Forms & Documents

Summary of Benefits (SOB)

Chiro/Acu: Landmark

	Acupuncture Schedule of Benefits $10 20 Plan Highlights
	Acupuncture Schedule of Benefits $10 20 Plan Highlights
	Acupuncture Schedule of Benefits $10 30 Plan Highlights
	Acupuncture Schedule of Benefits $10 30 Plan Highlights
	Acupuncture Schedule of Benefits $15 20 Plan Highlights
	Acupuncture Schedule of Benefits $15 20 Plan Highlights
	Acupuncture Schedule of Benefits $15 30 Plan Highlights
	Acupuncture Schedule of Benefits $15 30 Plan Highlights
	Acupuncture Schedule of Benefits $20 20 Plan Highlights
	Acupuncture Schedule of Benefits $20 20 Plan Highlights
	Acupuncture Schedule of Benefits $20 30 Plan Highlights
	Acupuncture Schedule of Benefits $20 30 Plan Highlights
	Acupunture Schedule of Benefits $35 10 Plan Hightlights
	Acupunture Schedule of Benefits $35 15 Plan Hightlights
	Acupunture Schedule of Benefits $35 20 Plan Hightlights
	Chiropractic Schedule of Benefits $10 20 Plan Highlights
	Chiropractic Schedule of Benefits $10 20 Plan Highlights
	Chiropractic Schedule of Benefits $10 30 Plan Highlights
	Chiropractic Schedule of Benefits $10 30 Plan Highlights
	Chiropractic Schedule of Benefits $15 20 Plan Highlight
	Chiropractic Schedule of Benefits $15 20 Plan Highlights
	Chiropractic Schedule of Benefits $15 30 Plan Highlights
	Chiropractic Schedule of Benefits $15 30 Plan Highlights
	Chiropractic Schedule of Benefits $20 20 Plan Highlight
	Chiropractic Schedule of Benefits $20 20 Plan Highlights
	Chiropractic Schedule of Benefits $20 30 Plan Highlights
	Chiropractic Schedule of Benefits $20 30 Plan Highlights
	Chiropractic Schedule of Benefits $25 10 Plan Highlights
	Chiropractic Schedule of Benefits $25 15 Plan Highlights
	Chiropractic Schedule of Benefits $25 20 Plan Highlights
	Combined Schedule of Benefits $10 20 Plan Highlights
	Combined Schedule of Benefits $10 20 Plan Highlights
	Combined Schedule of Benefits $10 30 Plan Highlights
	Combined Schedule of Benefits $10 30 Plan Highlights
	Combined Schedule of Benefits $15 20 Plan Highlights
	Combined Schedule of Benefits $15 20 Plan Highlights
	Combined Schedule of Benefits $15 30 Plan Highlights
	Combined Schedule of Benefits $15 30 Plan Highlights
	Combined Schedule of Benefits $20 20 Plan Highlights
	Combined Schedule of Benefits $20 20 Plan Highlights
	Combined Schedule of Benefits $20 30 Plan Highlights
	Combined Schedule of Benefits $20 30 Plan Highlights
	Landmark Chiropractic Only Expanded Evidence of Coverage
	Landmark Chiropractic Only Standard Evidence of Coverage
	Landmark Combined Expanded Evidence of Coverage
	Landmark Combined Standard Evidence of Coverage

Vision: VSP

	CoPower VSP EasyOptions Plan Summary
	VSP Basic Choice Enhanced Plan B $130, $25 with Retail
	VSP Basic Choice Plan A $20 with Retail
	VSP Choice Plan A $20
	VSP Choice Plan A $25 $25
	VSP Choice Plan A $25 $25 with Retail
	VSP Choice Plan B $150 $20 $20
	VSP Choice Plan B $180 $10
	VSP Choice Plan C $150 $10 $25
	VSP Choice Plan C $180 $10
	VSP Choice Plan C $200 $300 $10 $25 EZO
	VSP Easy Option 5 Choice Plan C $10 $25
	VSP Elite Choice Enhanced Plan B $25 with Retail
	VSP Elite Choice Plan C $25 with Retail
	VSP Signature Enhanced Plan B $0 $20
	VSP Signature Enhanced Plan B $0 $20 with Retail
	VSP Signature Enhanced Plan B $25
	VSP Signature Plan A $25
	VSP Signature Plan A $25 with Retail
	VSP Signature Plan C $0 $20
	VSP Signature Plan C $0 $20 with Retail
	VSP Signature Plan C $10
	VSP Signature Plan C $10 with Retail
	VSP Standard Choice Plan C $130, $25 with Retail
	VSP Standard Signature Health Plan B $25 with Retail
	VSP Vol Choice Enhanced Plan B $150, $10 $25 with Retail
	VSP Vol Choice Enhanced Plan B $180, $10 $25 with Retail
	VSP Vol Choice Enhanced Plan B $20 $20
	VSP Vol Choice Enhanced Plan B $20 $20 with Retail
	VSP Vol Choice Plan C $10 $25 with Retail
	VSP Vol Choice Plan C $20 $20 with Retail
	VSP Vol Choice Plan C $25 with Retail
	VSP Vol Easy Options 5 Choice Plan C $10 $25
	VSP Vol Signature Enhanced Health Plan B $10
	VSP Vol Signature Enhanced Health Plan B $10 with Retail
	VSP Vol Signature Plan C $10
	VSP Vol Signature Plan C $10 with Retail