participant at the time of service. Non -Network Provider- Participant pays full fee to the provider, and UnitedHealthcare reimburses the participant for services rendered up to the maximum allowance. Copays do not apply to non -network benefits. All receipts must be submitted at the same time. Written proof of loss should be given to the Company within 90 days after the date of the loss. If it was not reasonably possible to give written proof in the time required, the Company will not reduce or deny the claim for this reason. However, proof must be filed as soon as reasonably possible, but no later than 1 year after the date of service unless the Covered Person was legally incapacitated. Additional Materials Benefit UnitedHealthcare offers an additional Materials Discount Program. At a participating network provider you will receive a 20% discount on an additional pair of eyeglasses or contact lenses. This program is available after your vision benefits have been exhausted. Please note that this discount shall not be considered insurance, and that UnitedHealthcare shall neither pay nor reimburse the provider or member for any funds owed or spent. Not all providers may offer this discount. Please contact your provider to see if they participate. Discounts on contact lenses may vary by provider. Additional materials do not have to be purchased at the time of initial material purchase. Additional materials can be purchased at a discount any time after the insured benefit has been used. Customer Service is available toll -free at 1-800-638-3120 from 8:00 a.m. to 11:00 p.m. Eastern Time Monday through Friday; and 9:00 a.m. to 6:30 p.m. Eastem Time on Saturday. This Benefit Summary is intended only to highlight your benefits and should not be relied upon to fully determine coverage. This benefit plan may not cover all of your healthcare expenses. More complete descriptions of benefits and the terms under which they are provided are contained in the certificate of coverage that you will receive upon enrolling in the plan. If this Benefit Summary conflicts in any way with the Policy issued to your employer, the Policy shall prevail. UnitedHealthcare Vision® coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, or its affiliates. Administrative services provided by Spectera, Inc., United Healthcare Services, Inc. or their affiliates. Plans sold in Texas use oolicv form number VPOL.06.TX and associated COC farm number VCOC.INT.06.TX. Plan V1114 Plan V1114 ODSVPI-02A 1OD-9799 6112 02013 United Healthcare Services, Inc. CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDIYYYY) 2/22/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). �..�.�.,....��....,.�,..�..�.�..�. ____ _...................... CONTACT......._...................�»���,�...,-.. PRODUCER NAME: Mark Demont, CIC Demont Insurance Agency & Financial Services � �a tl. (850) 942-7760 FAX NeI. (eso)Ba2-77se E-MAIL mdemont@demontinsurance.com E-MAIL 2400 Mahan Drive AnnRF:q.q.mdemont@demontinsurance.com AFFORDING COVERAGE NAIC ff Tallahassee FL 32308 INSURERA.NW Property and Casualty Ins. CO 25453 INSURED INSURER B Allied Property ,and Casualty Ins . 92579 FLORIDA LEAGUE OF CITIES INC INSURER C: PO BOX 1757 INSURER D INSURER E : TALLAHASSEE FL 32302-1757 INSURER F: _..... . _ �._ . ................ COVERAGES CERTIFICATE NUMBER:CL1722203671 REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iN3'R TYPE OF INSURANCE ADbL SURk POLICY EFF POLICY EXP LIMITS ....... ........ i.rR POLICY NUMBER MM/DD(YY'YY) WMIDOIYYYYt X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 . � I X D' 6t .. TO W-NTED -.. A CLAIMS -MADE OCCUR `J PREMISES (Ea ogoungnce) , $ _ 100,000 ACPGLZO5955328582 1/27/2017 1/27/2018 MED EXP (Any one person) $ 5,000 '.... '.. PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X._ POLICY PRO- D LOC '... PRODUCTS $ JECT 2,000,000 OTHER: Exclude Advertising Injury $ AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT - AUTOMOBILE 500, 000 X ANY AUTO BODILY INJURY (Per person) $ A ALL OWNED SCHEDULED ACPBAz5955328582 1/27/2017 1/27/2018 BODILY INJURY (Per accident) $ AUTOS NUTOS ON OWNED PROPERTY DAMAGE $ " HIRED AUTOS AUTOS 4 Per accident} ........ r ....... ......... Medical ar ments $ 5,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 5, 000, 000 13 j ! EXCESS LIA6.... CLAIMS -MADE i AGGREGATE..... �......... 5,000,, 000... IDED (RETENTION ACPCAP5955328582 1/27/2017 1/27/20111 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y/ N .... STATUTE ER.. ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N / A E.L. EACH ACCIDENT $ DFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE - EA EMPLOYEE( $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ " I DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Insurance Purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2014/01) INS025 r51014ntl AUTHORIZED REPRESENTATIVE G Demont, CIC, CRIB/T -' ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD FLLEAGU 01 AGUYA ACORO DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 1/412017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. - .....-. ___. _....... -------- IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Rogers, Gunter, Vaughn Insurance, Inc. 1117 Thomasville Road Tallahassee, FL 32303 INSURED Florida League of Cities, Inc. PO Box 1757 Tallahassee, FL 32302-1757 386-1111 385-9827 _INSURER A: Associated Industries Insurance a Company, Inc,- INSURER B : INSURER C__, INSURER E : INSURER F : THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ...... ..