GlobalCare Local National Pilots Health Plan...mPassport app, email, fax or mail. • Submit...

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In partnership with: baymac.net Worldwide Comprehensive Health Insurance for Pilots Global Care ® Local National Pilots Health Plan

Transcript of GlobalCare Local National Pilots Health Plan...mPassport app, email, fax or mail. • Submit...

Page 1: GlobalCare Local National Pilots Health Plan...mPassport app, email, fax or mail. • Submit separate form for each patient & complete in its entirety • Attach Itemized Receipts,

In partnership with:baymac.net

Worldwide Comprehensive Health Insurance for Pilots

GlobalCare® Local National Pilots Health Plan

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3Coverages, terms, conditions and exclusions subject to policy document.

TABLE OF CONTENTS

OVERVIEW 4

PLAN ELIGIBILITY 5

KEY BENEFITS 6

SUMMARY OF BENEFITS 7 - 8

ANNUAL PREMIUMS 9

ENROLLMENT 10 - 11

FREQUENTLY ASKED QUESTIONS 12 - 15

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Baymac has partnered with Clements Worldwide to provide world-class insurance solutions to Baymac members. Together, Baymac and Clements have created the GlobalCare® Pilots Health Plan, a comprehensive health insurance plan underwritten by Lloyd’s of London, to meet the needs of professional pilots who reside in their home country.

About Clements Worldwide

Founded in 1947, Clements brings extensive experience in the international insurance domain. As a Lloyds coverholder, our insurance solutions are designed in direct response to extensive international experience and the feedback we receive from clients around the world. With a reputation for unparalleled customer service, Clements is the preferred insurance provider for international risks.

• Most of our clients have sophisticated international operations. We travel frequently—often to more than 40 countries a year— to meet with them and discuss their insurance portfolio: progress, claims and renewals.

• Our company's strength lies in the quality and depth of our products and staff.

• With three strategic office locations in Dubai, London, and Washington DC, we are uniquely positioned to provide dedicated support with teams of Account Executives and Account Managers assigned to each client.

• Our long-term client relationships are a recognition of our high standard of service and strong customer confidence in our capabilities.

The Baymac GlobalCare® Local Nationals Pilots Health Plan

The Baymac GlobalCare® Local Nationals Pilots Plan has been designed to meet the needs of local national pilots worldwide. Local national pilots (pilots living and working in their home countries) are often faced with domestic or employer-provided health plans that fall short of their needs. Additionally, they may face standards of medical care that may vary significantly from provider to provider.

With the Baymac GlobalCare® Local Nationals Pilots Health Plan we offer you peace of mind and access to the very best of health care. In addition claims staff are available to assist you in several languages via our 24 hour toll-free call centre.

OVERVIEW

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5Coverages, terms, conditions and exclusions subject to policy document.

The Plan has been designed to include local national pilots within the Baymac Professional Pilots Group and their dependents.

To be eligible for enrollment, pilots must meet the following criteria:

• Must be actively employed as a pilot at time of enrollment

• Must, hold a valid Commercial Pilot’s License (CPL) or Air Transport Pilots License (ATPL)

• Must have a valid medical certificate issued by an aviation medical practitioner (AME) approved by the licensing authority for the CPL or ATPL held

• Must reside in your country of citizenship

• Must have active Baymac Membership

No medical underwriting is required for pilots under 63 years of age. Pilots who are 63 years of age or older at the time of enrollment are required to complete a medical form and may be required to provide additional medical information if required by the underwriters.

Dependents who meet the following criteria are eligible for medical coverage under the Plan:

• Lawful spouse or Domestic Partner of an Insured; or

• A dependent child of an insured under age 26 years including child of the Insured’s lawful spouse; or

• Natural, adopted or children under the legal guardianship of the insured including step children who are at least 51% dependent upon the Insured Person for support; or

• Unmarried children 19-26 years of age provided such child is a full-time student in an accredited educational institution and is not employed on a full-time basis.

At all times during the policy period, Baymac Professional Pilots Group members must be members in good standing.

