17
Summary of Benefts 2020 Virginia Premier Advantage Elite (HMO SNP) H9877-001 H9877_0719-SBE20-800074_M FU 9/27/19
Summary of Benefts 2020
Virginia Premier Advantage Elite (HMO SNP) H9877-001
H9877_0719-SBE20-800074_M FU 9/27/19
Our 2020 Service Area Service Area - the entire state
Accomack, Albemarle, Alexandria City, Alleghany, Amelia, Amherst, Appomattox, Arlington, Augusta, Bath, Bedford, Bland, Botetourt, Bristol City, Brunswick, Buchanan, Buckingham, Buena Vista City, Campbell, Caroline, Carroll, Charles City, Charlotte, Charlottesville City, Chesapeake City, Chesterfeld, Clarke, Colonial Heights City, Covington City, Craig, Culpeper, Cumberland, Danville City, Dickenson, Dinwiddie, Emporia City, Essex, Fairfax, Fairfax City, Falls Church City, Fauquier, Floyd, Fluvanna, Franklin, Franklin City, Frederick, Fredericksburg City, Galax City, Giles, Gloucester, Goochland, Grayson, Greene, Greensville, Halifax, Hampton City, Hanover, Harrisonburg City, Henrico, Henry, Highland, Hopewell City, Isle of Wight, James City, King and Queen, King George, King William, Lancaster, Lee, Lexington City, Loudoun, Louisa, Lunenburg, Lynchburg City, Madison, Manassas City, Manassas Park City, Martinsville City, Mathews, Mecklenburg, Middlesex, Montgomery, Nelson, New Kent, Newport News City, Norfolk City, Northampton, Northumberland, Norton City, Nottoway, Orange, Page, Patrick, Petersburg City, Pittsylvania, Poquoson City, Portsmouth City, Powhatan, Prince Edward, Prince George, Prince William, Pulaski, Radford City, Rappahannock, Richmond, Richmond City, Roanoke, Roanoke City, Rockbridge, Rockingham, Russell, Salem City, Scott, Shenandoah, Smyth, Southampton, Spotsylvania, Stafford, Staunton City, Suffolk City, Surry, Sussex, Tazewell, Virginia Beach City, Warren, Washington, Waynesboro City, Westmoreland, Williamsburg City, Winchester City, Wise, Wythe and York
Virginia Premier is an HMO and HMO SNP organization with a Medicare contract. Enrollment in Virginia Premier depends on contract renewal. This information is not a complete description of benefts. Contact the plan for more information.
Let’s talk about Virginia Premier Advantage Elite (HMO SNP) (H9877-001) This Summary will let you fnd out more about our Advantage Elite plan including the medical and drug services it covers.
Virginia Premier Advantage Elite is a Medicare Advantage (HMO SNP) plan with a Medicare contract. Enrollment in the plan depends on contract renewal.
The beneft information in this document is a summary of what we cover and what you pay. It does not list every service we cover or every limitation or exclusion from our plan. To get a complete list of services we cover, please call our Member Services department to request a copy of the Evidence of Coverage or visit us online at VirginiaPremier.com.
To be eligible for our HMO plan:
To join Virginia Premier Medicare Advantage Elite (HMO SNP), you must be entitled to Medicare Part A, be enrolled in Medicare Part B and live in the service area of the plan. Please see the map of our service area on the previous page of this booklet.
This plan is a Dual Eligible Special Needs Plan (D-SNP) for people who have both Medicare and Medicaid and don't pay anything for covered medical services. How much Medicaid covers depends on your income, resources and other factors.
Note: As a member you must select an in-network doctor to act as you Primary Care Provider (PCP). However, you can see one of our Specialist doctors without a referral from your PCP. We do encourage all of our members to seek Specialist referrals with their PCP.
What doctors and hospitals you can use:
How to contact us:
If you are not a member of our plan, please contact us toll-free at 1-833-264-0811 (TTY: 711) for more information. You will be connected with a licensed Medicare Benefts Advisor.
