SOUTHERN TRUST COMPANY 6100 RED HOOK QUARTER, B-3 ST THOMAS Vi 00802-0000 ) Unitedtlealthcare 272605 Number: SOUTHERN TRUST COMPANY G UnitedHealthcare Choice Plus Uncterwriten by UnitedHoatticare lsurance Company N 55 BSRBREY -002669 7080107 003082 = J. EPSTEIN og 6100 RED HOOK QUARTER B-3 z = 88 ST THOMAS VI 00802-0000 73 B es 3 F 8 2 Fy a So wil BG 03082 7080107 0000 0002669 1002669 3519 116 EFTA00316296

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EFTA00316297

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SOR ASS SOREL IU NEO Fe Cremep 2 JOOS Is ee SEEN BD te, PHN BED 0 Br2aQ00 NS Op MaUEH)A ue EPEAUO GD Ep |0 SROWRENEWY e19Lsm] exeNU ePtd sen & JETBMUOD epong WAP EUAO/L! OP EPURIaISUED A GuniDe ME OPER HIDE ‘CUQuERY CUED MoUE~OdKD 20[0W Gun eyecoiodard Bred EpEYeRP gute UNPEDIVED p ele ersnu ng ‘C1QRDN|e8 SPU EPH GUN Jena] @ CEpre wepENd end sonyues e OSBD3€ OUDR PaIEN “MEONBO} PRIN BP CiQwoRE ep EaDgU UPQEOYpESPY OP EPO, ersnU Ns VOD, SeoueoOUN HGepe 0d seDEID “EEE [SIP UB S788N AL) "PUES Qj ANCA UO sequNY eUOUd JeqwoWw 984-210) 64} [189 40 WOT DynKus WEA “SUORSEND Brey NOA j| “doy OF B04 BON, *pue2 Q| 20K yo Adoo 2 UU 20 PeORUMOD ‘MRA WAND UBD NOA ‘GJ0W PUR 'S|S09 oyrwRsO “swajo Ald PUB YEA “S10}0p JOMIAU PUY UEDNOA “08 oly UO PUE e’wOY Je SWeLEG but Wi1eey sNOK aGevEW NOK djoy o} VoRELUOW PUL $001 PUI) OF de SRQoW SON PUIERH S1COUNBOHPSYUN SY) PEOILMOP PUB goo SynAw 20) dn uBIS “BUCASOND Yam Sn 1/69 NOK ys APB eABY pUE ‘Swewuiodde nok 0} DIED QI INOK 42) 0} JoQueWeyY “s}EP eAND@yO UNDA UO puedo UNOK Buyen uj6eq Kew mo, (BUD Oy) UO ZeQWNU JOQUeW og OuImeD AG MOU SN 3] @SBRIC "OU 5) "BUS S VONEUOJU! IE GNF 6G OF PIED NOK HAYS BSR AId ‘POYDEHE s} PveD (qi) VONEIYRLOP UEIG YIICOY GAP DUNEOHPAHUN ZNO, : 877-842-3210 Of wre Modleat Claims: £0. BOX 74000 RIEANTS PR - MAPFRE - PO 80x70297, San Providers: "NOK @nJes 0} proud G22 a” LaquIDW BJEDMjEBHDSUN @ BuEG 20) MOA YUL EFTA00316298 ireOnline.com 740800 Juan, PR 00936-8297 003082 002670 01/01 Pharmacy Ciaims: OptumFx PO Box 29044 Hot Springs, AR 71903 a: MAPFRE 002669 9000000 7080107

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EFTA00316299

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349R05D1060179002 UnitedHealthcaré 0 A Urerediteaith Group Company UnitedHealthcare 185 Asylum Street Cityplace | Hartford, CT 06103 December 14, 2016 VINO 0 G/GA272605IM SOUTHERN TRUST COMPANY 6100 RED HOOK QUARTER, B-3 ST THOMAS, VI 008020000 Dear Customer: The Affordable Care Act requires all health plan issuers and group health plans to provide eligible enrollees with a Summary of Benefits and Coverage (SBC). The SBC provides you information to better understand your plan and allows you to compare coverage options. You are receiving this package due to one of the following plan coverage events that requires you to receive an SBC. * Upon application for coverage, * Prior to any material modification of your plan coverage, * — Prior to your plan renewal, or * You are a special enrollee. If you are an Employer, you can find your group's SBC documents by logging into www.employereservices.com and select "Summary of Benefits and Coverage” under the Resources menu. For more information regarding this document, please visit uhc.com/summary or contact the Member Services number on the back of your ID card. Very truly yours, CL hf. tok Christopher Hock Broker & Employer Operations UnitedHealthcare EFTA00316300