__.. ....... --_! EFF POUCY LXP 4 - -. _... - -. .__..._ .......... ADDLSLIBR R �N;pfd_,-�YV4_ LM..t'1&74YYY �,PyTYPE OF INSURANCE POLICY NUMBER FYY"yYk LIMITS COMMERCIAL GENERAL LIABILITY ___ _EACH OCCURRENCE CLAIMS -MADE OCCUR DAMAGE TO RENTED $ I L -_., _ PR. EMISES._(E.e vevurtencel $ _.... GENT AGGREGATE LIMITAPPLIES PER: POLICY LJ Ea l—J LOC AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED _ AUTOS ONLY _........_. AUTOS ONLY UMBRELLA LAB OCCUR EXCESS LU1B CLAIMS -MADE .......: AAND NY P OPO ERR' ARBILITY XECUTIVE YIN - --� A WORKERS COMPENSATION AWC1074279 PFFICERIMEMBER EXCLUDED? NIA l (Mandatory in NH) ----- If ves. describe under MED EXP. (Any one. person) _PERSONAL & ADV INJURY GENERALAGGREGATE PRODUCTS GOMPIOP AGG E.,tl; q d„bda', URIRN4GWM'E MILKD� H "'" :aft"; H - I C" 0110112017 0110112018 E.L. EACH ACCIDENT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space Is required) For Informational Purposes Only $ 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INSURANCE REQUIREMENTS FORM 1. The vendor shall be required to provide to the Purchasing Coordinator, prior to signing a contract for or commencing any work, a Certificate of Insurance which verifies coverage in compliance with the requirements outlined below. Compliance of said certificate must be acknowledged by the Purchasing Coordinator prior to start of work. Any work initiated without completion of this requirement shall be unauthorized and the City of Winter Springs will not be responsible. 2. The City of Winter Springs reserves the right to require coverage and limits as considered to be in its best interests. Insurance requirements shall be on a case by case basis determined by the project, conditions and exposure. 3. Except for Professional Liability and Workers Compensation Policies, when required, all policies are to be endorsed to include the City of Winter Springs as Additional Insured. In the cancellation clause the number 1130" shall be inserted into the blank space provided prior to the words "days prior notice...". All vendor policies are to be considered primary to City coverage and shall not contain co- insurance provisions. 4. In the event that the insurance coverage expires prior to the completion of services, a renewal certificate shall be issued 30 days prior to said expiration date. 5. Subvendors or sub -Service Providers retained by the primary vendor are the responsibility of said primary vendor in all respects. 6. Insurance requirements: Coverage Recfui red - Minimum Policy Limits Workers' Cornpensatron Statuto _ _._ .... w_ ___ . ........... _� _. __ w.��. _....A�.. m ..... ___ Commercial General Liability (including $1,000,000 Occurrence Contractual liability, products and competed operations, XCU and owners and service providers _protective) Professional $1,000,000 Occurrence (NOTE: All limits are per occurrence and must include Bodily Injury and Property Damage. Deductibles and self insured retentions must be approved by the City of Winter Springs, and all insurers must have an A.M. Best rating of at least A: VII.) 7. Bonding Required: None This Submittal 8. Vendor will be required to provide a certificate of insurance in compliance with the above, within four (4) days of notification of award with continuing coverage, without a break. 9. I hereby certify that the insurance and bonding requirements outlined above shall be met as required, if I am awarded a contract for the services specified herein. Firm: FLORIDA LEAGUE OF CITIES Authorizedtle: Signature I Dat AR�ON ACC©t�1XEU E y 5/9/2018 This Form Must Be Completed and Returned with your Submittal iN FLORIDA STATUTES ON PUBLIC ENTITY CRIMES FORM THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is submitted to the City of Winter Springs by:. LINDSEY LARSON on behalf of- FLORIDA_LEAGUE OF CITIES whose b_usincss addressis.........-___............_.._....._._..............................m.._......._..___..__w.�_............... _.__ 125 E. COLONIAL DRIVE ORI ANDO FL 1 ..__ .... _._ ._a... ...... 3280_... _ ......, Federal Employer Identification Number (FEIN) _59 600124 _ or Social Security # of the person signing this statement; 2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), F.S., means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any bid or contract for goods or services, any lease for real property, or any contract for the construction or repair of a public building or public work, involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. I understand the "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), F.S., means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilt or nolo contendere. 4. 1 understand that an "affiliate" as defined in Paragraph 287.133(1)(a), F.S., means; A predecessor or successor of a person convicted of a public entity crime or an entity tinder the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate " includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not fair market value under an arrn 's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 5. 