If you are a member of our plan, please call us toll-free at 1-877-739-1370 (TTY: 711) to speak to a Medicare Member Service Representative. Our representatives are available 7 days a week, 8 am to 8 pm October 1 through March 31. From April 1 through September 30, they are available Monday through Friday 8 am to 8 pm. On certain holidays and weekends from April 1 through September 30, you call will be handled by our automated phone system.
Visit our web site at VirginiaPremier.com.
We have a network of doctors, hospitals, and other providers. If you use providers that are not in our network, the plan may not pay for these services.
You can see our plan’s provider and pharmacy directory and view our prescription drug formulary on our website at VirginiaPremier.com.
This document is available in other formats such as large print and audio.
To fnd out more about the coverage and costs of Original Medicare, look in the current "Medicare & You" handbook. View it online at medicare.gov or get a copy by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
http://Virginiapremier.comhttp://Virginiapremier.comhttp://Virginiapremier.comhttps://medicare.gov
Premiums and Benefts
Virginia Premier Advantage Elite (HMO SNP)
What you should know
Monthly Plan Premium You pay nothing Part B premium is covered by Virginia Department of Medical Assistance Services for D-SNP enrollees.
Deductible This plan does not have a medical beneft deductible
This is the most you pay Maximum Out-of- You pay no more than $3,400 annually Pocket Responsibility in co-pays, co-insurance (does not include and other costs for medical prescription drugs) services from in-network
providers for the year.
Our plan covers 90 days for Inpatient Hospital In-network (Acute) You pay nothing an inpatient hospital stay.
The plan also covers 60 “lifetime reserve days.” These are “extra” days that we cover. If your hospital stay is longer than 90 days, you can use these extra days. But once you have used up these extra 60 days, your inpatient hospital coverage will be limited to 90 days.
Some services may require Prior Authorization (approval in advance) to be covered.
Outpatient Hospital In-network You pay nothing
Some services may require Prior Authorization (approval in advance) to be covered.
Doctor Visits
• Primary
• Specialists
In-network You pay nothing
Ambulatory Surgical Center
In-network You pay nothing
Some services may require Prior Authorization (approval in advance) to be covered.
Premiums and Benefts
Virginia Premier Advantage Elite (HMO SNP)
What you should know
Preventive Care (e.g., fu vaccine, diabetic screenings)
You pay nothing
• Covered preventive services include:
• Abdominal aortic aneurysm screening
• Alcohol misuse counseling
• Annual “Wellness” visit
• Bone mass measurement
• Breast cancer screening (mammogram)
• Cardiovascular disease (behavioral therapy)
• Cardiovascular screening
• Cervical and vaginal cancer screening
• Colorectal cancer screenings (colonoscopy, fecal occult blood test,fexible sigmoidoscopy)
• Depression screening
• Diabetes screenings and monitoring
• HIV screening
• Lung cancer screenings
• Medical nutrition therapy services
• Medicare-covered Glaucoma Screening
• Medicare-covered Diabetes Self-Management Training
• Medicare-covered Barium Enemas
• Medicare-covered Digital Rectal exams
• Medicare-covered EKG following Welome Visit
• Obesity screenings and counseling
• Prostate cancer screenings (PSA)
• Sexually transmitted infections screenings and counseling
• Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)
• Vaccines, including fu shots, hepatitis B shots, pneumococcal shots
• “Welcome to Medicare” preventive visit
(one-time)
• Yearly “Wellness” visit
For all preventive services that are covered at no cost under Original Medicare, we also cover the service at no cost to you.
Cost-sharing may apply when other services are received in addition to the preventive service.
Any additional preventive services approved by Medicare during the contract year will be covered. This plan covers preventive care screenings and annual physical exams at 100% when you use in-network providers.
Premiums and Benefts
Virginia Premier Advantage Elite (HMO SNP)
What you should know
Annual Physical Exam In-network You pay nothing
You will receive a $25 incentive for completing either an annual physical exam or yearly "well-ness" visit each year.
