22-500 CA 319 Cambodian Medicare Savings Programs Brochure · snßM ® k' elak/ñk/acTTYl...

snß M

®◊k '

elak/ñk/acTTYl◊nsiTÛ®sbc∫ab's®mab'kmμviZIEdl/ace/

ayelak/ñk snßM®◊k'e®cInCag $1,600 dul¬a kñ¨gmYyqñaM .

kmμviZIsnßM®◊k'BIkarZana òab'rgsg†mCYydl'mnusßEdl-

mansiTÛ®sbc∫ab'edaybg'®◊k'elIbuB√laP Zanaòab'rgs-

g†m tM´lEdl/ackat'kgecj nigtM´lEdlTak'Tgnwg

karZanaòab'rgsg†m . elak/ñkk°/acmankarZanaòab'rgs-

g†ms†g'dar … karZanaòab'rgsg†mEdl®Kb'®KgEpnkarEzTaM .

kardak'Bak¥sMuKWmanPaBgay®sYy .

sUmTUrsBÊmkenA´z©enHs®mab'Bt·man nigCMnYykar — elak/ñ

k/acdak' ®◊k'rbs'elak/ñkeTAkñgeha◊"vrbs'elak/ñkvij . kñ¨gZanaòab'rgsg†m

s®mab'Bt·manbEnΩmeT\tenAkñ¨gshKmn—rbs'elak/ñk :

HCA 22-500CA (3/20) Cambodian

etImankarcMNay/√Ix¬H®tUv◊n®Kb'dN†b'elIkarZanaòab'rg?

kmμviZIsnßM®◊k'BIkarZanaòab'rgsg†m/

ac®KbdN†b'eTAelIEpñkxage®kam :

buB√laPEpñk A

buB√laPEpñk B

shZanaòab 'rgeTAelIcMnYnEdl-

bg'®◊k'karZanaòab'rgsg†m

tM´lEdl/ackat'kgecjBIkarZanaòab'rgsg†m

etIá/acdwg`agmiuczaámanlk≈xNÎ®Kb'®Kan'?

manmnusßrab'Ban'nak'enAkñ¨grdƒ´nTI®kugùasIunetanman-

lk≈xNÎ®Kb'®Kan's®mab' kmμviZIsnßM®◊k'BIkarZanaòab'rgsg†m . edI

m∫IEs√grkzaelak/ñk manlk≈xNÎ ®Kb'®Kan sUmemIlelItaragcM-

NUlenAkñ¨ges\vePAm"UtKMrUnH . s®mab'Bt·man bEnΩmsUmemIles\

vePAm"UtKMrUenHvij ehIys®mab'eQμaH nigelx TUrsBÊ rbs'nr

Namñak'Edl/acCYy/ñk◊n .

etI/tΩ®beyaCn—TaMgenHnwgb"HBal'dl'/

cln:®TB¥rbs'áEdr…eT?

/t'eT, minmankarTTYlkmμsiTÛ/cln:®TB¥mkvijs®mab'

kmμviZIsnßM®◊k'BI karZanaòab'rgsg†menaHeT .

dak'®◊k'®tLb'mkvijenAkñ¨gkar®tYtBinit¥sn†isuxsg†m!

man®◊k'e®cInCag $1,600 dul¬a kñ¨gmYyqñaM

HCA /nuelamtamcÒab'siTiÛsuIvIlrâùasIunetan

nigshB¤nÛCaZrmanTaMg/s' ehIy◊neb∂C∆ap∂l'nUvkarcUle®bIesμI@

KñaeTAkan'esvakmμrbs'eyIg.

ebIsin/ñk®tUvkarkarCYys®mYl …TamTarGksarkñgT®mg' …

Pasaepßg sUmTUrs¤BÊeTAelx 1-800-562-3022 (TRS: 711).

®bsinebIelak/ñkCa/ñkTTYlplBI kmμviZIZanaòab'rgsg†m kmμviZIsnßM®◊k'BIkarZanaòab'rgsg†m

/ MB kmμviZIsnßM®◊k'BIkarZa-

naòab'rgsg†metIádak'Bak¥◊nedayreb\bNa?

sUmeZ√ItamCMÓan®sYl@xage®kam ehIye®b

\beZ\bsrubelItaragenAxag s†aMedIm∫IBinit¥emIlzaetI/ñ

kmanlk≈N:sm∫t†i®Kb'®Kan's®mab'TTYlkmμviZI

snßM®◊k'BIkarZanaòab'rgsg†mEdr…eT .

