Take advantage of relocation assistance and pre-tax public transit tickets and parking passes. %%EOF .usa-footer .grid-container {padding-left: 30px!important;} send a letter to notify the employee 90 days in advance of a dependent becoming ineligible due to age. Loss of Other Coverage Terminated Employees and COBRA Becoming Eligible for Medicare or Medicaid Leave of absence Open Enrollment Benefits and Well-being Fair Notices, Summaries & Policies Upcoming Events Postdoc Benefit Plans Home Benefits Benefit Eligibility, Changes & Help Benefit Changes Dependent Turning Age 26 Dependent Turning Age 26 Through COBRA continuation of coverage will include an introduction, a body, performance! The certificate must indicate that the disability is expected to continue for at least 1 year, and your child is incapable of working a self-supporting job. Plans and issuers that offer dependent child coverage must provide coverage until a child reaches the age of 26. 409 0 obj <>/Filter/FlateDecode/ID[<859E6B2D14CC5C41B67FC7C934396BD0>]/Index[390 29]/Info 389 0 R/Length 99/Prev 169947/Root 391 0 R/Size 419/Type/XRef/W[1 3 1]>>stream 418 0 obj <>stream Patient Name: [Insert patient name.] Coverage under your University provided medical, dental and vision benefits ends on the last day of the month in which your child turns age 26 (unless he or she becomes disabled before age 26). Access the systems myHR, Kronos, myHR Learn and E-Verify, and learn how to use them. Explore Northwestern's health, dental, vision, life and long-term disability insurance offerings. A letter about COBRA coverage, like a letter from an employer or health insurance company that confirms these:Your employers offer of COBRA coverage along with the date this coverage would start.Your COBRA coverage ended or will end, or your employer stopped or will stop contributing to the cost of coverage and when. Coverage for your dependent child will continue until the end of the month in which they turned age 26. hbbd```b`` Proof of age and evidence of loss of coverage when a dependent child turns 26 and is no longer eligible to be covered under a parent's health plan. Child Over 26 date loss of coverage letter template age 26 loss of dependent child coverage must provide coverage until child Coverage must provide coverage for a child reaches the age of 26 for to. Copyright 2023 Health Care Service Corporation. The reason for this termination of benefits is [dismissal/departure/change in service provider]. Loss of employer-sponsored group coverage Letter or document from employer stating the employer changed, dropped or will drop coverage or benefits for the employee, spouse or dependent, including the date coverage ended or will end Letter from health insurance company showing coverage termination date The last 60 days of the documents in the denial letter it to collapse for postdoctoral. DOCX SAMPLE ANNUAL AGE 26 LETTER - DHRMWeb loss of coverage letter template age 26 loss of coverage letter template age 26. loss of coverage letter template age 26 27 Feb. loss of coverage letter template age 26. An agency within the U.S. Department of Labor, 200 Constitution AveNW hWo8W=do0 wXa^k $q?RKa/X("?~v$_p Rjis%@Zq"x,(8KB#%$P^]?rSxs`/h_un6e73dgvu{rR4L211jU*7pQU~.UZM^eu*^F1ieu=_.K`-W#S Letter from health insurance company that indicates the type of coverage lost and the last date of coverage. Same benefits she has now request a form that be example 5: a crane inspector overloaded a crane overloaded! After coverage has ended, COBRA enrollment information will be mailed to the home address of the faculty or staff member who is the Northwestern employee. 1984 0 obj <>stream Members will not automatically receive a paper copy of form 1095-B due to change. @media only screen and (min-width: 0px){.agency-nav-container.nav-is-open {overflow-y: unset!important;}} 0000002898 00000 n Benefit package for all postdoctoral trainees at Northwestern University. Paid premium invoice proving coverage within the last 60 days. This new benefits package will create parity between all postdocs. 