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provider, referral, specialist, cost sharing application/pdf SBC Template Standard Format CMS Provides a fillable Summary of Benefits and Coverage template to provide answers to key questions and information about common medical events Microsoft® Word 2019 2024-10-02T10:59:54-03:00 2024-10-09T13:10:14-05:00 2024-10-09T13:10:14-05:00 uuid:6A87C580-18BD-47D9-9328-A893318326A9 uuid:4b40540a-39f9-418d-833a-34a7f17742f6 endstream endobj 3424 0 obj <> endobj 3430 0 obj <> endobj 3432 0 obj <> endobj 3435 0 obj <> endobj 3436 0 obj <>stream HWmsHίGw 󦑔J*f{u6l݇d bUgZ# 0e1~z~ߎ'vz_ʌ MNxs7UC7.a*f:+`Ȣ~ Yb`C~ ~]6~/qx/?ާLR˲($K%Z{ _X螻X܏/HKԽϜq,X3q}<^||v97dM,-đ&QMPj/Ȭ!*Xpۮ=p{T׵{_Km]?%$oCkd"E,$r#s7BkLcs6٢%-RsW&MӉiӉٕ3^$s|H/$ &d 3 Q+-5 `D7C@|r~xLí]6Pvt섹 sA ۑfی߸/s t3onE ,<6 S< {R3ιz @mWr@kݟ[ѝi@Fk{ [x bֻ7i.ه4,`)Q p, !]& oht*ș44S/l@5ECxWș)Fۢm.-KJ4S\Jr]lLӢ-/Y%h_VtE͂*TCIcGVXUu[.ΏE[53Ƶd][d_:%d} |uBX2r͜Zbtl[ ?rs޻7p_{Zߒ7.V!qCh(gUWF=_n/:od]ف' Rg ziIB@35Uj]LrnzڀbOKݑz:Gtm|j[ӹcUo;wZ=óFnRx$% 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