H5322 025 - TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete LP (HMO-POS D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify ...

 
2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details . Skss

Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today.OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars. UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H5322-025. $ 0.00.To watch the debate live on Wednesday from 0900 local time click on the link below. For more information, click on the link below: To see some of them in action, click on the link below. To watch the plenary live and to get more information on the debates and votes, click on the links below. To see today's agenda and watch the Plenary click on ... UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details Maximum 3 visits every year. Copayment for Fluoride Treatment $0.00. Maximum 2 visits every year. Copayment for Dental X-Rays $0.00. Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3000.00 every year for Preventive and Non-Medicare Covered Comprehensive combined. Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars. UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H5322-025. $ 0.00.Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com Jan 1, 2023 · 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_025_000_2023_M Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of Coverage (EOC) for complete list of covered services, limitations and exclusions. UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll. UnitedHealthcare offers Texas 2023 UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools. Jan 1, 2022 · 3 ©2021 WellMed Medical Management, Inc. El Paso Waco H4527-005- AARP Medicare Advantage (HMO) H4527-002W-AARP Medicare Advantage (HMO) Sep 1, 2023 · UnitedHealthcare Dual Complete (HMO-POS D-SNP) You're viewing plan details for. 27053 Alamance County. Update your ZIP Code to view accurate plan details for your area. Monthly Premium. $ 0 - $ 38.40. Primary Care Provider. $ 0 copay - 20 % of the cost. Out-of-Pocket Maximum. 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details 2021 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO D-SNP) Location: Brazos, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711.2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) - H5322-025-0 in TX Plan Benefits Details Jan 1, 2023 · Summary of Benefits 2023 UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) H5322-031-000 Look inside to take advantage of the health services and drug coverages the plan provides. COVERAGE Cigna T otalCare (HMO D-SNP) H4513-060-002 1 Summary of Benefits H4513_22_99651_M Additional coverage and extra benefits for people with Medicare and any level of Medicaid assistance Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of our plan This document gives you the details about your Medicare health care and prescription drugApr 1, 2023 · -060 002 Cigna TotalCare (HMO D SNP) H4590-025-AARP Medicare Advantage SecureHorizons (HMO) H4513-061-002 -Cigna Preferred Medicare (HMO) H4590-033- UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP) Plan ID: H5322-025-000 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium The UnitedHealthcare Dual Complete (HMO D-SNP) (H5322 - 025) currently has 35,217 members. There are 259 members enrolled in this plan in Hood, Texas. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4.5 stars. The detail CMS plan carrier ratings are as follows: Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of our plan This document gives you the details about your Medicare health care and prescription drugThis page features plan details for 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT : This page has been updated with plan and premium data for 2023. Jan 1, 2023 · UnitedHealthcare Dual Complete® (HMO-POS D-SNP) Premiums and Benefits In-Network Out-of-Network Monthly Plan Premium $35.90 Annual Medical Deductible Your deductible is $233 per year for covered medical TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete LP (HMO-POS D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify ... Sep 1, 2023 · UnitedHealthcare Dual Complete (HMO-POS D-SNP) You're viewing plan details for. 27053 Alamance County. Update your ZIP Code to view accurate plan details for your area. Monthly Premium. $ 0 - $ 38.40. Primary Care Provider. $ 0 copay - 20 % of the cost. Out-of-Pocket Maximum. Maximum 3 visits every year. Copayment for Fluoride Treatment $0.00. Maximum 2 visits every year. Copayment for Dental X-Rays $0.00. Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3000.00 every year for Preventive and Non-Medicare Covered Comprehensive combined. 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_025_000_2023_M Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of Coverage (EOC) for complete list of covered services, limitations and exclusions.2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H5322-025-000 no QMB card Subject: UnitedHealthcare Dual Complete additional benefit overview for health care professionals. Created Date: 20221229012412Z We would like to show you a description here but the site won’t allow us. 2021 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO D-SNP) Location: Brazos, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711.VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2.Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today.VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2.2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Number of Members enrolled in this plan in (H5322 - 025): 9,816 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... Sep 26, 2022 · H5322-025-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_025_000_2023_M This page features plan details for 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT : This page has been updated with plan and premium data for 2023. H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details UnitedHealthcare Dual Complete (H5322-025) • Submit claims to WellMed. WellMed will reimburse you for the member’s medical services. UnitedHealthcare will reimburse you for the applicable member cost s hare. H5322-025-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_025_000_2023_M H5322-025-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H5322_025_000_2023_M Apr 1, 2023 · -060 002 Cigna TotalCare (HMO D SNP) H4590-025-AARP Medicare Advantage SecureHorizons (HMO) H4513-061-002 -Cigna Preferred Medicare (HMO) H4590-033- UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP) Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Hmm … it looks like your browser is out of date. Maximum 3 visits every year. Copayment for Fluoride Treatment $0.00. Maximum 2 visits every year. Copayment for Dental X-Rays $0.00. Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3000.00 every year for Preventive and Non-Medicare Covered Comprehensive combined. Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com Jan 1, 2022 · 3 ©2021 WellMed Medical Management, Inc. El Paso Waco H4527-005- AARP Medicare Advantage (HMO) H4527-002W-AARP Medicare Advantage (HMO) 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com H1416_2023_TN_SB_DSNP_104494E_M ©Wellcare 2023 TN3IMRSOB04494E_0285 2023 Summary of Benefits Tennessee Wellcare Dual Access (HMO D-SNP) H1416 | 035 UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars* for plan year 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H5322-025-000Number of Members enrolled in this plan in (H5322 - 025): 25,188 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: Insufficient data to rate this plan. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split ... TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete LP (HMO-POS D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify ... 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details The UnitedHealthcare Dual Complete (HMO D-SNP) (H5322 - 025) currently has 35,217 members. There are 259 members enrolled in this plan in Hood, Texas. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4.5 stars. The detail CMS plan carrier ratings are as follows: 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details 2021 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. UnitedHealthcare offers Texas 2023 UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plans for Texas and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools. This page features plan details for 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT : This page has been updated with plan and premium data for 2023. Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Mar 13, 2023 · Hospitalization Coverage. Inpatient hospital-acute: In-network: $0 or $1,556 per stay. $0 per day for days 91 and beyond. Out-of-network: Not Applicable. Inpatient hospital psychiatric: In-network: $0 or $1,556 per stay. Out-of-network: Not Applicable. 2021 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO D-SNP) Location: Brazos, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711.Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Hmm … it looks like your browser is out of date. Apr 1, 2023 · -060 002 Cigna TotalCare (HMO D SNP) H4590-025-AARP Medicare Advantage SecureHorizons (HMO) H4513-061-002 -Cigna Preferred Medicare (HMO) H4590-033- UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP) Plan ID: H5322-028-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. Ohio Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and ... 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details