Urgently Needed Services
In-network You pay nothing
Diagnostic Services/ Labs/Imaging
• Diagnostic and procedures
• Lab services
In-network You pay nothing
Some services may require Prior Authorization (approval in advance) to be covered
Routine hearing exams and the hearing aid beneft is
Hearing Services
• Routine hearing Exam to diagnose and treat hearing and administered through EPIC exam balance issues; you pay nothing Hearing Healthcare. You must
• Hearing aid You pay nothing (One routine hearing exam per year)
use our EPIC hearing vendor to purchase your hearing aid. To register on line please visits
$1,250 allowance towards the cost of a hearing aid every three years
epichearing.com/Virginia Premier, or call an EPIC heating counselor at 1-866-445-2284 Monday - Friday, 9 am - 9 pm EST (TTY:711).
Routine and comprehensive dental is covered by our
Dental Services
• Preventive Dental • 1 Oral exam (up to 1 per year): You pay nothing
• 1 dental x-ray(s) (up to 1 per year): You pay nothing
partner, DentaQuest. You must use an in-network provider at DentaQuest for theses services.
• 1 Cleaning per year (up to 1 per year): You pay nothing
• Comprehensive $2,000 annual beneft for fllings, extractions, Dental crowns, implants and bridges
http://epichearing.com/Virginia Premierhttp://epichearing.com/Virginia Premier
Premiums and Benefts
Virginia Premier Advantage Elite (HMO SNP)
What you should know
Vision Services
• Medicare-covered vision services
• Routine eye exam
• Eyeglasses (frames and lenses)
For diabetics, one exam is covered every 12 months. You pay nothing
Not covered
Up to $200 allowance towards eyeglass frames, lenses, or contact lenses every two years
You must use our service vendor, VSP to fnd a provider and purchase eyewear. VSP Member Services can be reached at 1-800-877-7195, TTY: 1-800-428-4833, Monday - Friday 8 am - 11 pm; Saturday, 10 am - 11 pm, and Sunday 10 am - 10 pm ET.
Inpatient: Our plan covers 90 days for an inpatient psychiatric hospital stay.
Mental Health Services
• Inpatient Hospital In-network (Psychiatric) You pay nothing
Mental Health Individual/Group Sessions - you pay nothing
Psychiatric Services Individual/Group sessions - you pay nothing
Opioid Treatment Services - you pay nothing
Outpatient Substance Abuse - you pay nothing
In-network
The plan also covers 60 “lifetime reserve days”. These are “extra” days that we cover. If your hospital stay is longer than 90 days, you can use these extra days. But once you have used up these extra 60 days, your inpatient hospital coverage will be limited to 90 days.
There is a lifetime maximum of 190 days for inpatient mental health care in a freestanding psychiatric facility. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital.
Some services may require Prior Authorization (approval in advance) to be covered, except in an emergency.
Mental Health Services
• Outpatient
Some services may require prior authorization (approval in advance) to be covered.
Skilled Nursing Facility Our plan covers up to 100 days in a SNF. (SNF) You pay nothing
Some services may require Prior Authorization (approval in advance) to be covered, except in an emergency.
Premiums and Benefts
Virginia Premier Advantage Elite (HMO SNP)
What you should know
Rehabilitation Services
• Occupational therapy
• Physical therapy and speech/ language therapy
In-network You pay nothing In-network You pay nothing
Some services may require Prior Authorization (approval in advance) to be covered, except in an emergency.
Ambulance - Ground and Air
In-network You pay nothing
For Original Medicare-covered ambulance services.
Transportation Not covered
Medicare Part B Drugs You pay nothing Part B drugs include drugs given by your doctor in his or her offce, some oral cancer drugs, and some drugs used with certain medical equipment. Read the Evidence of Coverage for more information on these drugs
Some services may require Prior Authorization (approval in advance) to be covered, except in an emergency.
Foot Care (Podiatry services
• Medicare-covered services
• Routine footcare
In-network You pay nothing You pay nothing
Our plan covers up to 8 visits per year for routine (non Medicare-covered) foot care.
