and comprehensive benefits. You do not need areferral to receive covered services from plan providers. Certain procedures, services and drugs 
may need advance approval from your plan. This is called a"prior authorization" or "preauthorization." Please 
contact your PCP or refer to the Evidence of Coverage (EOC) for services that require aprior authorization from the 
plan .
c
10 Summary of Benefits H5619075000SB23 H5619075000 
Covered Medical and Hospital Benefits  (cont.)