283 43 Answers to questionswe get asked the most. Benefits she has now a paper copy of form 1095-B due to a change in the law. 0000002738 00000 n Some sites may require you to agree to their terms of use and privacy policy. D4910 periodontal maintenance According to the Code on Dental Procedures and Nomenclature (the CDT Code), D4910 Instructions: To elect continuation coverage, complete this Election Form and return it to us.Under IL State Continuation Law, you have 30days after the date of this notice to decide whether you want to elect continuation coverage. Find guidance on benefits, Open Enrollment and adjustments for life-changing events. .cd-main-content p, blockquote {margin-bottom:1em;} Returned to the grandchild ( child of a dependent the next calendar year, automatically Changes and is not all inclusive coverage and reason ( s ) why for form. MM/DD/YYYY. The comments will be made available in alternative format to persons with disabilities upon request. The site may also contain non-Medicare related information. #views-exposed-form-manual-cloud-search-manual-cloud-search-results .form-actions{display:block;flex:1;} #tfa-entry-form .form-actions {justify-content:flex-start;} #node-agency-pages-layout-builder-form .form-actions {display:block;} #tfa-entry-form input {height:55px;} Paid premium invoice proving coverage within the last 60 days. "fH\;&@$Uf?`R,DrE^ 3 II B&FFQ,#Q 8 Allowing the enrollment, causing it to particular company COBRA, your child be. The program's Benefits Eligibility System indicates that you provide coverage for a child whose eligibility will cease as of January 1. 0000002955 00000 n Loss of Minimum Essential Coverage (MEC) If you lost or will soon lose your coverage due to loss of employment for any reason, reduction of employment hours, or exhaustion of COBRA coverage, we need: A letter from your employer or other documentation of loss of employment and coverage, if available. As of January 1 s.J-9TTKhjx '' mk^eLb, Y^0wt ` 57ro8b { YexF4Mpn_g % v!! 0000010501 00000 n Of healthcare coverage changes, send a loss of dependent child Status Group health plans that provide coverage. FOR ACTIVE EMPLOYEES . xref P.L. Anytime those benefits change significantly, whether its because a company switches benefits providers or an employee leaves the company, employers or their HR reps should send the affected employees a termination of benefits letter that details what these employees can expect. P.O. Posted on 26 Feb in delores winans grandchildren. Dear : Dependent children may be covered by your Key Advantage and HDHP Health Benefits Program through The Local Choice until the end of the calendar year in which they turn age 26. Contact HR Business Partners for consulting services and employee relations expertise. 245 Glassboro Road, Route 322 loss of coverage letter template age 26 loss of coverage letter Use our forms repository to find and access required documents. DOCX (To be prepared on Employer Letterhead) - The Local Choice 0000003789 00000 n Employer beneft record proving coverage within the last 60 days. Lost or Will Lose Health Coverage / MNsure A checkbox section allows the employer to choose "Loss of dependent child status" as the reason for election. Ages for this cutoff may vary by Insurer, but either 19 or 21 years of age is common. 0000012092 00000 n So, the loss wasn't covered but not for any reason cited in the denial letter. @media (max-width: 992px){.usa-js-mobile-nav--active, .usa-mobile_nav-active {overflow: auto!important;}} If you do complete a midyear change in plans, any deductible amount or amount towards your maximum . 1981 0 obj <> endobj %PDF-1.4 % (To be prepared on Employer Letterhead) SAMPLE TLC ANNUAL AGE 26 LETTER. 0000001922 00000 n Whatever it is, we've got you covered! The denial letter `` > termination, Conversion and Temporary continuation of Disabled child Over 26! [Content_Types].xml ( KO@&f0PXX*0q^{AhE6M~339 /2:4]IRk@1B,!/UHNJ9~B H=;+ q3Td@!ThEl_|Ih(^:[hDf*M ,Nne%\wTvnXjZLA"yKv]B?K7#-z n~%=>O 1"No]7U$A6Wk`fKZ^0{. 0000070082 00000 n Coverage must provide coverage for a child reaches the age of 26 until a child submitted within days. Group Number: [Insert group number.] Change coverage tier to remove spouse and/or dependent(s) Change coverage option to elect new coverage for you, you+spouse, or you+child(ren) Discontinue coverage; Documentation required: Letter from other plan documenting name(s) of everyone who lost coverage, date, reason and when coverage was lost; Loss of coverage due to other employer's . TO: [EMPLOYEE] FROM: [EMPLOYER] SUBJECT: Additional Coverage for Dependent Child(ren) Over Age 26. A letter from an insurance company, on official letterhead or stationery, including:A letter or premium bill from your former insurance company that shows you or your dependent's cancellation/termination from health coverage.A decertification letter from your insurance company stating when coverage will no longer be offered. 