providers in the network. This is called a"referral." Certain procedures, services and drugs 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 areferral and/or prior authorization from the plan .
2022 - 6 - Summary of Benefits H1036265001 
Monthly Premium, Deductible and Limits 
Monthly Plan Premium $0 
You must keep paying your Medicare Part Bpremium.