AGENT DETAILS
Sarah Leb (LEB INSURANCE GROUP)
ASKFORSARAH@YAHOO.COM
920.552.4846 Cell
920.243.4100 Office
PLAN SECTION
LEB INSURANCE GROUP
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Choose a Plan
Annual Deductible Per Member
Formulary
Retail Co-pay
Copay-1
Copay-2
Copay-3
Mail Order Co-pay
Copay-1
Copay-2
Copay-3
Maximum Benefits Payable
Per Member Per Month
Monthly Rates
Individual
Individual + Spouse
Individual + Child(ren)
Family
No plan is available.
FG = Formulary Generic
FB = Formulary Brand
NF = Non-Formulary
PB = Preferred Brand
NPB = Non-Preferred Brand
PRIMARY MEMBER APPLICANT DETAILS
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Select the desired effective date from the list of available options above.

APPLICANT ADDRESS

Congratulations!

Your enrollment is completed. Please check your e-mail box for a Welcome Packet.

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