Device Eligibility And Deductible Schedule For Mobile .
Device Eligibility and Deductible ScheduleFor Mobile Insurance* (standalone or as part of Mobile Protection Pack)11/1/2015 UpdateThe Equipment Tier List is updated regularly to include new models. Devices introduced underEquipment Tier 2 or Equipment Tier 3 may be moved to a lower tier during their lifecycle. The nonrefundable deductible is based on the device in use and the equipment tier assigned on the date of loss.If you are not certain of the model of your device, refer to your original receipt or you may be able todetermine the model by following these steps (if applicable): Turn the power off. Carefully remove thebattery cover and the battery. The model is typically printed on the white label located under the battery.This list is changed from time to time. Please check this list any time your equipment changes.AT&T Mobile Insurance (standalone or as part of Mobile Protection Pack) is not available for andcoverage does not apply to: Samsung Galaxy Camera (EK-GC100A)PlayStation VitaAmazon Kindle Amazon Kindle Touch 3BlackBerry PlayBook Phones on GoPhone accountsTablets with prepaid data plansAT&T MicroCell Phone or device models not sold by AT&TDocks (such as for the Motorola ATRIX 4G)Eligibility is subject to change.Protect Plus appPlease visit att.com/protectplus to view app device compatibility.*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 1 of 13
AT&T Mobile Insurance (standalone or as part of Mobile Protection Pack) Deductible ScheduleA non-refundable deductible applies to each approvedclaimEquipment Tier 1 Equipment Tier 2 Equipment Tier 3Standard Deductible 50.00 125.00 199.00Declining Deductible: At 6 months since the incidentdate of your last approved claim * 37.00 93.00 149.00Declining Deductible: At 12 months since the incidentdate of your last approved claim * 25.00 62.00 99.00*Customers continuously enrolled in AT&T Mobile Insurance who remain claim-free for at least sixconsecutive months will be eligible for a Declining Deductible discount. See terms and conditions for fulldetails.Device Eligibility and Equipment Tier AZONAMAZONAMAZONAMBER ALERT 1830TASPIRE ONEASPIRE 1830ASPIRE NETBOOK(A0722)ICONIA TAB (A501)Fire (SD4930UR)KINDLEKindle Touch 3GKindle Fire HD 8.9” 4GLTE (53-000485)Kindle Fire HDX 7”(C8X4DE)AMBER ALERT GPS(AAGPS-3G)iPhone 2GiPhone 3GiPhone 3GSiPhone 4iPhone 4SiPhone 5iPhone 5CiPhone 5SEquipment TierEquipment Tier 3Equipment Tier 3Equipment Tier 3Standard Deductible 199 199 199Equipment Tier 2Equipment Tier 3Equipment Tier 3IneligibleIneligible 125 199 199N/AN/AEquipment Tier 2Equipment Tier 1 125 50Equipment Tier 1 50Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 2Equipment Tier 2Equipment Tier 3Equipment Tier 3Equipment Tier 3 50 50 50 125 125 199 199 199*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 2 of 13
AT&TAT&TAT&TAT&TAT&TAT&TAT&TAT&TAT&TiPhone 6iPhone 6S (A1633)iPhone 6 PlusiPhone 6S Plus (A1634)iPad (all models)iPad Mini (all models)iPad Air (A1475)iPad Air 2 (A1567)MeMo Pad FHD 10LTE (ME302KL)MeMO Pad 7 LTE(ME375CL)PadFone X (T00D)VIVOTAB RT(TF600TL)8525BEAM (AC340U)F160IMPULSE 4G (U8800)MOBILE HOTSPOTELEVATE 4G (AC754S)MOBILE HOTSPOTMiFi 2372MOBILE HOTSPOTMIFI LIBERATE 5792MOBILE HOTSPOTUNITE (AC770S)MODIO LTE Case foriPad mini (Y860OA)QUICKFIRETILT (8900/8925)Trek USBCONNECT 881USBCONNECT 900USBCONNECTADRENALINE (AD600)UNITE PROUSBCONNECT FORCE4G ECTMOMENTUM 4G(AC313U)Equipment Tier 3Equipment Tier 3Equipment Tier 3Equipment Tier 3Equipment Tier 3Equipment Tier 3Equipment Tier 3Equipment Tier 3 199 199 199 199 199 199 199 199Equipment Tier 1 50Equipment Tier 1Equipment Tier 3 50 199Equipment Tier 3Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1 199 50 50 50 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1 50 50 50 50 50 50Equipment Tier 1Equipment Tier 1 50 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 3 of 13