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EFTA00316301

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QOD 8101 a9 “Adoo v ysanbas 03 ¢9¢7-L8p-998-T [[Z2 10 WaIOJaIIpTeay /esqa /Aod-jop- Arar 40 AOB-susd“OTD9"ALaLAs yw Arvsso[4 DY] AVDA ULD NOX *AlvssO[H aYp das ‘WAOJ sty UI pasn sua papjoq ayy jo Auv anoge avajo 2,uag¥ Nod J] *WIOD'DYNOUIODIAL-MALAL TE SN STA JO OPLE-ZSL-008-T [XD :suONsaNyH é39A09 ‘SIOTAINS POPNoxo INog" VORwUIOJUT [eUONIPpL Joy JUaLUNDOP UL 3,us90p ued styy 30 Aaqod anoX aag “¢ aSed uo pais] a1¥ 39409 2,usa0p uEjd sty sadrAras ay JO DUIOg . SIOTAIaS DIDI aIW ase ads & 99s 03 ‘uy siya wosy UoIsstued ynoYsIA asOOY> NOA TSHPEHodS oy2 998 UY NOX ‘On Jesi9j21 & pasu | og : Od JO spury judIajjIp sAud ued siya MOY JOj Z Sdud UO Bupieys yy ay) dag “IOAIST sup ur SToprAosd 10; Bunvdionied 30 Porsoyord “yIOAMIOU-UT Wa} DYY ASN SUL{J "SAdIAIIS DWOS JO} FSPIAGId yIOMJau-jo-3no uv asn Avw peudsoy “OPLE-Z8L-008-1 éStopraosd 40 JOI1DOP YsOAYoU-UT INOK ‘IVA dg "S9DIAIDS PIDAOD JO $ISOD JUD JO [Ie JO aWOS [[U9 10 WHOS DYNOJIUTOSTIAL-ALALAL jo SioMjou fed jin ueyd srya FaprAosd asvs wpyeay s9yp0 Jo JOOP yrOMAaU-UT UE asn NOK JT aas ‘stopraord yoayjau jo ast] v 10,] ‘saA| ¥vasn urd sup ss0q esked ued aya “SUISIA DIYJO SB YINS “SadLAIAS palaAod YM UO IW enuuE afioeds soy Sed [pos urd aya avy uo situ uv saquosap z o8vd uo Sunams uvyo oy, “0D [[@39A0 uv aay 8] ‘ssnap uondussaid pu sXvdoo ‘ saotasas 10} UONVIYRON-23q FA] ureaqo 0} aanyrey 10} sanjeuad ‘a9A09 1,usa0p ued) JSxSOd-FO-jno oyp ur FyHPod-Jo-Mo ayy pavavoi unos a,uop Aays ‘sasuadxa asaya Avd nos yBnoya vaag_| srya asvo ypyeay ‘soSswyo payiq-souypeq ‘summussg | papnyouy 30u st VY AK : xa aav9 Yafeay 103 uy no potiod oeiaa09 v utinp Aud pynoo noX ysous ay st FU JoxDOd-JO-jNO ayy, twee} Q00'S$ / AIPUT QOS'Z$ “OMAN d820}A708 SETS *s19A09 uvyd sip} SadTAIas 30] SISOD Joyo 30] Z aSed UO Joy Sayquonpep Suzys IVY ayy des Ing ‘sadtAsas DyIdads Joy S3[QHoONpop ow 03 Davy 1,uop nox i: JayIO aJay) dIW ‘s[qponpep ‘w?StBY) ON dup 199W NOA Jaye S9dtAIAS par9Aaod Joy Aed nod YOnuT Moy J0y Z aed uO BunIms S¥ MOJAq Parsi] SetAzas pu ‘snap uoNduosaad qeyd ayy dag “as] Arenuef ‘sdemye jou ang ‘AyeNsN) 12A0 ues B[QHONpep ua ‘skedoo 03 Ajdde 30u sa0q “sead epuayes Jog Yaya das 02 }UaLUNDOp ULI 40 AdJOd 4NOA yDaY‘D “ASN NOA sadIAJas PazaAod 105 Aud APU OOO'LS / A!PUL DOSS B2OMaNQ-VON 0) surdaq uvyd sry ar0jaq auNOWTY D[quoNpop op 2 dn sisoo aya FY Avd asnw noX 0$ 220MPN [TeI9A0 Juyp sT IVY AY nee SR aKY Tt eR aca oN inn Phen eeu aR COM Rin RIL Ta ano | Arata, life) Cis, 3} SISHEIM SI} AUM SIGMSUY qUPPOCLY 3 = I & SOd :edhy uel | Ajtwes/eekojdwz :103 aBesaaog S}SOD }! JEUM BF SISAOD Ue} SIU} JEU :eBeBAO|D Jo ArewunSs a 2 LOZILEIZL - LLOZ/LO/LO :poLied eBesen0g 6H/ 9A SNid 8210Y4D sroppaqpaun @ EFTA00316302

