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BENEFIT PLAN Prepared Exclusively for The Vanguard Group, Inc. Choice POS II DHP What Your Plan Covers and How Benefits are Paid Table of Contents Preface ........................................................................1
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1 Medicare 3.2 Medicaid 3.3 Children's Health Insurance Program 3.4 The Children's Health Insurance and Enrollment Simplification Act of 2010 3.5 Other Benefits and Coverage Provided by the Plan 3.6 What to Look for in a Plan 3.7 What to Consider When You Compare Plans This Plan Provides Health Insurance Coverage and Medical, Rehabilitation, and Dental Benefits Only to You and Your Children (You and your children may be entitled to other benefits under the Plan and under other contracts or plans). It does not cover: Your spouse, if he or she is covered under a separate, spouse's health insurance policy of his or her own (and not your spouse's health insurance policy); Any dependents, unless those dependents are covered under the Plan itself and not under other contracts; Any abortion expenses or other items that are outside the coverage requirements of the Plan or any insurance policies. This Plan Does Not Cover Any Benefits Under the Medicare Supplement to the Medicaid Program, the Supplementary Medical Insurance Plan for People With Limited Income, the Indian Health Service (IHS), or the Health Insurance Portability and Accountability Act (“HIPAA”). If you are enrolled in Medicare or Medicaid, it will generally be necessary for YOU to pay these additional benefits even with coverage under this Plan. You may be subject to a penalty if you do not comply with these requirements. 3.1 Medicare If You Are an Eligible Veteran or Retired Member of the Armed Forces, this Plan may include certain benefits which are not available to you or your spouse, dependents (if any). This Plan also does not cover: Certain Medicare supplemental benefits under the Medicare Supplement to the Medicaid Program, which are not available under the Medicare Supplement to the Medicare Program; Certain Medicare dental benefits for medically necessary procedures that are not available under this Plan; and Certain benefits of the Medicaid Program for qualified state-authorized medical services offered by eligible community health care providers, including certain Medicaid dental benefits for medically necessary services that are not available under or that would be excluded from this Plan (for example, Medicaid dental services for the treatment or prophylaxis of sexually transmitted infections (“STIs”). To learn more about Medicare benefits, see. The plan also does not cover any Medicare premiums.

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