Premium
Total Premium | [Amount] | Plan Level | [field-value] |
---|---|---|---|
Frequency | [Daily] | Payment Exemptions | [field-value] |
Co-Payment Limit
Max Limit | [Amount] | ||
---|---|---|---|
Effective From | [Date] | Effective To | [Date] |
Are you sure you want to authorize this assistance unit? | [] |
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Total Premium | [Amount] | Plan Level | [field-value] |
---|---|---|---|
Frequency | [Daily] | Payment Exemptions | [field-value] |
Max Limit | [Amount] | ||
---|---|---|---|
Effective From | [Date] | Effective To | [Date] |
Are you sure you want to authorize this assistance unit? | [] |
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