View Premium and Co-Payment Limit

Assistance Unit Details

Assistance Unit[parameter-value]
of[parameter-value]
Selected Assistance Unit Members[field-value]
Payment Exemptions[field-value]

Premium Details

Total Premium for Assistance Unit[Amount]
Premium Frequency[Daily]
Premium Plan Level[field-value]

Co-Payment Details

Maximum Co-payment Limit[Amount]
Effective From Date[Date]
Effective To Date[Date]

Confirm Selection

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