Simplified Silver Application

Enrollment received

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Simplified Silver Medical Plan

Payment Frequency
Monthly
Optional Coverage
Primary Insured — Alex Morgan (Age 40, Male)
Excess Coverage Rider
$X.00
Outpatient Prescription Drug Rider
$X.00
Cancer Treatment Rider
$X.00
Spouse — Taylor Morgan (Age 38, Female)
Outpatient Prescription Drug Rider
$X.00
Payment Breakdown
Base Premium $202.00
Optional Riders $128.00
Total Paid $333.00/mo