1. sUmsresrcMNUl®KYsar®bcaMExsrub

rbs'elak/ñk $ ___________

2. kat'®◊k'cMnYn 20 dul¬a

(karkat'®◊k'm†gs®mab'smaCik®kum -

®KYsarTaMg /s'kñ¨gtMbUlpÊHEtmYy) $

3. cMNUlsrub $

4. sUmsresrcuHnUvkar◊"n'®bmaN®TB¥ -

skmμsrubrbs'elak/ñk

sac'®◊k' $

snñiZi $

KNnIZanaKar $

/cln:®TB¥

(minEmn pÊHEdlelak/ñkrs'enAeT) $

®bkasnIyb‡®tbeJÔI $

Lans®mab'dMeNIrkMsan†

(manbnÊb'Twk pÊH◊y bnÊb'eKg) $

sJÔab‡Nˆ®◊k'snßM $

®TB¥skmμsrub $

5. ®bsinebI®◊k'cMNUl®bcaMExrbs'elak/ñkKWesμI …Tab-

CagkMritenAelItarag enAxags†aM ehIynwg ®TB¥skmμs-

rubrbs'elak/ñkTabCag®TB¥skmμman kMNt'Edl◊n-

rayeQμaHxage®kamtarag elak/ñk/acCamanlk≈N:

sm∫t†i®Kb'®Kan's®mab'kmμviZImYyenAkñ¨gcMeNamkmμvi-

ZIsnßM®◊k'BIkarZana òab'rgsg†mTaMgLay .

mankmμviZIcMnYnbYnenAkñ¨grdƒùasIunetan :

kmμviZITI 1

kmμviZI/ñkmansiTÛTTYlkarZanaòab'rgsg†m (QMB) bg'®◊k'buB√laPEpñk A nigEpñk B

bg'®◊k'Edl/ackat'kgecj

bg'´z¬shZanaòab'rg elIkElgEtevCÇbJÇar

kmμviZITI 2

/ñkTTYlplBIkarZanaòab'rgsg†mmancM NUlTabEdl manlk≈N:Biess (SLMB) bg'®◊k'buB√laPEpñk B

kmμviZITI 3

kmμviZIGkt†CnEdlmanlk≈N:®Kb'®Kan' (QI-1) bg'®◊k'buB√laPEpñk B

kmμviZITI 4

kargarGkt†CnBikarEdlmanlk≈N:®Kb'®Kan' (QDWI) bg'®◊k'buB√laPEpñk A

vagay®sYlNas'! sUmTak'Tgkarriyal‡yesvakmμshKmn—

kñ¨gtMbn'rbs'elak/ñk (CSO) .

elak/ñk/ac/ñkEs√grkkariyal‡y CSO EdlenACit

elakenAkñ¨grdƒa Pi◊lrbs'shrdƒ enATMB‡r (blue)enAkñ¨ges\vePAkt'®taelxTUrsB√rbs' elak/ñk …

sUmeTAemIleKhTMB‡r enAelI/IunZ‡reNtwww.washingtonconnection.org, …

/ñk/acTUrs¤BÊeTakan'/aC∆aZrEzTaMsuxPaB tamelx 1-800-562-3022 EpñkbEnΩm 16129 edImÒIO¥eKep∆IsMbu®tmk/ñk.

®TB¥skmμ®tUv◊n/nuJÔats®mab'buK†l ................................$7,860®TB¥skmμ®tUv◊n/nuJÔats®mab'b†I®bBn Û ...............................$11,800

* kmμviZI QDWI s®mab'kargarCnBikarmankarkat'®◊k'cMNUlEdl-

rk◊n edayBiess dUecñHelak/ñknwg®tUvTUrsBÊsMCYyenAkñgkarkM

Nt'siTÛTTYl ◊n®sbc∫ab's®mab'kmμviZIenH .

®TB¥skmμs®mab' QDWI ®tUv◊n/nuJÔats®mab'buK†l .............. $4,000®TB¥skmμs®mab' QDWI ®tUv◊n/nuJÔats®mab'b†IBnÛ ................ $6,000

sUmBinit¥emIl®bsinebIelak/ñkmansiTÛ®Kb'®Kan'

sUme®bIsn¬wkkargarpÊal'x¬ÁnenH

s†g'darZnZan nig®◊k'cMNUl

kmμviZIsnßM®◊k'BIkarZanaòab'rgsg†m

man®bsiTÛPaB 4/1/2020

®bePTkmμviZIkarZa-naòab'rgsg†m

®◊k'cMNUl®b-caMEx (buK†l)

®◊k'cMNUl®b-caMEx (b†I®bBnÛ)

kmμviZI 1 QMB eLIgeTA $1,064 eLIgeTA $1,437

kmμviZI 2 SLMB eLIgeTA $1,276 eLIgeTA $1,724

kmμviZI 3 QI-1 eLIgeTA $1,436 eLIgeTA $1,940

kmμviZI 4 QDWI eLIgeTA $2,127 eLIgeTA $2,874

22-500 CA 319 Cambodian Medicare Savings Programs Brochure · snßM ® k' elak/ñk/acTTYl...

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Transcript of 22-500 CA 319 Cambodian Medicare Savings Programs Brochure · snßM ® k' elak/ñk/acTTYl...