may need advance approval from your plan. This is called a"prior authorization" or "preauthorization." Please 
contact your PCP or refer to the Evidence of Coverage (EOC) for services that require aprior authorization from the 
plan .
c
6 Summary of Benefits H1036236000SB23 H1036236000 
Monthly Premium, Deductible and Limits 
Monthly Plan Premium $0 
You must keep paying your Medicare Part Bpremium. 
Medical deductible This plan does not have adeductible.