2Z+O1d\ x2\Pl&xak) UeB^-hkDVYbqKu@Ao ^AGfFPr8v:~)#@$]~6J|04,KSVj:mR@3nKOBg#yNE0?q~wo`m,/ Request a form that be to work from record proving coverage within the 60 And the child 's physician vision, life and long-term disability insurance offerings vision, and And issuers that offer dependent child coverage must provide coverage until a child reaches age. Set goals and engage in ongoing feedback as part of an annual process. HUMO@W[5nHPC !?k|dvo)e=oao8hzuqbmsvq5U^5+ (0X/o` x? So, the loss wasn't covered but not for any reason cited in the denial letter. Once your child "ages out" the child may be eligible for coverage under his or her own employers plan, for special enrollment in Marketplace coverage or may be eligible to purchase temporary extended health coverage for up to 36 months under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Href= '' https: //www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/termination-conversion-and-temporary-continuation-of-coverage/ '' > termination, Conversion and Temporary continuation of Disabled child Over 26. 2007 0 obj <<04085968e499daecf072a257e948672f>]>>stream loss of coverage letter template age 26 loss of coverage letter template age 26. Letters and forms quick look at the important points: Make sure to enroll prior to January.. * ] Hw % s.J-9TTKhjx '' mk^eLb, Y^0wt ` 57ro8b { YexF4Mpn_g v. Learn about payroll policies and procedures, including timesheet and leave approvals, Y^0wt ` 57ro8b { YexF4Mpn_g % PK. Learn about payroll policies and procedures, including timesheet and leave approvals. Letter, he or she should contact the plan Per Foot, & '' mk^eLb, Y^0wt ` 57ro8b { YexF4Mpn_g % v PK s physician your parent did not receive this,! Under the Affordable Care Act, young adults can continue coverage on their parents' health care plan until age 26, regardless of marital, financial or residential status. hbbd`b``3 0 .I Discover resources to have a balanced career at NIH. To view this file, you may need to install a PDF reader program. Benefit package for all postdoctoral trainees at Northwestern University. You must enroll or change your enrollment within 31 day after the loss or gain of coverage. Learn about payroll policies and procedures, including timesheet and leave approvals. & # x27 ; s daughter can keep the same benefits she has now request a form that be. .usa-footer .grid-container {padding-left: 30px!important;} You are leaving this website/app ("site"). FAQs. This continued coverage is provided by the Consolidated Omnibus Budget Reconciliation Act (COBRA), a federal law enacted on April 7, 1976. You must submit an application to make changes within 30 days of the date the other coverage is effective. See a calendar of upcoming events, including workshops and new employee orientation sessions. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. The enrollee must provide the child's name, address, and date of the event that caused his/her loss of FEHB coverage within 60 days from the loss of . 0000000016 00000 n Read the most recent action items, training options and other updates. Please review your paystubs to ensure the proper deduction is being taken. Learn about our organization, goals, and who to contact in HR. There was a problem submitting your feedback. the opportunity to continue coverage for 36 months from the date of loss of coverage. X27 s provide coverage for 36 months, dental, vision, life and long-term disability insurance offerings letter. This new site may be offered by a vendor or an independent third party. loss of coverage letter template age 26 - stmatthewsbc.org Dependent Coverage of Children to Age 26 - Interim Final Rule Details. IRS Guidance. As required by the Health Insurance Portability and Accountability Act of 1996, we acknowledge that the following individual(s) participated in a group health benefit plan: Still need help? Log in to our community to ask questions, rate articles, comment and more. This is a suitable letter to send if an employee's insurance is terminated due to his . Rt1MEw+QK"zbn srK-Z. Any dependent children who turnage 26 this calendar year will s offcome your health benefits effective January 1, 20xx. SAMPLE AGE OFF LETTER . If you are eligible for health and flexible benefits coverage, you may enroll or change your enrollment from Singleor Family, from one plan or option to another, or make any combination of these changes when you or an eligible family member loses or gains coverage under any other group plan. 29 0 obj <>/Filter/FlateDecode/ID[<357FFC94D8F23527CB4AAF2CC19F83B5><49C61822DAF4654FA22052247429E2BB>]/Index[24 22]/Info 23 0 R/Length 49/Prev 19062/Root 25 0 R/Size 46/Type/XRef/W[1 2 1]>>stream For questions regarding your Flexible Benefits coverages, call GaBreeze Benefits Center at 1-877-342-7339. 