Page 44 - Benefits Book Tanner Manor 2020
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SODQ at 1-888-306-0905, the , or the Department of Health and Human Services, .  Other coverage options may be available to you too, including  or call 1-800-318-2596. ZZZ +HDOWK&DUH JRY  DSSHDO. For more information about your  JULHYDQFH DSSHDO, or a  FODLP,  0DUNHWSODFH.  śȱ˜ȱŜ













                       There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: contact the


         SODQ document.)       0DUNHWSODFH, visit  JULHYDQFH or SODQ documents also provide complete information to submit a  SODQ through the





                          ZZZ GRO JRY HEVD KHDOWKUHIRUP  ZZZ FFLLR FPV JRY  FODLP. This complaint is called a SODQ. For more information about your rights, this notice, or assistance, contact: the Department of Labor's Employee Benefits Security Administration at 1- 0LQLPXP (VVHQWLDO &RYHUDJH for a month, you'll have to make a payment when you file your tax return unless you qualify for an exemption from the requirement  SUHPLXP WD[ FUHGLW to help you pay for a

         Other Covered Services (Limitations may apply to these services. This isn't a complete list. Please see your
                               0DUNHWSODFH. For more information about the









                                        SODQ for a denial of a  FODLP. Your                         ȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬ ˜ȱœŽŽȱŽ¡Š–™•Žœȱ˜ȱ‘˜ ȱ‘’œȱ™•Š—ȱ–’‘ȱŒ˜ŸŽ›ȱŒ˜œœȱ˜›ȱŠȱœŠ–™•Žȱ–Ž’ŒŠ•ȱœ’žŠ’˜—ǰȱœŽŽȱ‘Žȱ—Ž¡ȱœŽŒ’˜—ǯȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬȬ
                             Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or
                          Department of Labor's Employee Benefits Security Administration at 1-866-444-EBSA or






                                          rights, look at the explanation of benefits you will receive for that medical
                                        There are agencies that can help if you have a complaint against your
                               buying individual insurance coverage through the Health Insurance
                                                      Yes.                               866-387-0489
                                                                   Yes.




                                                . ZZZ GRO JRY HEVD KHDOWKUHIRUP  0LQLPXP 9DOXH 6WDQGDUGV, you may be eligible for a  Spanish (Español): Para obtener asistencia en Español, llame al 866-387-0489. Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 866-387-0489. Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 866-387-0489.














             •   Chiropractic care  Your Rights to Continue Coverage:  Your Grievance and Appeals Rights:  for any reason to your  866-444-EBSA or Does this Plan Provide Minimum Essential Coverage?  If you don't have that you have health coverage for that month. Does this Plan Meet the Minimum Value Standard?  SODQ doesn't meet the  If your  Language Access Services:  Chinese
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