PLAN ELIGIBILITY

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Coverage Highlights:

1. This program provides comprehensive medical coverage on a worldwide basis, allowing insured’s to seek treatment anywhere in the word.

2. Provides USD 5 million lifetime limit in healthcare benefits.

3. No medical underwriting or medical tests required for pilots less than 63 years of age.

4. Coverage for professional pilots and their families. Children under 19 are covered as part of the policy, student rates apply until age 26.

5. Select your doctor; the plan does not limit you to any particular doctor or practitioner worldwide, excluding the U.S. (out of network condition may apply in U.S.)

6. Pre-existing conditions are covered in home country only. Pre-existing, Critical Illnesses, Pre-existing Congenital, Hereditary and Maternity conditions are covered, subject to waiting periods.

7. Program is guaranteed admittance for Baymac Professional Pilot Group Members.

8. Claims are handled by a third-party administrator (HTH) with multi-lingual representatives, available 24/7.

9. This policy provides optional coverage for dental (emergency dental included in the standard Plan), Accidental Death and Dismemberment (AD&D).

10. USD 250 deductible.

11. Flexible payment options.

12. Air Ambulance and Medical Evacuation services are included at no additional cost. (Only applicable for travel outside of home country)

13. Coverage continuation post-retirement.**

14. Multi-lingual servicing capabilities for doctor consultations.

*Subject to waiting periods. **Subject to the laws of your home country.

KEY BENEFITS

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7Coverages, terms, conditions and exclusions subject to policy document.

SUMMARY OF BENEFITS*

BENEFIT COVERAGE

General Benefits

Overall Maximum Benefits USD 5,000,000 lifetime max.(Treatment worldwide, including US)

Eligibility Actively at work pilot with CPL or ATP license. Accidental Damage of Teeth Covered up to USD 2000 per accident AIDS Covered** (up to policy limit) Complications of Pregnancy and Childbirth USD 100,000 (max/lifetime)

Congenital Conditions Covered*** USD 300,000 max / lifetime

Hereditary Conditions Covered*** (up to policy limit)

Maternity - Cesarean-Section 50% of USD 15,000 max Maternity - Normal Delivery 50% of USD 10,000 max Newborn Coverage Must be added within the first 31 days of birth Nursing Care - Home or Convalescent Home Max 30 days per condition

Oncology

Passive War and Terrorism Covered (subject to co-insurance and policy limit)

Pre-existing Conditions

Repatriation of Mortal Remains 10,000 (outside of home country only)

Treatment Abroad Direct Billing for most hospitals and practitioners

Waiting Periods Maternity Covered - (12 months waiting period)

Mental and Nervous Conditions Covered – (18 month waiting period)

Minor Surgery Immediate Coverage

Newborns Immediate Coverage

Organ Transplant Immediate Coverage

In-Patient Benefits (Pre-certification required except in emergency)

CT, PET and MRI Scans

Day-care Treatment

Organ Transplant USD 500,000 lifetime max

Parental Accommodation

Prescription Drugs, Doctors’ Fees, Diagnostic Tests

Room and Board Surgical Procedures

Covered*** (subject to co-insurance and policy limit, excluded first 12 months)

Covered (subject to co-insurance and policy limit)

Covered (up to policy limit)

Covered (up to policy limit)

Covered (up to policy limit)

Covered (up to policy limit)

Covered (up to policy limit)

Covered (up to policy limit)

Deductible USD 250 per individual, USD 750 family

* Summary of Benefits subject to policy document ** AIDS not covered if contracted prior to enrollment date *** Mental and Nervous conditions, Maternity, AIDs and Pre-existing Critical conditions subject to waiting periods. - 100% coverage for claims filed outside the USA. 100% coverage for claims filed in-network. 80% coverage for claims filed out of network in U.S.

