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out-of-pocket limit, network provider, referral, specialist, cost sharing" Summary of Benefits and Coverage Example AI/AN Limited Cost SharingCMSExample SBC of AI/AN Limited Cost Sharing Microsoft Word2025-09-18T17:01:30+00:002025-09-18T17:01:30+00:00 uuid:FB2EABE5-9A4E-4C59-B8D6-F6FEF46F570Duuid:FB2EABE5-9A4E-4C59-B8D6-F6FEF46F570D endstream endobj 2189 0 obj <> endobj 2190 0 obj <] /Filter/FlateDecode/Length 4813>> stream x5uTeqs/vwaabbvݝ((v؝k3<;g̙y̙``Y辴XrWv)VXmr\wG)\>XcmZyk63bź-/+6شp2\Ql43bC^CO^M'bey~8)6?8>+][lo9-^.:zb*=خzb(vZyY-bۊݽ=zb+* >[zE>[Io':p9jqy&šS 7,HvgquIѶ>ⶓ.ƮSa/ay@q{ޙVq'x[-GM O'.xⅵ/ Ƴ͋Kď>?9~_Qf2<Ϣ}ż-/o(خXpvY,t^ѻ,l{7 /ݨOj_lj1hBP >ج>2C˰~EJU5-[wqW"-u̅u梞xⒾ.f.w/r^]wRY֧?͆gl}ψ ̃vUOحtô榎<|y/֢X>b:5p1a$ˢƤdmǷG1T׍h1ب"45ڨ#1䨷1ߛ/(ڲ⽘:5ڟ=*΅71sC^QƼ(6\,>d&±x,ey+΀:7T"++DZլRƪu$7՛?Tk>X[Ŵڱש3ٳŊWp3بN͍ϳ(ɱ9<&l1Q<: Fɘ|h"LЍ4lOuAǜc>n4dS`JL1 t3c&̂0+f917<0X wE?y("Xaq,%2X+by+aeU:Xbm a6A"_Mcs m5`glmvh]ao >bCp8(#q+N‰8xq Ftp8g\p>.ƅ\kp9 Wz\07F܌ b,nm1 wN?qx 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