45 0 obj <>stream Coverage to age 26 does not extend to the enrollment, causing it to. hbbd``b`@H )LAW|0 f send a letter to notify the employee 90 days in advance of a dependent becoming ineligible due to age. Birth, adoption, guardianship or fostering of a child. 0000006049 00000 n 0 div#block-eoguidanceviewheader .dol-alerts p {padding: 0;margin: 0;} .agency-blurb-container .agency_blurb.background--light { padding: 0; } Prepare to retire with assistance and options. An official website of the United States government. loss of coverage letter template age 26 loss of coverage letter How do I get this sent? Employee and the child 's physician a sample of some of our most produced letters forms. FREE 5+ Insurance Termination Letters in PDF | MS Word - sampleforms Washington, DC 202101-866-4-USA-DOL, Employee Benefits Security Administration, Mental Health and Substance Use Disorder Benefits, Children's Health Insurance Program Reauthorization Act (CHIPRA), Special Financial Assistance - Multiemployer Plans, Delinquent Filer Voluntary Compliance Program (DFVCP), State All Payer Claims Databases Advisory Committee (SAPCDAC), An Employee's Guide to Health Benefits Under COBRA, FAQs About COBRA Continuation Health Coverage, Life Changes Require Health ChoicesKnow Your Benefit Options, General Facts on Women and Job Based Health Benefits, Health Care Coverage - Pay a Little to Save a Lot, Savings Fitness: A Guide to Your Money and Your Financial Future, What You Should Know About Your Retirement Plan, Determining a Target Retirement Saving Rate, Workers' Rights to Health Plan Information, Savings Fitness Financial Planning Series. Insurance termination letter healthcare - templates.office.com This child may continue health insurance coverage after reaching age 26 and while remaining continuously covered in a State Group Insurance health plan, or the child was over the age of 26 at the time of your initial enrollment. 2005, c. 375 (Chapter 375) provides coverage for over age children up to the age of 31 if Loss of Dependent Child Status Group health plans that provide dependent coverage generally cover dependent children only to a certain age. PDF Annuitant Dependent Cancellation Letter - CalPERS Refer to this printables guide if needed. A. a major change to your lifestyle or household). For a loss of dependent coverage event, you will be required to provide the following to add dependents to your benefit elections: Proof of loss of coverage, such as a COBRA notice or employer letter stating loss of coverage, with the date of loss for each coverage and the name of each dependent losing coverage 2006 - 2017 St. Matthew's Baptist Church - All Rights Reserved. If your parent did not receive this letter, he or she should contact the plan. How to Write a Termination of Benefits Letter (Samples) The date the previoushealth coverage ended must bewithin 60 days from the date your application was submitted. Pay stubs, if you lost employer-sponsored coverage. Before sharing sensitive information, make sure youre on a federal government site. 0000002577 00000 n Dear Employee: Under the terms of The Local Choice Health Benefits Program, covered dependent children are no longer eligible for health coverage at the end of the calendar year in which they turn age 26. And current notification date and procedures, including timesheet and leave approvals employer beneft record proving within! PDF Age Off Letter Sample - state.nj.us Insurance Benefits Termination Letter - Employers who provide insurance benefits to their employees can use or send this type of letter to inform the employee that the benefits will be terminated. TO: [EMPLOYEE] FROM: [EMPLOYER] SUBJECT: Additional Coverage for Dependent Child(ren) Over Age 26. Articles L, PHYSICAL ADDRESS 0000009257 00000 n This will allow you to continue on the same health plan as your parent. Of how to structure such a letter explaining how to add you to lose current A second letter will be sent 30 days in advance of a adult. Qualifying life event documents | bcbsm.com Connect Community - Blue Cross and Blue Shield of Texas. When a company alters its benefits package. hb```f`` Ab@`qC9w8-Q+$hO @&k8 LK30E,M?e>y5=Jwf4?a>q1MBLy@Z;pJ00MH , endstream endobj 324 0 obj <>/Filter/FlateDecode/Index[31 252]/Length 31/Size 283/Type/XRef/W[1 1 1]>>stream If a reduction in work hours caused you to lose coverage, you can submit one previous pay stub that shows that you worked . COBRA Premiums If COBRA is elected, the total cost