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SUMMARY OF BENEFITS

BENEFIT COVERAGE

Out-Patient Benefits

Accident & Emergency Treatment Inside Coverage Area Covered (up to policy limit)

Accident & Emergency Treatment Outside Coverage Area Covered (up to policy limit)

Alternative Medicine

Covered - up to USD 250 (Acupuncture, Naturopathy, Osteopathy,

Magnetic Therapy, Herbal Therapy, Massage Therapy, Aroma Therapy and Vitamin Therapy)

Check up Wellness - USD 250 annual

Chronic Conditions Covered (up to policy limit)

CT, PET and MRI Scans Covered 100% - (Precertification Required)

General Practitioner, Specialist Fees and Diagnostic Tests Covered 100%

Hospice Care / Terminal Care Covered - (Precertification Required)

Out Patient Benefit Sublimit Covered (up to policy limit)

Out Patient Surgery Covered (up to policy limit)

Prescribed Physiotherapy Covered - (Precertification Required)

Prescription Drugs Covered with USD 10 or USD 20 co-pay (per 30 day supply)

Rehabilitation Covered 80%

Routine dental

Covered with rider at maximum limit of USD 1,000 and USD 100 deductible: Class I- 100%;

Class II-80% and Class III-50% (18 months waiting period to apply for Class III)

Vaccinations Covered up to USD 250 - no deductible

Additional

Air Ambulance & Emergency Medical Evacuation USD 75,000 - Not available in home country

Emergency Reunion Covered (up to policy limit - Not available in home country)

Local Ambulance USD 15,000 per occurrence

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9Coverages, terms, conditions and exclusions subject to policy document.

ANNUAL PREMIUMS - WORLDWIDE LOCAL NATIONAL PLAN

Medical Insurance Annual Premiums

Adult USD 1,667

Young Adults - Dependent (age 19-23) USD 747

Children (0-18) No Charge

Optional Dental Expense Benefits

Ages Annual Premiums

0-4 No Charge

5-14 USD 218

15-74 USD 472

Optional AD&D Benefit

Age 0-65 USD 100,000 USD 111

Age 66-74 USD 50,000 USD 56

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HOW TO ENROLL

Existing Baymac Pilot MembersFor existing members of the Baymac Professional Pilots Group, download and complete the online Baymac GlobalCare® Pilots Application form at:www.baymac.net

Within five business days of receiving your application, you will be informed whether your application has been accepted or if additional information is required. Once accepted, payment may be made to Clements Worldwide by credit card or wire transfer.

For payment details contact Clements Worldwide at +1.202.478.6589, +1.800. 693.1087 or via email at [email protected] Monday through Friday between 8am to 5pm EDT.

Non-MembersThe Baymac GlobalCare® Local Nationals Pilots Health Plan is available exclusively for Baymac Professional Pilot Group Members. Pilots holding a valid Commercial or Airline Transport Pilot License are eligible for membership of the Baymac Professional Pilots Group. Complete the Baymac Professional Pilot Membership Online Application at www.baymac.net and submit payment for membership fees as provided in the Application Form.

On acceptance of your application, you will be provided with a membership number that will be required for each applicant wishing to purchase the Baymac GlobalCare® Local Nationals Pilot Health Plan. Membership is confirmed once your payment has been received and your application approved.

For non-members interested in knowing more about the Baymac GlobalCare® Local Nationals Pilot Health Plan, contact Baymac at +971 55 111 3674 or email at [email protected].

Effective Date of CoverageOnce accepted, you will be given an effective date of coverage and a kit containing your Identification Card, Certificate of Coverage, and instructions on how to use your insurance coverage. Included in your instructions will be details on how to access to Clement Worldwide’s international and U.S. PPO Network and information providing you with an online suite of tools and resources to help you locate and obtain quality medical care throughout the world.

Renewals

The Baymac GlobalCare® Local Nationals Pilots Health Plan is renewable annually. Renewal is subject to continued eligibility.

Filing a Claim

Claims can be filed in the following ways: online, mPassport app, email, fax or mail.

• Submit separate form for each patient & complete in its entirety

• Attach Itemized Receipts, Invoices or Bills

• Select the preferred reimbursement currency supported by your bank

• Select your Reimbursement Option (Check vs. wire transfer- faster method using ACH with US bank accounts).