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Copayments are fixed dollar amounts (for example, $15) you pay for covered health care, usually when you receive the service. * Coinsurance is your share of the costs of a covered service, calculated as a percent of the allowed amount for the service. For example, if the ’s allowed amount for an overnight hospital stay is $1,000, your coinsurance payment of 20% would be $200. This may change if you ven't met your deductible. The amount the plan pays for covered services is based on the allowed amount, If an out-of-network provider charges more than the allowed amount, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowed amount is $1,000, you may have to pay the $500 difference. (This is called balance billing.) This plan may encourage you to use network providers by charging you lower deductibles, copayments and coinsurance amounts. ore | ee 1 Your Costif \ | Your Castlf /Madical Event ‘Services You May Need. ee veh ees ae Limitations & Exceptions | Provider Provider If you visit a health care If you receive services in addition to office visit, additional copays, deductibles, or co-ins may apply. Primary care visit to treat an 20% co-ins, after injury or illness additional Specialist visit $30 copay per + fein cine If you visit ded cop deductibles, or co-ins may apply. Other practitioner office visit | $20 copay per 20% co-ins, after | Cost Share pues for only Manipulative (Chiropractic) Services visit Pre-Notification required for non-network or benefit reduces to 50% of allowed. care/screening/immunizati- ded MRIs service If you have a test $20 copay per visit receive services in addition to office visit, ded and is limited to 20 visits per policy period. Preventive No Charge Not Covered No coverage non-Network. Includes preventive health services specified in the health care reform law. ded 2 of 8 EFTA00316303

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iGommon paecical Event Services You May Need Physician/surgeon fee Mental/Behavioral health inpatient services Substance use disorder outpatient services Substance use disorder inpatient services Your Cost lf You Use a Network Provider Not Covered =e Your Cost If ‘You Usea Non-Network Provider 20% co-ins, after Limitations & Exceptions Limited to 20 visits per policy period (combined with Outpatient Substance use). Pre-Notification required for certain services for non-network or benefit reduces to 50% of allowed. Limited to 30 days per policy period (combined with Inpatient Substance use). Pre-Notification required for non-network or benefit reduces to 50% of allowed. Limited to 20 visits per policy period (combined with Outpatient Mental health). Pre-Notification required for certain services for non-network or benefit reduces to 50% of allowed. Limited to 30 days per policy period (combined with Inpatient Mental health). Pre-Notification required for non-network or benefit reduces to 50% of allowed. Additional copays, deductibles, or co-ins may apply depending on services rendered. Inpatient Notification may apply. $500 Inpatient Stay per occurrence deductible applies prior to the Annual Deductible. Limited to 60 visits per policy period. Pre-Notification required for non-network or benefit reduces to 50% of allowed. Depending on the type of therapy, there is a limit of 20-36 visits per policy period. No coverage for Habilitative services. 20% co-ins, after | Limited to 60 days per policy period (combined with Inpatient 40f8 Rehabilitation). Pre-Notification required for non-network or benefit reduces to 50% of allowed. EFTA00316305