AUDIOVOXDELLUSBCONNECTSHOCKWAVE(USB308)USBCONNECT TURBOUSBCONNECTVELOCITYWireless Home Phone(LG-AF300)WIRELESS HOMEPHONE (WF720)WIRELESS HOMEPHONE (WF721)WIRELESS HOMEBASE (ZTE Z700)WIRELESS HOMEBASE (ZTE Z700A)Z331CAR CONNECTIONELITE SERIES(CCOBD2A)AERODELLEVADOINSPIRON MINI 10 HDFiLIP (EF-0001)AT&TAT&TAT&TAT&TAT&TAT&TAT&TAT&TAT&TFiLIP TechnologiesFiLIP 2 (EF-0001)GARMINHPHPHPHTCNUVIFONE (G60)IPAQ GLISTENMINI 110VEER 4G (P160UNA)ARIA (A6366)Desire 610(0P9O110 P)Desire HTCDesire EYE (0PFH100)First (PM33100)FREESTYLE (F5151)FUZE (P4600/P4605)HD7S (T9295)JETSTREAM(PG09410)INSPIRE 4G (PD98120)One (M8) (OP6B120)One (M8) (0P6B180)One M9 (OPJA110)One (PN07120)Equipment Tier 1Equipment Tier 1 50 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1Equipment Tier 1 50 50Equipment Tier 1Equipment Tier 1 50 50Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 2Equipment Tier 1Equipment Tier 1 125 50 50 50 50 125 50 50Equipment Tier 1Equipment Tier 1 50 50Equipment Tier 2Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 2 125 125 50 50 125Equipment Tier 3Equipment Tier 2Equipment Tier 3Equipment Tier 3Equipment Tier 3Equipment Tier 3 199 125 199 199 199 199*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 4 of 13
LGLGLGONE VX (PM36100)ONE MINI(PO58220)ONE X (PJ83100)ONE X (PM63100)PURE (ST6356)SURROUND (T8788)TILT 2 (ST7377/ST7378)TITAN (PI39100)TITAN II (PI86100)VIVID (PH39100)WINDOWS PHONE 8X8G & 16G (PM23300)DuraForce (E6560)IDEATAB A2107S10ArenaA340A380CF360CU405ENCORE (U5AT)ESCAPE (P870)Escape2 EXPOG Flex (D950)G Flex2 (H950)G2 (D800)G3 (D850)G4 (H810)G3 Vigor (D725)G Pad 7.0 (V410)G Pad F 8.0 (LGV495)G Pad X 10.1 (LGV930)GR500GU292GU295G Vista (D631)G Vista 2 (H740)INCITE (CT810)INVISION (CB630)NEON (GT365)NEON II (GW370)Equipment Tier 1Equipment Tier 2Equipment Tier 3Equipment Tier 3Equipment Tier 1Equipment Tier 1 50 125 199 199 50 50Equipment Tier 1Equipment Tier 3Equipment Tier 3Equipment Tier 2 50 199 199 125Equipment Tier 2Equipment Tier 2Equipment Tier 1Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 3Equipment Tier 3Equipment Tier 3Equipment Tier 3Equipment Tier 3Equipment Tier 1Equipment Tier 1 125 125 50 125 50 50 50 50 50 50 50 50 50 199 199 199 199 199 50 50Equipment Tier 1Equipment Tier 2 50 125Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1 50 50 50 50 125 50 50 50 50*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 5 of 13