• For claims payment and wires, the payments can only be made to the primary insured member and not to the dependents. Members should make sure that only the primary insured member’s payment information i.e. bank details are on the claim form. If the name on the bank account does not match the primary insured, then a claim cannot be settled.

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11Coverages, terms, conditions and exclusions subject to policy document.

ENROLLMENT (cont.)Pre-Certifi cationCertain benefi ts under the Baymac GlobalCare® Local Nationals Pilots Health Plan require pre-certifi cation to receive the full benefi ts under the Plan. This simply means that you must contact the GlobalCare® third party administrator as soon as possible before a planned hospitalization or surgical procedure, within 48 hours of an emergency hospital admission, or within the fi rst 90 days of pregnancy. Pre-certifi cation allows us to establish contact and make payment arrangements with your providers. Pre-certifi cation may be done by logging online through the GlobalCare® website or by calling the phone number on the back of your insurance card.

Medical MonitoringClements Worldwide through its network provide consultations with attending medical professionals during hospitalization and provide a single point-of-contact for family members to receive ongoing updates regarding medical status.

Post Retirements Benefi tsPilots may remain on the Baymac GlobalCare® Local Nationals Pilots Health Plan post retirement for as long as they remain a member of the Baymac Pilot Group and continue to meet the eligibility requirements. Post-retirement benefi ts are subject to the laws of your home country.

Optional Benefi ts

DentalThere is a USD 100 deductible for dental coverage, with a maximum coverage amount of USD 1,000 per individual. Diagnostic and Preventive dental services (Class I) and Basic Restorations, Endodontics, Periodontics, Prosthodontic Maintenance and Oral Surgery (Class II) are covered immediately, at 100% and 80%, respectively. Major Restorations, Dentures and Bridgework (Class III) require an 18 months of a policy

period (a renewal would take eff ect) before 50% of coverage takes eff ect. Accidental Death, Accidental Loss of Limb or SightOptional benefi ts up to USD 100,000 are available for loss of sight, loss of limbs or loss of life at an additional annual premium.

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1. What is the GlobalCare® Local Nationals Pilots Plan? The GlobalCare® Local Nationals Pilots Plan is specifically designed to meet the needs of professional pilots and their families where the pilot lives in his or her home country. This program is offered by Clements Worldwide, a Lloyd’s coverholder who has provided comprehensive global insurance for multinationals worldwide for the last 68 years. The plan provides medical coverage with children being covered until their 19th birthday, with further coverage between the ages of 19-26 years while enrolled in an educational institution.

2. Do I require additional healthcare cover if I already have coverage by my airline? This plan is supplementary to any employer or locally required plan. Many airlines provide some medical coverage for their employees. In many instances the coverage provided has several limitations and major medical treatment may either not be covered, not be totally covered, or may require lengthy approval processes, often being financially limited to the cost of local health care. The GlobalCare® Local Nationals Pilots Health Plan is cost effective, transparent and covers most medical conditions globally. Approval is fast (not required in the event of an emergency), and lifetime coverage is up to USD 5M per person. Pilots and their families have the peace of mind of knowing that in an emergency, when treatment is not provided locally, transportation is available (by ground or air ambulance), without concerns about cost or employer approval. Employers have the benefit of knowing that major worldwide medical coverage is provided to their employees at lower costs than that included in many local medical plans.

3. What are the advantages of the Baymac GlobalCare® Local Nationals Pilots Plan?The Baymac GlobalCare® Local Nationals Pilots Health Plan provides worldwide access to superior medical care and treatment by

healthcare professionals. The GlobalCare® Local Nationals Pilots Health Plan is flexible, covering pre-existing conditions, post- retirement benefits, as well as being easily transferable when pilots are required to change employment. The following additional benefits make the Baymac GlobalCare® Local Nationals Pilots Health Plan a leader in its class:

• Competitive premiums • Low deductible of USD 250• Truly Comprehensive Cover• Children under 19 years of age are covered

at no additional cost. Reduced rates for students up to 23 years of age.

