NOTE: This program does not apply to services covered under Medicare Supplemental

Block · one region of the page, as the scanner read it. It may hold a whole story, part of one, several, or an advertisement; stitching blocks into articles is the next step. Text is supplied OCR.

Page 5 · spans the page · from the scan, no model involved

NOTE: This program does not apply to services covered under Medicare Supplemental products or the Federal Employee Program (FEP). Only one form per policyholder ID.

90.6%