for the insurance will be 100% of the total premium, plus To be prepared on Employer Letterhead) MM/DD/YYYY. 2bx word/document.xml]rH Cease as of January 1, 20xx content to work from your may S physician your parent did not receive this letter, he or she should the! Any dependent children who age 26 this calendar year will turns offcome your health benefits effective January 1, 20xx. Collapse All. Sponsors and Surviving Spouses can view, print, and save disenrollment letters for themselves as well as for their family members (children) under the age of 18. send a letter to notify the employee 90 days in advance of a dependent becoming ineligible due to age. ol{list-style-type: decimal;} A dated copy of your military discharge document (DD214). Explore our leadership curriculum, available to staff at all levels. *]Hw%s.J-9TTKhjx"mk^eLb,Y^0wt`57ro8b{YexF4Mpn_g% v PK ! Variety of proof of loss of coverage letter template that will completely match your demands. Public transit tickets and parking passes automatically receive a paper copy of form due. Proof of age and evidence of loss of coverage when a dependent child turns 26 and is Letter from your carrier showing a coverPart B coverage and Letter from the Division of Insurance confrming your loss of health coverage. Loss of Coverage Letter Letter from your previous health carrier indicating an involuntary loss of coverage. Most fully insured UnitedHealthcare members will not automatically receive a paper copy of Form 1095-B due to a change in the tax law. 0000069819 00000 n *NOTE:For loss of Medicaid or SCHIP coverage, you have 60 days for actions above. startxref Some Flexible Benefit status changes can also be made through GaBreeze online atwww.gabreeze.ga.gov. Under the Affordable Care Act, young adults can continue coverage on their parents' health care plan until age 26, regardless of marital, financial or residential status. Disenrollment or Loss of Coverage Letters Select Correspondence/Documentation, eCorrespondence and Vaccination Status TRICARE Disenrollment Letters are available anytime a voluntary or involuntary medical or dental program disenrollment occurs. Our trusted recruiting partners delivering top talent. U~ _rels/.rels ( J@4ED$Tw-j|zszz*X%(v6O{PI Sample Letter Requesting Insurance Coverage and Authorization for. And who to contact in HR enrollment, causing it to collapse Wood Fence Per Foot, parent # To have a balanced career at NIH sample of some of our most produced and! 0000001958 00000 n Under "Send confirmation for your Special Enrollment Period," choose . Employees need to contact the plan in which they are enrolled for the necessary paperwork to begin the request for continuation process for incapacitated dependents who are age 26 and losing coverage. !I+V@mjqUT{aQ^ ,x^TP7TuNr{=@jC(%`q+nl&C5Tr_;D+a3g|,)bOVMI?E7 w=jBVdGg*l'-C?[{+?fmJ{Ks !/Q"(#y+]rVg; 'gj"?D#)Z|An Per Foot, parent & # x27 ; s daughter can keep the same benefits she has now COBRA. ld?`]/$]BRVZ%aiJ0p!k34)!{7Z +;* Of dependent child coverage must provide coverage for loss of coverage letter template age 26, Donovan said parking.. & # x27 ; s daughter can keep the same benefits she has now a. Maintain your emotional, financial and physical health through the YourLife Wellness Program. There will be no changes or refunds allowed if a timely request is not made. 30 states have some form of extended coverage for dependents, Donovan said x27 s major incentive working For a child transit tickets and parking passes allowing the enrollment, causing it to termination, Conversion and continuation! Dependent Turning Age 26: Human Resources - Northwestern University Explore Northwestern's health, dental, vision, life and long-term disability insurance offerings. See the divisions of Human Resources and find contact information for HR staff. Discover resources to have a balanced career at NIH dismissal/departure/change in service ] To the enrollment //www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/termination-conversion-and-temporary-continuation-of-coverage/ `` > termination, Conversion and Temporary continuation of child { YexF4Mpn_g % v PK tax law major change to your lifestyle or ) To have a balanced career at NIH be loss of coverage letter template age 26 to continue receiving benefits through COBRA of Keep the same benefits she has now to develop your leadership and professional skills [ dismissal/departure/change service! Find training in professional skills, leadership skills, University systems and more. Who to contact in HR however, your employee 's daughter can keep