• Worldwide network• 24 hours claims assistance

4. Are Pre-existing conditions covered? Yes. Pre-existing conditions are covered in your home country only and are subject to waiting periods. Baymac does not, however, expect persons to apply for coverage for the main purpose of claiming for treatment of pre-existing conditions. This plan does not cover HIV/AIDS if contracted before policy inception date.

5. Is outpatient treatment covered? Yes. See Summary of Benefits.

6. Are prescription drugs covered under out-patient treatment? Yes. See Summary of Benefits.

7. Are congenital conditions covered?Yes. Unlike many policies which exclude congenital conditions, or only cover them when diagnosed during the policy duration, the GlobalCare® Local Nationals Pilots Health Plan will provide cover subject to the waiting period.

8. What is the USD 5 million lifetime coverage?Under the GlobalCare® Pilots Plan the policy provides coverage for a lifetime limit of USD 5 million for each family member covered under the policy.

FREQUENTLY ASKED QUESTIONS*

* See policy for full terms and conditions

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13Coverages, terms, conditions and exclusions subject to policy document.

9. Can I choose any doctor, clinic or hospital any where in the world?Yes. You are free to use the doctors, clinics and hospitals of your choice. The GlobalCare® Local Nationals Pilots Plan does not limit you to a particular network of doctors or hospitals (in the USA subject to out-of-network conditions).

10. What is the Preferred Provider Network and is it only for the USA?The Preferred Provider Network (PPN) is a large network of hospitals within the US only where arrangements have been made with the insurance provider for treatment of its clients within the US. Utilization of this network allows for 100% benefits to be available for treatment in the US.

11. What if I require treatment in the USA but choose not to use a hospital or clinic within the PPN?You may choose to use other hospitals of your choice within the USA. Where a hospital is chosen within the USA that is outside of the PPN, 80% of the benefit will be paid.Outside of the US the PPN is not applicable and 100% of the benefits are available for all doctors, clinics and hospitals. (subject to policy terms and conditions)

12. Are Air Ambulance and Medical Evacuation available?Yes. In the event of acute or serious injury air ambulance expenses are covered to the nearest suitable place of treatment in cases where no qualified treatment can be obtained locally. Only applicable for travel outside of your home country.

13. Who is eligible for the GlobalCare® Local Nationals Pilots Health Plan?To purchase the GlobalCare® Local Nationals Pilots Health Plan you must be actively employed as a pilot, hold a valid Commercial Pilots License or Air Transport Pilots License and a valid aviation medical. You must also be

a member in good standing of the Baymac Professional Pilots Group, and you must be a fully paid up member if not otherwise exempted.

14. Are my family members eligible for cover under the GlobalCare® Local Nationals Pilots Health Plan?The dependents of the Baymac members enrolled in the program who meet the following criteria are eligible for medical coverage under this plan:

Spouse: Spouses of eligible pilots may become members of the Baymac Group. This includes common law as defined by legislation in the employee’s home country. Once a member, a spouse may obtain cover under the plan.

Children: Children of a pilot or pilot’s spouse who are natural or legally adopted by the pilot or his or her spouse and are unmarried, may be covered under the plan. A child, whose parent is eligible for maternity coverage, is automatically enrolled in the parent’s policy regardless of the child’s state of health. Congenital and hereditary conditions are covered, subject to waiting periods. Clements Worldwide must be notified upon birth of a newborn.

On reaching 19 years of age a child can continue to enjoy cover, provided they are unmarried and a full time student at an accredited tertiary institution, until their 26th birthday without having to undergo new medical underwriting. The child will be removed from the policy after their 26th birthday.

15. My children study overseas; can they be enrolled in the plan?Yes. Up to 26 years of age.

16. Can my children be covered if my wife is not on the plan?Yes. (subject to age limitations)

FAQ (cont.)

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17. How do I apply?Visit www.baymac.net and join the Baymac Professional Pilots Group. Applications are made online. Once your Baymac membership is approved you will receive a membership number that you may use to apply for your GlobalCare® Local Nationals Pilots Health Plan on the Professional Pilots Group Page. Clements will process your application for the healthcare plan. A response will usually be provided within 5 working days.

