SBC Disclosure

Summary of Benefits and Coverage and Uniform Glossary (CMS-10407)

Chamorro_Why this Matters NO Answers_Final_11.01.24 (clean)

SBC Disclosure

OMB: 0938-1146

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Kadada' na Sinangan I Benefisiu Siha yan Kinobre Siha: Hafa esti na Planu ha Kokobre siha & Hafa Un Apasi para Ma Kobre na Setbisiu siha Tiempon Kinobre: [See Instructions] : Kinobre para: | Klasin Planu:

Shape1



Impottante na Kuestion Siha

Ineppe Siha

Hafa Na Gai Sustansia Esti:

Hafa i kinabales deductible?

$0

Atan i Sesso na Sinisedin Medikat na chart gi san papa para iyo-mu gasto siha para setbisiu ni esti planu ha kokobre.

Kao guaha siha setbisiu man ma kobre antes di un fakcha'i iyo-mu deductible?

Åhe’

Siempre debi na un fakcha'i i deductible antes di i planu ha apasi para maseha hafa na setbisiu siha.

Kao guaha siha otro deductibles para spesifiku na sebisiu siha?

Åhe’

Ti nesesario na un fakcha'i deductible para spesifiku na setbisiu siha.

Hafa ayu i san hiyong-i- boksa limite para esti planu?

Ti Aplikao.

Esti planu tai iyo ni limiten san hiyong-i-boksa.

Hafa ti ma inkluso gi halom i limiten san hiyong-i-boksa?

Ti Aplikao.

Esti planu tai iyo ni limiten san hiyon-i-boksa gi iyo-mu ginasta siha.

Kao para un apasi ti megai yanggen un usa i man pribeniniyi network?

Ti Aplikao.

Esti planu ti ha u'usa i man pribeniniyi network. Sina un risibi setbisiun kinobre siha ginen maseha hayi na man pribeniniyi.

Kao un nisisita i riniferi para un li'e i specialist?

Åhe’

Sina un li'e i specialist un ayek sin i riniferi.

PRA Disclosure Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1146. The time required to complete this information collection is estimated to average 0.02 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850


(OMB control number: 0938-1146/Expiration date: 05/31/2026) Pahina 1 gi 1

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleSBC Why This Matters No Answers
SubjectDescribes why "No" answers to important questions matter
AuthorCMS
File Modified0000-00-00
File Created2024-12-24

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