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RE means Reasonable Expense 65 RE 75 RE 80 RE 65 RE to 500 Maximum 75 RE to 800Maximum 80 REto 1 500 Maximum 25 of Surgical Benefits 65 RE/ 25Visit/5VisitMax. 75 RE/ 30Visit/7VisitMax. 80 RE/ 40Visit/8VisitMax. 150 Maximum 700Maximum GER0514 EFTB 0009 2015 2016 ENROLLMENT APPLICATION please print or type Student s Last Name Student s First Name Student s Middle Initial Address City State Telephone Number Birthdate Chula Vista Elementary School District School System Name of School Grade Zip...
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