18. Can we enroll for the GlobalCare® Local Nationals Pilots Health Plan at any time or is enrollment open for a limited time?Once you have been accepted as a member of the Baymac Professional Pilots Group, you may enroll at any time. Application for membership may be found at www.baymac.net.

19. If I lose my pilot’s medical or license can I renew the plan?Yes. A valid pilot’s medical and license are required for initial enrollment, however, if you lose your license or medical after being on the plan you are able to renew your policy.

20. If I leave my job or the profession of flying can I remain on the plan?Yes. The plan is designed for you to be able to continue on it if you change your employer or lose your job. You and your family can stay on the plan as long as you remain a member in good standing of the Baymac Professional Pilots Group (abiding by the rules of membership and have paid the annual membership fees).

21. Is the GlobalCare® Local Nationals Pilots Health Plan a top-up plan, or does it stand alone as a primary plan?The GlobalCare® Local Nationals Pilots Health Plan can work as a primary plan if the member has no other health insurance, and as a secondary plan if the member has other health insurance coverage and/or is required by local law. Whatever is not covered by the member’s

primary may be covered by the GlobalCare® Local Nationals Pilots Health Plan to the coverage limits of the plan. This plan is in excess of any employer or locally required plan.

22. What happens with my plan when I retire?You and your family may continue on the plan at the retirement level (continuation plan). You will however need to inform Clements Worldwide when you retire to enable them to check that the plan does not contravene the laws of your home country and that there are no changes to the terms or premium. The policy requires that the insured provide further medical information for medical underwriting after the age of 63. Results of medical underwriting and age change will lead to an adjustment in premium.

23. Can premiums be paid monthly?Yes. Premiums are in US Dollars and may be paid monthly, quarterly, bi-annually or annually. There are no penalties for monthly payment however, the equivalent of a 2.5-month premium is deducted initially for monthly payments to avoid the policy lapsing in the event of any issues preventing payment going through on the credit card provided (e.g. lost or stolen cards, replaced cards, etc.)

24. What is the USD 250 deductible? Is this per claim or per year?The USD 250 deductible is the amount each policyholder must pay per year (not per claim) on their medical costs before claiming on the policy. This is limited to USD 750 per family.Some benefits do not require the policyholder to pay a deductible, e.g. annual check-up and lens replacements etc. If there is a claim for USD 300, the member will pay the first USD 250 and claim for the remainder. If there is a subsequent claim in the same policy year for USD 800, the member can claim the full USD 800.

25. How does this coverage compare to other global policies?

FAQ (cont.)

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15Coverages, terms, conditions and exclusions subject to policy document.

The plan ranks as one of the best plans available for pilots. It has been designed by pilots for pilots to ensure the needs of pilots and their families are met. The policy provides comprehensive global cover, which compares favorably with other international policies. The inclusion of such conditions as Hereditary, Congenital and Chronic, which are often excluded in other policies, and the benefi t of elective treatment worldwide (including in the USA and Canada), has made the GlobalCare® Local Nationals Pilots Health Plan popular among pilots.

26. When will the policy commence?Once Clements has been advised of approval of your membership of the Baymac Professional Pilots Group and your application for the health plan has been received, your policy will usually be issued within 5 working days. The eff ective date of the policy will be the eff ective date requested by you on application or the date the policy is approved whichever comes last. Your policy documents will be mailed along with your health cards to the mailing address provided in your application.

FAQ (cont.)

William Warby

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In partnership with:

Baymac is the trade name of Baymac Management Services Ltd., an international aviation management consultancy fi rm consisting of aviation professionals including international aviation consultants, airline managers and pilots, who specialize in providing turn-key manage-ment solutions for companies and individuals within the aviation industry. Baymac is not an insurance company or broker, nor does Baymac provide insurance, fi nancial or investment advice. These services are provided to members by highly regulated organizations licensed to do so in the relevant jurisdictions. Baymac’s Professional Member Services are only available for paid up members.”

Copyright © 2016 Clements Worldwide. All Rights Reserved.

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