Medical Equipment/ Supplies
• Durable Medical Equipment (e.g., wheelchairs, oxygen)
• Prosthetics (e.g., braces, artifcial limbs)
• Diabetes supplies
In-network You pay nothing
In-network You pay nothing
In-network You pay nothing
Some services may require Prior Authorization (approval in advance) to be covered, except in an emergency.
Fitness program You pay nothing
Outpatient Prescription Drugs
Deductible Phase
If you receive “Extra Help” to pay your prescription drugs, then this payment stage does not apply to you.
Initial Coverage Phase (after you pay your deductible, if applicable)
After you have met your deductible (if applicable), the plan pays its share of the cost of your drugs and you pay your share of the cost.
Cost-sharing may change when you enter another phase of the Part D beneft. For more information about the costs for Long Term Supply, Home infusion or additional pharmacy-specifc cost-sharing and the phases of the beneft, please call us or access our Evidence of Coverage online.
Cost-Sharing Tier Standard Retail Rx 31-Day supply
Mail Order and Standard Retail 90-day supply
Cost-Sharing Tier 1: Generic drugs
The co-pay will be between $0 and $3.60 for a 31-day supply
The co-pay will be between $0 and $3.60 for a 90-day supply
Cost-Sharing Tier 2: Brand-name drugs
The co-pay will be between $0 and $8.95 for a 31-day supply
The co-pay will be between $0 and $8.95 for a 90-day supply
Catastrophic Phase
When you reach the out-of-pocket limit of $6,350 for your prescription drugs, the Catastrophic Coverage Phase begins. You will stay in the Catastrophic Coverage Phase until the end of the calendar year. During this phase, the plan will pay most of the cost for your covered Medicare drugs.
Important Information
Premium, co-pays and deductibles may vary based on the level of “Extra Help” you receive. Please contact the plan for further details. If you qualify for “Extra Help” with your prescription drug costs, then the “Extra Help” program will pay all or part of your monthly plan premium, and your prescription drug deductibles and co-pays/co-insurance. If you are not eligible for “Extra Help," refer to the Evidence of Coverage, Chapter 6, for outpatient prescription drug cost-sharing information.
We cover Part D drugs. In addition, we cover Part B drugs such as chemotherapy and some drugs administered by your provider. You can see the complete plan formulary (list of Part D prescription drugs) and any restrictions on our website at VirginiaPremier.com. You can see our plan’s pharmacy directory at our website at VirginiaPremier.com.
http://Virginiapremier.comhttp://Virginiapremier.com
Additional Benefts
Virginia Premier Advantage Elite (HMO SNP)
What you should know
Chiropractor
• Medicare covered services
• Routine services
Over-The-Counter (OTC) $250.00 mail order allowance per quarter Unused OTC amounts do Drug Beneft not roll over from quarter
to quarter. Please visit our website to see our list of covered over-the-counter items.
You pay nothing
In-network You pay nothing
Our plan covers up to 6 visits annually for routine chiropractic services
Find Your Doctors, Hospitals, Pharmacies and Research Our Drug Formulary Providers/Pharmacies
You can easily fnd a list of our providers online at VirginiaPremier.com. Select Find a Provider to fnd the most up-to-date list of our providers, including doctors, hospitals, urgent care centers and pharmacies in our network. You can always call one of our Medicare Benefts Advisors toll-free at 1-833-264-0811 (TTY:711) to ask about providers and facilities in our network.
Formulary
You can check our full formulary online at VirginiaPremier.com or call one of our Beneft Advisors at the number above.
http://medicare.virginiapremier.comhttp://Virginiapremier.com
State of Virginia Medicaid (DMAS) Program Covered Benefts for Dual Eligible (Medicare and Medicaid) Benefciaries
The benefts described below are covered by Medicaid (DMAS). The benefts described in the Covered Medical and Hospital Benefts section of the Summary of Benefts are covered by Medicare. For each beneft listed below, you can see what Medicaid (DMAS) covers and what our plan covers. What you pay for covered services may depend on your level of Medicaid (DMAS) eligibility.