1 understand that a "person" as defined in Paragraph 287.133(1)(e), F.S., means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Please indicate which statement applies.) X Neither the entity submitting this sworn statement, nor any of its officers, director, executives, partners, shareholders, employees, members, or agents who are active in the 23 management of the entity, nor any affiliate of the entity were charged with and convicted of a public entity crime after July 1, 1989. The entity submitting this sworn statement, or one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or any affiliate of the entity was charged with and convicted of a public entity crime after July 1, 1989, The entity submitting this sworn statement, or one of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or any affiliate of the entity was charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of the final order.) I understand that the submission of this form to the City of Winter Springs is for the City of Winter Springs only, and that this from is valid through December 31, 2013. T also understand that I am required to inform the City of Winter Springs prior to entering into a contract in excess of $25,000 of any change in the information contained in this form. Signature 5/9/2018 Date State of Florida, County of. ORANGE On this _9_th_ day of MAY 2018 before me, the undersigned Notary Public of the State of Florida, personally appeared: LINDSEY LARSON .. . ........ . ..... . . . . ....... (Name(s) of individuals who appeared before notary) whose name(s) is/are Subscribed to the within instrument, and he/she/they acknowledge that he/she/they executed it. Sworn to and subscribed before me this 9thdayof.._MAy___.__-.—,20i8 . x Personally Known Produced Identification: (Type) .. . ...... __ __ Did take an Oath X Did Not take an Oath 9 ........... Notary Public My Commission expires: February 28, 2020 DOROT myc,OMM EXi NIFS This Form Must Be Completed and Returned with your Submittal 24 DRUG -FREE WORK PLACE FORM The undersigned, in accordance with Florida Statute 287.087 hereby certifies that the company named below does: 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition, 2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are proposed a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo- contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, by any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug -free workplace through implementation of this section. Firm: FLORIA LEAGUE OF CITIES .......... Name/ Title: J,JNDSEY LA,RSN AP Authorized Signature / Date: This Form Must Be Completed and Returned with your Submittal 25 CONFLICT OF INTEREST STATEMENT 1. LINDSEY LARSON Of FLORDA LEA(3UE OF CITIEs deposes and states that -1-11 -- - - -------- . . ....... (Name of Afriant) (Name of Company) the above named entity is submitting a proposal to the City of Winter Springs for the project identified above. 2. The Affliant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 3. The Affiant states that only one submittal for the above project is being submitted and that the above named entity has no financial interest in other entities submitting qualifications for the same services. 4. Neither the Aff iant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive pricing in connection with the entity's submittal for the above project. This statement restricts the discussion of pricing data until the completion of negotiations and execution of the Agreement for this project. 5. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise ineligible from participating in contract lettings by any local, state, or federal agency. 6. Neither the entity, nor its affiliates, nor anyone associated with them have any potential conflict of interest due to any other clients, contracts, or property interests for these services. 7. 1 certify that no member of the entity's ownership, management, or staff has a vested interest in any aspect of or department of the City of Winter Springs. 8. 1 certify that no member of the entity's ownership or management is presently applying for an employee position or actively seeking an elected position with City of Winter Springs. 9. In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will immediately notify the City of Winter Springs in writing. Signature of Affiant 5/9/2018 Date ACCOUNT EXECUTIVE LIND Title Typed or Printed Name of Afflant State of Florida, County of ORANGE On this 9th day of ...... _ M 2018 before me, the undersigned Notary Public of the ,_6y State of Florida, personally appeared LINDSEY LARSON and (Name(s) of individuals who appeared before notary) whose name(s) is/are subscribed to the within instrument, and he/she/they acknowledge that he/she/they executed it. 26 W11 ,N1.,,SS my hand and official seal. NOTARY PU13LIC, STATE OF FLORIDA NOTARY PUBLIC SEAL OF OFFICE: DOROTHY ROLLINS (Name of Notary Public: Print, Stamp, or Type as Commissioned.) DOROTHY ROLLINS My COMMISSION A FF965433 E'xpaEs: Few-Y This Form Must Be Completed and Returned with your Submittal 27 PUBLIC RECORDS FORM All proposals are subject to the Florida Public Records Act, F.S. 119. The submission of a proposal authorizes release of your firm's credit data to the City of Winter Springs. Responsive proposals are "public records" and shall be subject to public disclosure consistent with Chapter 119.071 (1)(b), Florida Statutes. Vendors must invoke any exemptions to disclosure provided by law in the response to the proposal, and must identify the data or other materials to be protected, and must state the applicable statutory exemption for exclusion from public disclosure. Please list below any exemptions to disclosure as provided by law and sign and date the form where indicated: If you are not claiming any Public Records Exemptions, please check the box below and sign and date the form where indicated. Y'-� 5 XWe are claiming no exemptions /9/2018 . . . . . .......... V6or SignatureMate This Form Must Be Completed and Returned with your Submittal 28