Page 75 - Appendices for Paul Stelter PDF Version
P. 75

V
                   
    
     	
%
*(+,
-
.(&/0+/
1234678659:;<     
    
     	
 
 
    
     
#   $  K 
L   $  
	
     
	   
M
# 
$  $
                               J
      %&'()1524=&(
12343     >?@A 
0;
5;B
28>?@A 
0;
                 	
  
 
    
 
	   
   
   
 
       
    	  	
!   
"
# 
$  $  9CDEC;F9GDHI
C;F9GDHI
>?@A 
289CDEC;F9GDHIN 
    
	
	    N 
O P $ $
K  
# K
Q
      RH:<S9
'BT5;95<F
U=/`\[
a
b`_c
def
]ghihjkkljk 
   
   
 
       
    	  	
!   
"
# 
$  $  
#   $  K 
L   $  
	
     
	   
M
# 
$  $

      WXYZ[\
]^_
   
 
m
  
N

$
    
	    
    
 %&'()1524=&(
12343     J
                                        2     /2n4=)%
.(&/0+/         	
  
 
    
 
	     
     	
%
*(+,
-
.(&/0+/
1234678659:;<     
    
     	
 
 
    
        
	
	    N 
    
	
	    N
      !













































                                                                                 Neither of your
                                                                                 doctors are listed in
                                                                                 this plan's network
   70   71   72   73   74   75   76   77   78   79   80