Primary Member (Primary)
First Name
Last Name
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Cost
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iEverydayCARE without Hospitalization
$125.00 per Month for Member
$240.00 per Month for Member plus Spouse
$240.00 per Month for Member plus Child(ren)
$365.00 per Month for Member plus Family
Product
$0.00
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Total
$0.00
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${firstname} ${lastname}
(${relationship})
