Noblesville Schools Medical Plan 11 Schedule of Benefits Set 001 Payment Term And Description Amounts The Amount You Pay Designated Network and Network The Amount You Pay Out-of-Network Coinsurance is the amount you pay (calculated as a percentage of the Allowed Amount or the Recognized Amount when applicable) each time you receive certain Covered Health Care Services. Details about the way in which Allowed Amounts are determined appear at the end of the Schedule of Benefits table.

[UHC] HDHP Basic - Medical Plan Summary - Page 18 [UHC] HDHP Basic - Medical Plan Summary Page 17 Page 19