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www.ltg.gov.vi/division-of-banking-and-insurance.html. Additionally, a consumer assistance program can help you file your appeal. Contact U.S. Virgin Islands Division of Banking and Insurance at 340-773-6459 or visit www.ltg.gov.vi. Does this Coverage Provide Minimum Essential Coverage? The Affordable Care Act requires most people to have health care coverage that qualifies as "minimum essential coverage." This plan or policy does provide minimum essential coverage. Does this Coverage Meet the Minimum Value Standard? The Affordable Care Act establishes a minimum value standard of benefits of a health plan. The minimum value standard is 60% (actuarial value). This health coverage does meet the minimum value standard for the benefits it provides. Language Access Services: Spanish (Espafiol): Para obtener asistencia en Espafiol, llame al 1-800-782-3740 Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 1-800-782-3740 Chinese (F130): MURA REP ICHIGD, WARITIXABW 1-800-782-3740 Navajo (Dine): Dinek'ehgo shika at' ohwol ninisingo, kwiijigo holne’ 1-800-782-3740 To see examples of how this plan might cover costs for a sample medical situation, see the next page: 6 of 8 EFTA00316307

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349R05D1060179006 ILIV SUOISNPX2 JO SILUFT adUBINSUIOT) sajqnonpaq :sAed quaneg aanuaaaid Jayio ‘souoA, sisaq G10 wI0quT SdINPIIOIY PUL SISTA IIO sayddng pur quauidmbs jeorpayy suondussaig 1S}SO9 aed ajdwes OvL' L$ sAed juaneg 09z'r$ sAed uel = O0P‘S$ :S1eplAosd 0} pamo junowy «= BIOL SUOISN]DX9 JO SHUT auBINSUIOT) sajquonpaq :sAed juanedg aanuaaaid sayio ‘saursou A, suondissaag sysai Aloyeoquy visaysouy (Aqeq) sadavyo pendsozy oozes ard dEIaISqO suURNOY 00L‘tS (zaypou) saBivyo perrdsoyy :S}SO9 e1e9 ajdwes 0zz$ sAed yuoneg 0ze'L$ sKed uel » vS'Z$ :SseplAaoid 0} pamo yunowy i SOd :adhy uejg | Ajjwesseehojdwiz :10j aBesaA05 LLOZ/LE/ZL - LLOZ/LO/LO -POLed ebeisrAoy "sajduuexa asaya inoqge uoRPBWOsUT JUBOdUT 40} add yxau ayp aag “quasaygIp aq OSE [[HA o3e9 Jey JO 3809 aip pur ‘sajdurexa asayy Wily yuAJayZIpP 2q [[}\ aatadas nod oreo jenaoe ayy, ‘ued siya sopun s1S09 jenjdv anos ayeUIRSD 0) sojduxe asaya asn 3,u0¢q] “JoyeWINSe }SO9 B Jou W SI SIU, ‘suvyd quasayjIp JopuN parzdA0o ase Aaup jr 38 3ySiw quaned ajdurs v uonsa10id [eouvuy yon Aoy ‘es9Uad Ut ‘das 0} sajdurexa asayl asf] ‘sUONUNAS UDAIZ UT aIvD [vITPILL DAO qysiw urd sip moy Moys sajduexa asau, :sojdwexy ebeiaA05d esau} jnogy sajdwexy eBe1aa09g 6H/ AYA SNlid 8910Y4D areopeogparun @ EFTA00316308