ROLAMOTOROLAMOTOROLAMOTOROLAMOTOROLANITRO HD (P930)OPTIMUS G (E-970)OPTIMUS G PRO(E980)PHOENIX (P505)PRIME (GS390)QUANTUM (C900)SHINE (CU720)SHINE IITHRILL 4G (P925)THRIVE (P506)TRAX (CU575)V10 (H900)VU (CU920)VU PLUS (GR700)XENON (GR500)XPRESSION (C395)Xpression 2 (C410)Lumia 640 XL(A00023900,A00024336)Surface 3 (1657)ATRIX 4G (MB860)ATRIX 2 (MB865)ATRIX HD (MB886)BACKFLIPBRAVO (MB520)EM330FLIPOUT (MB511)FLIPSIDE (MB508)KARMA (QA1)Q9HRAZRTundra (VA76r)V365V3iV3rV3xx (IZAR)V9 (MOTORAZR2 V9)V9XMoto G (XT1045)MOTO X (XT1058)*MOTO X (XT1097)*Nexus 6 (XT1103)Z9Equipment Tier 3Equipment Tier 3 199 199Equipment Tier 3Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 3Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1 199 50 50 50 50 50 50 50 50 199 50 50 50 50 50Equipment Tier 1 50Equipment Tier 3Equipment Tier 2Equipment Tier 2Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 2Equipment Tier 2Equipment Tier 3Equipment Tier 1 199 125 125 125 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 125 125 199 50*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 6 of 13
PANTECHPANTECHPANTECHTERRAIN 065556555i6650C3E62E71XLUMIA 635LUMIA 820LUMIA 830 (RM-983)**LUMIA 900LUMIA 920LUMIA 925LUMIA 1020LUMIA 1520LUMIA 2520 TABLETMURAL (6750)N75 (NGAGE)SURGE (6790)FAEMA USBQUICKSILVERGTMAX 3.6HSUPA GT ULTRA(ETNA)HSUPA GT ULTRA(EXPRESS)CENTROPIXIE PLUSPRE PLUSBREEZE (C520)BREEZE II (P2000)BREEZE IV(P2050)BURST (P9070)CROSSOVER (P8000)DISCOVER (P9090)Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 2Equipment Tier 2Equipment Tier 2Equipment Tier 2Equipment Tier 3Equipment Tier 3Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 1 125 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 125 125 125 125 199 199 125 50 50 50Equipment Tier 1Equipment Tier 1 50 50Equipment Tier 1 50Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 1 50 50 50 125 50 50 125 50 50 50*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 7 of 13
IMRIMRIMRIMRIMRIMDUO (C810)EASE (P2020)ELEMENT (P4100)FLEX (P8010)IMPACTLAZERLINK (P7040)LINK II (P5000)MATRIX (C740)MATRIX PRO (820)POCKET(P9060)PURSUITP6010RENUE (P6030)REVEAL (C790)SLATE (C530)SWIFT (P6020)BLACKBERRY 7100GBLACKBERRY 7130CBLACKBERRY 8820BLACKBERRY BOLD9000BLACKBERRY BOLD9700BLACKBERRY BOLD9900Blackberry Classic(SQC100-2)BLACKBERRY CURVE8300BLACKBERRY CURVE8310BLACKBERRY CURVE8320BLACKBERRY CURVE8520BLACKBERRY CURVE8900BLACKBERRY CURVE3G (9300)BLACKBERRY CURVE3G (9360)Blackberry Passport(SQW100-3)BLACKBERRY PEARL8100CEquipment Tier 1Equipment Tier 1Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1 50 50 125 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50Equipment Tier 2 125Equipment Tier 2 125Equipment Tier 2 125Equipment Tier 2 125Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 3 199Equipment Tier 1 50*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 8 of 13
ACKBERRY PEARL8110BLACKBERRY PEARL8120BLACKBERRY PEARL3G (9100)BLACKBERRYPLAYBOOKBLACKBERRY Q10(SQN-100-1)BLACKBERRY TORCH(9800)BLACKBERRY TORCH(9810)BLACKBERRY TORCH(9860)BLACKBERRY CURVE(9360)BLACKBERRY 7A657A717A727A737A777ATIV SMART PC(XE500T1C-HA1US)ACCESS (A827)BLACKJACK II (i617)CAPTIVATE (i897)CAPTIVATE GLIDE(SGH-i927)DOUBLETIME (SGHi857)EPIX (i907)Equipment Tier 1 50Equipment Tier 1 50Equipment Tier 1 50IneligibleN/AEquipment Tier 3 199Equipment Tier 3 199Equipment Tier 3 199Equipment Tier 3 199Equipment Tier 1Equipment Tier 3Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1 50 199 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50Equipment Tier 3Equipment Tier 1Equipment Tier 1Equipment Tier 2 199 50 50 125Equipment Tier 2 125Equipment Tier 1Equipment Tier 1 50 50*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 9 of 13
