Member for 7 years 1 month Submitted by Site Factory admin on Fri, 10/20/2023 - 18:47 Covered Service Text 11154 12962 12428 13112 12835 77 12963 78 79 13120 11570 80 82 13123 84 86 12490 13121 Plan ID 5 Plan Name HMO Blue New England Product Type Medical Service Benefit Category Id 19 Service Benefit Category Name Medical Care Outpatient Visits