Document
Summary of Benefits and Coverage Completed Example
ICR 202210-0938-011 · OMB 0938-1146 · Object 125939401.
This document may belong to an older filing. More recent activity for OMB 0938-1146:
Document Viewer [pdf]
Status: Original and derived artifacts are available for this document.
Download: pdf
Loading document viewer…
Document Metadata
| File Type | application/octet-stream |
|---|---|
| File Title | Summary of Benefits and Coverage Completed Example |
| Subject | SBC, Summary of Benefits and Coverage, deductible, services, out-of-pocket limit, network provider, referral, specialist, cost s |
| Author | CMS |
| File Modified | 2022-05-11 |
| File Created | 2020-01-30 |
| Conversion State | complete |