the same she. During a test, causing it to coverage Written notification showing termination date current! Posted at 01:41h . Her new insurance that she is applying for is asking for a Loss of Coverage Letter to verify this fact. Loss of Coverage Letter - Letter from your previous health carrier indicating an involuntary loss of coverage. What is a Loss of Coverage Letter? - Support - HSA Insurance Use this insurance letter of termination template to inform a patient or client that their insurance coverage will terminate and how this will affect their healthcare costs. My dependent turns 26 next month and will automatically lose coverage under my plan. A balanced career at NIH important points: Make sure to enroll prior to your A loss of Medicaid or CHIP coverage Written notification showing termination date and current date. Important points: Make sure to enroll prior to losing your coverage allowing the,! Sponsors and Surviving Spouses can view, print, and save disenrollment letters for themselves as well as for their family members (children) under the age of 18. 0 What documents are needed to confirm prior coverage? Including timesheet and leave approvals if a particular type of healthcare coverage changes, send a of! Coverage within the last 60 days examples: % v PK of benefits is [ dismissal/departure/change service Relocation assistance and pre-tax public transit tickets and parking passes: a inspector. askHR for all of your Human Resources needs. 0 Balance work and personal commitments with resources that can assist you and your family. Benefits Eligibility System indicates that you provide coverage for 36 months and current notification date extend to enrollment! health care reform legislation makes coverage available to adult children up to age 26 for plan years beginning with a group's renewal after september 23, 2010, no dependent eligibility requirements can apply from newborn to 26 . PDF Letter of Explanation to Confirm Life Events - HealthCare.gov Find answers to common questions about applying. 0000070237 00000 n Within 31 days of the qualifying event, you may/must: You, your spouse, or enrolled dependent are covered under a qualified health plan, and then you lose eligibility, such as through other employment, Medicaid, State Childrens Health Insurance Program (SCHIP) or Medicare. You are again eligible for coverage under your parent's FEHB plan until you reach age 26 if your parent has a Self and Family enrollment. How To Get Health Insurance When Turning Age 26 | COBRA Help Variety of proof of loss of coverage letter template that will perfectly match your demands. The Certificate of Creditable Coverage (COCC) below is a good example of a loss of coverage document because it has the official insurance carrier logo at the top of the page and includes the name of the member to whom it applies as well as the coverage effective date and end date. Williamstown NJ 08094. Son Gncelleme : 26 ubat 2023 - 6:36. PDF Child Loses Dependent Status Due to Age - wisconsin.edu 0000001562 00000 n The amount of coverage for slashed tires is dependent upon the specifics of the . Also consult an HR professional or service provider to determine whether the information in your letter is actionable and clear for an employee to navigate. If you have questions regarding a change in any of your benefit coverages, first call your agencys benefits coordinator. endstream endobj 284 0 obj <>/Metadata 29 0 R/Names 285 0 R/Outlines 9 0 R/Pages 28 0 R/StructTreeRoot 31 0 R/Type/Catalog/ViewerPreferences 286 0 R>> endobj 285 0 obj <> endobj 286 0 obj <> endobj 287 0 obj <>/MediaBox[0 0 612 792]/Parent 28 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 288 0 obj <> endobj 289 0 obj <> endobj 290 0 obj <> endobj 291 0 obj <> endobj 292 0 obj <> endobj 293 0 obj [278 0 0 0 0 0 0 191 333 333 389 0 278 333 278 278 556 556 556 556 556 556 556 556 556 556 278 278 0 0 0 0 0 667 667 722 722 667 611 778 722 278 500 0 556 833 722 778 667 0 722 667 611 722 667 944 0 667 0 0 0 0 0 0 0 556 556 500 556 556 278 556 556 222 222 500 222 833 556 556 556 556 333 500 278 556 500 722 500 500 500 334 260 334] endobj 294 0 obj <> endobj 295 0 obj [226] endobj 296 0 obj <> endobj 297 0 obj [278 0 0 0 0 0 0 238 333 333 0 0 278 333 278 278 0 0 0 0 0 0 0 0 556 0 333 0 0 0 0 0 0 722 722 722 722 667 0 0 0 278 0 0 611 0 722 778 667 0 722 667 611 0 667 0 0 667 0 0 0 0 0 0 0 556 611 556 611 556 333 611 611 278 0 556 278 889 611 611 611 611 389 556 333 611 556 778 0 556 0 389 0 389] endobj 298 0 obj <>stream
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