AMSUNGSAMSUNGEternity (A867)Eternity II (A597)EVERGREEN (A667)FLIGHTFLIGHT II (SGH-A927)FOCUS (SGH-i917)FOCUS 2 (SGH-i667)FOCUS FLASH (SGHi677)FOCUS S (SGH i937)SAMSUNGGalaxy Alpha SAMSUNGSAMSUNGSAMSUNGSAMSUNGGALAXY EXHILARATE(SGH-i577)GALAXY EXPRESS(SGH-i437)GALAXY MEGA (SGH-i527)Galaxy Mega 2 (SMG750A)GALAXY RUGBY PRO(SGH-i547)GALAXY TAB (i987)GALAXY TAB 8.9(SGH-i957)Galaxy Tab 3 (7.0)(SM-T217A)Galaxy Tab 4 8.0Galaxy Tab 4 10.1(SM-T537A)Galaxy Tab S2 9.7”(SM-T817A)Galaxy Tab S 8.4 (SMT707A)Galaxy Tab S 10.5 (SMT807A)GALAXY S II(SGH-i777)GALAXY S IISKYROCKET(SGH i727)GALAXY S III (SGHi747)Galaxy S III MINI (SMG730A)Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1 50 50 50 50 50 50 50Equipment Tier 1Equipment Tier 3 50 199Equipment Tier 3 199Equipment Tier 1 50Equipment Tier 2 125Equipment Tier 2 125Equipment Tier 2 125Equipment Tier 1Equipment Tier 3 50 199Equipment Tier 3 199Equipment Tier 1Equipment Tier 1 50 50Equipment Tier 2Equipment Tier 3 125 199Equipment Tier 3 199Equipment Tier 3 199Equipment Tier 2 125Equipment Tier 3 199Equipment Tier 3 199Equipment Tier 1 50*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 10 of 13
UNGSAMSUNGGALAXY S 4 (SGHi337)GALAXY S 4 (SGHi537)GALAXY S 4 ZOOM(SM-C105A)Galaxy S 5 (SM-G900A)Galaxy S(R) 5 mini (SMG800A)Galaxy S 6 (G920A)Galaxy S6 active (SMG890A)Galaxy S 6 edge(G925A)Galaxy S6 Edge (SMG928A)GALAXY NOTE(SGH-i717)GALAXY NOTE II(SGH-i317)GALAXY NOTE 3 (SMN900A)Galaxy Note 4 (SMN910A)Galaxy Note 5 (SMN920A)Galaxy Note Edge(SM-N915A)Galaxy Note Pro 12.2(SM-P907A)GALAXY NOTE 8.0TABLET (i467)Gear S (SM-R750A)GO (N310)IMPRESSION (A877)INFUSE 4G (SGH-i997)Jack (i637)Magnet (SGH-a257)MYTHICP777Propel (A767)Propel Pro (SGH-i627)RUGBY (A837)RUGBY II (A847)RUGBY IIIEquipment Tier 3 199Equipment Tier 3 199Equipment Tier 3Equipment Tier 3 199 199Equipment Tier 2Equipment Tier 3 125 199Equipment Tier 3 199Equipment Tier 3Equipment Tier 3 199 199Equipment Tier 3 199Equipment Tier 3 199Equipment Tier 3 199Equipment Tier 3Equipment Tier 3 199 199Equipment Tier 3 199Equipment Tier 3 199Equipment Tier 3Equipment Tier 1Equipment Tier 2Equipment Tier 1Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1 199 50 125 50 125 50 50 50 50 50 50 50 50 50*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 11 of 13
AMSUNGSAMSUNGSHARPSHARPSIERRA WIRELESSSIERRA WIRELESSSIERRA WIRELESSSIERRA SONY-ERICSSONSONY-ERICSSONZTEZTERugby 4 (SM-B780A)RUGBY SMART(SGH-i847)SGH-A107SLM (A747)SOLSTICE (A887)SOLSTICE II (A817)STRIVE (A687)SUNBURST (A697)SYNC (A707)FX (STX-2)FX II/PLUS (ADS1)AC860AC875 3.6AC875UAC881XP5 (XP5700)XP6 (XP6700)C905aEC400EXPERIA TL (LT30at)TABLET P(SGPT211US)VIVAZ (U5AT)W350aW518aW580iW760AW810iXPERIA ION (LT28at)XPERIA PLAY 4G(R800AT)XPERIA X10Z300aZ310aZ750AMobley (VM6200)Spro 2 Smart Projector(MF97B)Equipment Tier 1 50Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 2 50 50 50 50 50 50 50 50 50 50 50 50 50 50 50 125 50 50 125Equipment Tier 2Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 2 125 50 50 50 50 50 50 125Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1Equipment Tier 1 50 50 50 50 50 50Equipment Tier 2 125*Motorola Moto X is eligible for AT&T Mobile Insurance (standalone or as part of Mobile Protection Pack).Claims on this device will be fulfilled with the non-customized black or white model - customizedreplacements will not be provided.*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 12 of 13