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Y UnitedHealthcare Choice Plus V6F /H9 Coverage Examples Coverage Period: 01/01/2017 - 12/31/2017 Coverage for: Employee/Family | Plan Type: POS Questions and answers about the Coverage Examples: What are some of the assumptions behind the Coverage Examples? ¢ Costs don’t include premiums. ¢ Sample care costs are based on national averages supplied by the U.S. Department of Health and Human Services, and aren’t specific to a particular geographic area or health plan. ¢ The patient’s condition was not an excluded or preexisting condition. ¢ All services and treatments started and ended in the same coverage period. ¢ There are no other medical expenses for any member covered under this plan. ¢ Out-of-pocket expenses are based only on treating the condition in the example. ¢ The patient received all care from in-network providers. If the patient had received care from out-of-network providers, costs would have been higher. e If other than individual coverage, the Patient Pays amount may be more. What does a Coverage Example show? For each treatment situation, the Coverage Example helps you see how deductibles copayments, and coinsurance can add up. It also helps you see what expenses might be left up to you to pay because the service or treatment isn’t covered or payment is limited. Does the Coverage Example predict my own care needs? x No. Treatments shown are just examples. The care you would receive for this condition could be different based on your doctor’s advice, your age, how serious your condition is, and many other factors. Does the Coverage Example predict my future expenses? x No . Coverage Examples are not cost estimators. You can’t use the examples to estimate costs for an actual condition. They are for comparative purposes only. Your own costs will be different depending on the care you receive, the prices your providers charge, and the reimbursement your health plan allows. Can I use Coverage Examples to compare plans? ¥Yes . When you look at the Summary of Benefits and Coverage for other plans, you'll find the same Coverage Examples. When you compare plans, check the "Patient Pays" box in each example. The smaller that number, the more coverage the plan provides. Are there other costs I should consider when comparing plans? ¥ Yes . An important cost is the premium you pay. Generally, the lower your premium, the more you'll pay in out-of-pocket costs, such as copayments, deductibles, and coinsurance. You should also consider contributions to accounts such as health savings accounts (HSAs), flexible spending arrangements (PSAs) or health reimbursement accounts (HRAs) that help you pay out-of-pocket expenses. Questions: Call 1-800-782-3740 or visit us at www.welcometouhc.com. If you aren’t clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossary at www.cciio.cms.gov or www.dol.gov/ebsa/healthreform or call 1-866-487-2365 to request a copy. V6F 8 of 8 EFTA00316309

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349R05D10601739007 We do not treat members differently because of sex, age, race, color, disability or national origin. If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to the Civil Rights Coordinator. Online: UHC_Civil_Rights@uhc.com Mail: Civil Rights Coordinator. UnitedHealthcare Civil Rights Grievance. P.O. Box 30608 Salt Lake City, UTAH 84130 You must send the complaint within 60 days of when you found out about it. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll-free number listed within this Summary of Benefits and Coverage (SBC), TTY 711, Monday through Friday, 8 a.m. to 8 p.m. You can also file a complaint with the U.S. Dept. of Health and Human Services. Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Complaint forms are available at http:/Awww.hhs.gov/ocr/office/file/index.html. Phone: Toll-free 1-800-368-1019, 800-537-7697 (TDD) Mail: U.S. Dept. of Health and Human Services. 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call the number contained within this Summary of Benefits and Coverage (SBC), TTY 711, Monday through Friday, 8 a.m. to 8 p.m. EFTA00316310

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ATENCION: Si habla espafiol (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposicién. Llame al niimero gratuito que aparece en este Resumen de Beneficios y Cobertura (Summary of Benefits and Coverage, SBC). FER : MRRP (Chinese) , RMRRAMARE BR. HRT RANARRAR (Summary of Benefits and Coverage, SBC) APTA RAS Bea. XIN LUU Y: Néu quy vi ndi tiéng Viét (Vietnamese), quy vi s& duoc cung cap dich vy tro gidp vé ng6én ae mién phi. Vui long goi sé dign thoai mién phi ghi trong ban Tém luge vé quyén loi va dai tho bao hiém (Summary of Benefits and Coverage, SBC) nay. Ql: 8S01Korean)\# ASAE BF Cloj AGI MU|AS FRR OSA + VAI. B SEY Q! KtSt 2 OFAl(Summary of Benefits and Coverage, SBC)0{| 7IMZ! FRUMSH SS MS AlAle. PAUNAWA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga libreng serbisyo ng tulong sa wika. Pakitawagan ang toll-free na numerong nakalista sa Buod na ito ng Mga Benepisyo at Saklaw (Summary of Benefits and Coverage o SBC). BHMMAHHE: 6ecnnarusie yonyru nepesoga FOcTynHE! ANA mopelt, Yel PONHOH AZBIK ABAAETCA pycciom (Russian). [lossonvte mo GecrimaTHOMy HoMepy Tesle(poHa, yKa3aHHOMY B aHHOM «OOsope JIBTOT H MOKpbITHA» (Summary of Benefits and Coverage, SBC). Coal cpilnall ag 8 ye Sect cpm} ll dalie taal Ay alll Gaeliedll cilead ofd (Arabic) Ay yall Coast cus |i raat Ss (Summary of Benefits and Coveraget SBC) 4sbxill s ty! jell Yoke Salas ATANSYON: Si w pale Kreydl ayisyen (Haitian Creole), ou kapab benefisye sévis ki gratis pou ede w nan lang pa w. Tanpri rele nimewo gratis ki nan Rezime avantaj ak pwoteksyon sa a (Summary of Benefits and Coverage, SBC). ATTENTION : Si vous parlez francais (French), des services d’aide linguistique vous sont proposés gratuitement. Veuillez appeler le numéro sans frais figurant dans ce Sommaire des prestations et de la couverture (Summary of Benefits and Coverage, SBC). UWAGA: Jezeli méwisz po polsku (Polish), udostepniligmy darmowe uslugi ttumacza. Prosimy zadzwonié pod bezptatny numer podany w niniejszym Zestawieniu swiadozeri i refundacji (Summary of Benefits and Coverage, SBC). ATENCAO: Se vocé fala portugués (Portuguese), contate o servigo de assisténcia de idiomas gratuito. Ligue para o ntimero gratuito listado neste Resumo de Beneficios e Cobertura (Summary of Benefits and Coverage - SBC). ATTENZIONE: in caso la lingua parlata sia |’italiano (Italian), sono disponibili servizi di assistenza linguistica gratuiti. Chiamate il numero verde indicato all'interno di questo Sommario dei Benefit ¢ della Copertura (Summary of Benefits and Coverage, SBC). EFTA00316311

