%PDF-1.6
%
2 0 obj
<<
/AcroForm 4 0 R
/Lang ( E N - U S)
/MarkInfo <<
/Marked true
>>
/Metadata 5 0 R
/Names 6 0 R
/Outlines 7 0 R
/PageLayout /OneColumn
/Pages 8 0 R
/StructTreeRoot 9 0 R
/Type /Catalog
>>
endobj
5 0 obj
<<
/Length 4729
/Subtype /XML
/Type /Metadata
>>
stream
2022-09-08T13:15:59-04:00
2022-09-08T13:35:23-04:00
Acrobat PDFMaker 17 for Word
2022-09-08T11:38:47-07:00
uuid:8ea5e172-dbff-436b-a06f-26b81c98a846
uuid:5a3e6276-0093-4e44-ba2d-9e66b546f1e2
2
application/pdf
Provides a fillable Summary of Benefits and Coverage template to provide answers to key questions and information about common medical events
CMS
Adobe PDF Library 17.11.238
SBC, Summary of Benefits and Coverage, deductible, services, out-of-pocket limit, network provider, referral, specialist, cost sharing
D:20220908171531
CMS
D:20190917
D:20191014
0x0101003BBF064D72B5814F91C1413FA2F47BA6
3d54ab2d-4a96-4206-ad78-901953a21573
QSXZK4DW25JC-2088971228-2979
https://share.cms.gov/center/cciio/CSG/TranDisc/_layouts/15/DocIdRedir.aspx?ID=QSXZK4DW25JC-2088971228-2979, QSXZK4DW25JC-2088971228-2979
Provides a fillable Summary of Benefits and Coverage template to provide answers to key questions and information about common medical events
endstream
endobj
97 0 obj
<<
/Filter /FlateDecode
/Length 1830
>>
stream
HWYoF~ׯ h q"[
%hڤéα\:7b5&+xlb&7ƃr*:IN $$ƹ8Sf,W#g׳"[??:9^* T@y=QS:JS!2T
F#4pBMoF_P(GȏzcdnNo H'*mh#a{dY3h6U6
[}f0n1t$6W^ͷ[(Dб$[R0K<ҩAL#{g9
f?}s|vMx1b&/(;֔wn`>ق(iM#7)\MYK3
)] W9v#Zc"94YIr;WDV.̈
Kf"yifn|#lT;q|92FّHyO,Q3DΌ9րxCWf#,\QвΧ]ihn-}$FgOLdeYYՄpئ#Zl6jcۍ*K,x(V~]{zǦU!Ro|YP1B{@
<