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
H5619075000SB23 Summary of Benefits 7H5619075000 
Monthly Premium, Deductible and Limits 
Monthly plan premium  $0 
You must keep paying your Medicare Part Bpremium. Your Part A 
and/or Part Bpremium may be paid on your behalf by the Kentucky