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349R05D1060179008 ACHTUNG: Falls Sie Deutsch (German) sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfiigung. Bitte rufen Sie die in dieser Zusammenfassung der Leistungen und Kostentibernahmen (Summary of Benefits and Coverage, SBC) angegebene gebiihrenfreie Rufhummer an. EMBA : ARB (Japanese) TMAH SBA, MOORE — CAE CAMAMVLETET. Ae TAME £ UIA OMEZ) (Summary of Benefits and Coverage, SBC) (CHAKA TWS 7 V— BA RVMIOCRBB< TES, OSA coil o fas ly CG) atts oo Lad LSS) 59 GIR ppb dy oly} lad Cikaad ccs! (Farsi) ca ld Led oh} SI 40. 5 8 vA (Summary of Benefits and Coverage: SBC) Wiig s Li js dod (yl _y2 024 485 cart &: aft air feet (indi) arora &, HTT HIT Bese Bare, fer:gea Soe F) aT aie Hare (Summary of Benefits and Coverage, SBC) & $F GNie & sax aes cher sh sae Ww Filet Ay! CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb rau koj. Thov hu rau tus xov tooj hu dawb teev muaj nyob ntawm Tsab Ntawv Nthuav Qhia Cov Txiaj Ntsim Zoo thiab Kev Kam Them Nqi (Summary of Benefits and Coverage, SBC) no. Gamurigal: wWidisyRSunwenantas (Khmer) watgumansawanAntg smesdndyget yegiigisiversianic launemeisign woguigungptiuns Ssenutns (Summary of Benefits and Coverage, SBC) 1s+4 PAKDAAR: Nu saritaem ti Ilocano (Llocano), ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Maidawat nga awagan ti awan bayad na nu tawagan nga numero nga nakalista iti uneg na daytoy nga Dagup dagiti Benipisyo ken Pannakasakup (Summary of Benefits and Coverage, SBC). Dif BAA'AKONINIZIN: Diné (Navajo) bizaad bee yanitti'go, saad bee aka'anida'awo'igii, t'dé jfik’eh, bee na'ahddt'’. Téa shogdi Naaltsoos Bee 'Aa'ahayan{ d66 Bee 'Ak'é’asti’ Bee Baa Hane'i (Summary of Benefits and Coverage, SBC) biyi' t'44 jiik’ehgo béésh bee hane'f bika'igif bee hodiilnih. OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyada taageerada luqadda, 00 bilaash ah, ayaad heli kartaa. Fadlan wac lambarka bilaashka ah ee ku yaalla Soo-koobitaanka Dheefaha iyo Caymiska (Summary of Benefits and Coverage, SBC). EFTA00316312

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