Eligibility
Virginia Premier Advantage Elite is available to the following Medicaid recipients
• Virginia Premier Advantage Elite (HMO SNP) members with Qualifed Medicare Benefciary Plus (QMB+) status are covered by the Virginia Department of Medical Assistance Services program for their Medicare cost sharing.
• Virginia Premier Advantage Elite (HMO SNP) plan members with full beneft dual eligible (FBDE) that are enrolled in the Virginia Department of Medical Assistance Services program that pays their Medicare cost sharing.
• Virginia Premier Advantage Elite (HMO SNP) plan members with Specifed Low-Income Benefciary Plus (SLMB+) status are covered by the Virginia Department of Medical Assistance Services program for their Medicare cost sharing.
Cost sharing and cost-sharing protections for all members
In the Virginia Premier Advantage Elite (HMO SNP) plan, the state Medicaid program pays the cost sharing for Medicare-covered medical services you receive. You pay no cost sharing for the Medicare-covered benefts described earlier in this Summary of Benefts. You will pay small co-payments for prescriptions covered under the Medicare Part D prescription drug beneft.
When you receive health services, the provider should only bill Virginia Premier Advantage Elite (HMO SNP) or the state Medicaid program for the cost of those services and cost-sharing amounts. The provider should not bill you for services or cost sharing. If you receive care from a non-contracted provider, the provider may not understand Virginia Premier Advantage Elite (HMO SNP) or these billing rules. If you receive a bill from a provider for Medicare-covered services, please notify Customer Services so we can help you. Please see Chapter 7 of your Virginia Premier Advantage Elite (HMO SNP) Evidence of Coverage for more information.
Beneft Category Medicaid (DMAS) Virginia Premier Advantage Elite (HMO SNP)
Behavioral Health Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Christian Science Sanatoria Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Clinic Services Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Colorectal Cancer Screening Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Dental Covered by Medicaid based on your eligibility level.
Limited Medicare coverage, with additional services available under our plan.
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services
Covered by Medicaid based on your eligibility level.
Not covered by Medicare.
Early Intervention Services Covered by Medicaid based on your eligibility level.
Not covered by Medicare.
Emergency Services Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Post Stabilization Care Following Emergency Services
Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
HIV Testing and Treatment Counseling
Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Home Health Services Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Beneft Category Medicaid (DMAS) Virginia Premier Advantage Elite (HMO SNP)
Hospice Services Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Immunizations Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Inpatient Hospital Services Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Laboratory and X-ray Services
Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Mammograms Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Medical Supplies and Equipment
Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Mental Health Services Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Organ Transplantation Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Outpatient Hospital Services
Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Pap Smears Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Physical Therapy, Occupational Therapy, Speech Pathology and Audiology Services
Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Beneft Category Medicaid (DMAS) Virginia Premier Advantage Elite (HMO SNP)
Physician Services Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Podiatry Covered by Medicaid based on your eligibility level.
Covered by Medicare, with additional services available under our plan.
Prescription Drugs Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Private Duty Nursing (PDN) Covered by Medicaid based on your eligibility level.
Not covered by Medicare.
Prostate Specifc Antigen (PSA) and digital rectal exams
Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Prosthetics/Orthotics Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Prostheses, Breast Reconstructive Breast Surgery
Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Skilled Nursing Facility Care Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Substance Use Disorder Treatment
Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Transportation Covered by Medicaid based on your eligibility level.
Limited coverage by Medicare.
Vision Services Covered by Medicaid based on your eligibility level.
Covered by Medicare. Check the Plan's Evidence of Coverage for any additional coverage.
Waiver Services (Home and Community Based)
Covered by Medicaid based on your eligibility level.
Not covered by Medicare.
H9877_0817-NND-600001 AI 08/25/2017
Notice of Non-Discrimination
Virginia Premier Health Plan, Inc. (Virginia Premier) complies with applicable Federal civil rights
laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Virginia Premier does not exclude people or treat them differently because of race, color,
national origin, age, disability, or sex.