In-Network: Preventive Dental Services: $0.00 copay. This plan covers: 2 oral exam (s), 2 cleaning (s), 1 dental X-ray (s), 1 fluoride treatment (s) every year. Medicare Covered Dental: $0.00 copay. Comprehensive Dental Services: $0.00 copay. This plan covers up to a $4,500.00 allowance for covered comprehensive dental services every year. . Dead and co charlotte setlist

h5322 025

UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars* for plan year 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H5322-025-000 2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO-POS D-SNP) Location: Webb, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711.H5322 - 025 - 0. 1-866-944-4983 TTY users 711. — This plan information is for research purposes only. — Click here to see plans for the current plan year. 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete (HMO D-SNP) benefit details. 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Plan Benefits Details Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. H5322-025-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug UnitedHealthcare Dual Complete (H5322-025) • Submit claims to WellMed. WellMed will reimburse you for the member’s medical services. UnitedHealthcare will reimburse you for the applicable member cost s hare. UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars* for plan year 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare Plan ID: H5322-025-000 2021 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO D-SNP) Location: Brazos, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711. Number of Members enrolled in this plan in (H5322 - 025): 25,188 members : Plan’s Summary Star Rating: 3.5 out of 5 Stars. • Customer Service Rating: Insufficient data to rate this plan. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split ... H4590-033- UnitedHealthcareDual Complete Plan 2 (HMO D-SNP) H4513-009 - Cigna Fundamental Medicare (HMO) H4590-803-Group Retiree Plan(s) H4527-013-AARP Medicare Advantage (HMO) UnitedHealthcare Dual Complete (HMO-POS D-SNP) 5 out of 5 stars. UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H5322-025. $ 0.00.2021 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO D-SNP) Location: Brazos, Texas Click to see other locations. Plan ID: H5322 - 025 - 0 Click to see other plans. Member Services: 1-866-944-4983 TTY users 711.Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Hmm … it looks like your browser is out of date. 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H5322-025-0 in TX Star Rating Details Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5322-025-000 plan for Texas. Check eligibility, explore benefits, and enroll today. Premium:$25.1. This page features plan details for 2022 UnitedHealthcare Dual Complete (HMO D-SNP) H5322 – 025 – 0 available in Select Counties in Texas. IMPORTANT: This page features the 2022 version of this plan. See the 2023 version using the link below: 2023 UnitedHealthcare Dual Complete (HMO-POS D-SNP) H5322 - 025 - 0. Y0066_EOC_H5322_025_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage .

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