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Home Office: Bloomfield, Connecticut
Mailing Address: Hartford, Connecticut 06152
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
a CIGNA company (called CG)
CERTIFICATE RIDER
No. CR7BIASO8-1
CR7BIASO9-1
Policyholder: Brookhaven Science Associates LLC.
Rider Eligibility: Each eligible employee as reported to the insurance company by your Employer
Policy No. or Nos. 3210488-OAP1, OAP4
EFFECTIVE DATE: January 1, 2008
You will become insured on the date you become eligible, if you are in Active Service on that date, or if you
are not in Active Service on that date due to your health status.
This certificate rider forms a part of the certificate issued to you by CG describing the benefits provided
under the policy(ies) specified above.
GM6000 R 7
CEP
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The section entitled Maximum Reimbursable Charge in THE SCHEDULE —Open Access Plus Medical Benefits — in your
certificate is changed to read as follows:
The definition in your certificate entitled “Maximum Reimbursable Charge” is replaced by the definition attached to this certificate
rider.
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Maximum Reimbursable Charge
Maximum Reimbursable Charge is
determined based on the lesser of the
provider's normal charge for a similar
service or supply; or
A percentile of charges made by
providers of such service or supply in
the geographic area where the service is
received. These charges are compiled
in a database we have selected.
Not Applicable
90th Percentile
Note:
The provider may bill you for the
difference between the provider's
normal charge and the Maximum
Reimbursable Charge, in addition to
applicable deductibles, copayments and
coinsurance.
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Definitions
Maximum Reimbursable Charge - Medical
The Maximum Reimbursable Charge for covered services is
determined based on the lesser of:
• the provider’s normal charge for a similar ser