Virginia Premier:
Provides free aids and services to people with disabilities to communicate
effectively with us, such as:
o Qualified sign language interpreters
o Written information in other formats (large print, audio, accessible
electronic formats, other formats)
Provides free language services to people whose primary language is not
English, such as:
o Qualified interpreters
o Information written in other languages
If you need these services, contact Member Services at 1-877-739-1370, TTY: 711.
If you believe that Virginia Premier has failed to provide these services or discriminated in
another way on the basis of race, color, national origin, age, disability, or sex, you can file a
grievance with:
Virginia Premier
Attn: Grievances & Appeals Manager
P.O. Box 5244
Richmond, VA 23220
1-877-739-1370, TTY: 711
Fax: 800-289-4970 [email protected]
You can file a grievance in person or by mail, fax, or email. If you need help filing a
grievance, the Grievances & Appeals Manager is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human
Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint
Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
mailto:[email protected]://ocrportal.hhs.gov/ocr/portal/lobby.jsfhttp://www.hhs.gov/ocr/office/file/index.html
H9877_0817-MLI-500009 Accepted 08/20/2017
Multi-Language Insert Multi-Language Interpreter Services ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-877-739-1370 (TTY: 711).
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-739-1370 (TTY: 711).
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.
1-877-739-1370 (TTY: 711) 번으로 전화해주십시오. CHÚ Ý: Nếu bạn nói Tiếng Việt, chúng tôi có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Xin gọi số 1-877-739-1370 (TTY: 711).
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-877-739-1370
(TTY: 711)。
1370-739-877-1، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم العربيةملحوظة: إذا كنت تتحدث
.(TTY :711) الهاتف النصي) PAUNAWA: Kung nagsasalita ka ng Tagalog, may mga magagamit kang libreng serbisyo ng tulong sa wika. Tumawag sa 1-877-739-1370 (TTY: 711).
فراهم می باشد. با شماره شما برای رایگان بصورت زبانی تسھیالت کنید، می صحبت فارسی زبان هب اگر :هتوج 1-877-739-1370 (TTY: 711) بگیرید تماس.
ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡፡ ወደ ሚከተለው
ቁጥር ይደውሉ 1-877-739-1370 (መስማት ለተሳናቸው: 711).
توجہ ديں: اگر آپ اردو بولتے ہيں تو، زبان سے متعلق اعانت کی خدمات، آپ کے ليے مفت دستياب ہے۔
1-877-739-1370 (TTY: 711) پر کال کريں۔
ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-877-739-1370 (ATS: 711).
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги
перевода. Звоните 1-877-739-1370 (линия TTY: 711).
ध्यान दें: यदद आप ह िंदी बोलते ैं तो आपके ललए मुफ्त में भाषा स ायता सेवाएिं उपलब्ध ैं।
1-877-739-1370 (TTY: 711) पर कॉल करें।
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-877-739-1370 (TTY: 711).
মননোনযোগ দিনঃ আপদন যদি বোাংলোনে কথো বলনে পোনেন, েোহনল দনঃখেচোয় ভোষো সহোয়েো পদেনষবো উপলব্ধ আনে। ফ োন করুন 1-877-739-1370 (TTY: 711) YI LE: I balè u pot tila hop won ngim bod i kobol mahop i la hola wè ni hop won, u saa béé to yom. Sébél 1-877-739-1370 (TTY: 711).
GENU NTI: Ọ buru na ina asu asusu Igbo, enyemaka na-ahazi asusu, bu n’efu, diri gi mgbe niile. Kpoo nomba ndi a 1-877-739-1370 (TTY: 711).
AKIYESI: Bi o ba nsọ èdè Yorùbá, ọfé ni iranlọwọ lori èdè wa fun yin. Ẹ pe ẹrọ-ibanisọrọ yi 1-877-739-1370 (TTY: 711).
SummaryofBenefitsElite2020.pdfNotice of Non-Discrimination No name - wo carats.pdfMLI.pdf