** Lumia 830 with the Fitbit Flex is eligible for AT&T Mobile Insurance (standalone or as part of MobileProtection Pack). Claims on this device will be fulfilled with the Lumia 830 Device-only model - Fitbit Flex accessory is not a standard accessory and is not covered.*AT&T Mobile Insurance is underwritten by Continental Casualty Company, a CNA company (CNA), and administered by AsurionProtection Services, LLC (In California, Asurion Protection Services Insurance Agency, LLC, CA Lic. #OD63161. In Puerto Rico,Asurion Protection Services of Puerto Rico, Inc.), a licensed agent of CNA. 2014 AT&T Intellectual Property. All rights reserved.AT&T and the AT&T logo are trademarks of AT&T Intellectual Property. All rights reserved.November 1, 2015Page 13 of 13
AMAZON Kindle Touch 3G Ineligible N/A AMAZON Kindle Fire HD 8.9” 4G LTE (53-000485) Equipment Tier 2 125 AMAZON Kindle Fire HDX 7” (C8X4DE) Equipment Tier 1 50 AMBER ALERT GPS AMBER ALERT GPS (AAGPS-3G) Equipment Tier 1 50 APPLE iPhone 2G Equipment Tier 1
Deductible plus 20% coinsurance Deductible plus 20% coinsurance Must meet emergency criteria. Urgent care 50 copay/visit Deductible plus 50% coinsurance None If you have a hospital stay Facility fee (e.g., hospital room) Deductible plus 20% coinsurance Deductible plus 50% coinsurance Prior Authorization is required. Physician/surgeon fees
Kaiser Permanente LLNL-PRES-xxxxxx 8 High Deductible Health Plan (HDHP) Must live in plan's service area - Californiaonly-No out-of-network coverage (except emergency) Deductible- 1,500individual- 3,000family - must meet cumulative family deductible-After deductible you pay10% Pharmacy-Until deductible is met you pay 100% of drug cost-
VSC-01D-SPM-EDS-2012 (rev. 2/15) Page 3 of 11 DEDUCTIBLE: In the event of a Breakdown of any Covered Part(s) listed below, You may be required to pay a Deductible.No Deductible payment is required with respect to Coverage listed in the Additional Benefits of Coverage Section of this Contract.The Deductible type and amou
Office Visit 10% after deductible 30% after deductible Emergency Room 150/visit 10% In patient services 10% 30% Outpatient services (surgery, x-rays, blood work) 10% 30% Prescription Drugs Tier Level (After Deductible) Retail (Up to 30-day supply) MailOrder (up to 90-day supply) Rx Deductible 0 Tier 1
500 deductible per auto/unlimited per occurrence 1,000 deductible per auto/unlimited per occurrence 2,500 deductible per auto/unlimited per occurrence 5,000 deductible per auto/unlimited per occurrence Exclude Windstorm Hurricane Hail Exclude Flood 33. List all Business Loca
NO CLAIMS WILL BE PAID WITHOUT PRIOR AUTHORIZATION CLAIMS: 877-414-0134 Page 3 of 16 VMCDR _01/20 Deductible - Means the amount You are required to pay as selected on the Application Page per Covered Repair.No Deductible payment is required with respect to Additional Benefits.If no Deductible is stated on the Application Page, the standard Deductible will be one hundred ( 100)
For Multi-Device Insurance* (part of Multi-Device Protection Pack) 11/1/2015 Update Devices connected to the AT&T network: The Equipment Tier list is updated regularly to include new models. Devices introduced under Equipment Tier 2 or Equipment Tier 3 may be moved to a lower Tier during their lifecycle. The non-refundable
DIR-330 A1 Device 6-18-2016 DIR-130 A1 Device 6-18-2016. DFE-690TXD A4 Device 6-8-2016 DFE-538TX F2 Device 6-8-2016 DFE-528TX E2 Device 6-8-2016 DXS-3250E A1 Device 5-31-2016 DXS-3250 A1 Device 5-31-2016 DXS-3227P A1 Device 5-31-2016 DXS-3227 A1 Device 5-31-2016 DEM-411T A1 Device 5-31-2016
