{"id":222001,"date":"2021-04-06T12:35:51","date_gmt":"2021-04-06T19:35:51","guid":{"rendered":"http:\/\/www.carewellseiu503.org\/nguon-tro-gip\/mau-don\/"},"modified":"2025-12-01T10:18:32","modified_gmt":"2025-12-01T18:18:32","slug":"forms","status":"publish","type":"page","link":"https:\/\/www.carewellseiu503.org\/vi\/resources\/forms\/","title":{"rendered":"C\u00e1c M\u1eabu \u0110\u01a1n \u0110\u0103ng K\u00fd v\u00e0 Ho\u00e0n Tr\u1ea3"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#ffffff&#8221; background_enable_image=&#8221;off&#8221; background_position=&#8221;bottom_left&#8221; min_height=&#8221;350px&#8221; min_height_tablet=&#8221;100px&#8221; min_height_phone=&#8221;&#8221; min_height_last_edited=&#8221;on|phone&#8221; custom_margin=&#8221;||0px||false|false&#8221; custom_padding=&#8221;50px||0px||false|false&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;0px||||false|false&#8221; bottom_divider_flip=&#8221;vertical&#8221; background_last_edited=&#8221;on|phone&#8221; use_background_color_gradient_phone=&#8221;off&#8221; background_enable_image_phone=&#8221;off&#8221; border_color_bottom=&#8221;#ffa89f&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row custom_padding_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;100px||2px||false|false&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_class=&#8221;addLine&#8221; _builder_version=&#8221;4.16&#8243; text_text_color_tablet=&#8221;&#8221; text_text_color_phone=&#8221;&#8221; text_text_color_last_edited=&#8221;on|phone&#8221; header_text_color_tablet=&#8221;&#8221; header_text_color_phone=&#8221;&#8221; header_text_color_last_edited=&#8221;on|desktop&#8221; background_layout_tablet=&#8221;&#8221; background_layout_phone=&#8221;&#8221; background_layout_last_edited=&#8221;on|phone&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1>M\u1eabu \u0110\u01a1n<\/h1>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; background_color=&#8221;rgba(0,0,0,0)&#8221; z_index=&#8221;4&#8243; custom_margin=&#8221;||0px||false|false&#8221; custom_padding=&#8221;1px||0px||false|false&#8221; border_color_bottom=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; background_color=&#8221;#ffffff&#8221; background_enable_image=&#8221;off&#8221; custom_padding=&#8221;3px||2px|||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; max_width=&#8221;900px&#8221; custom_margin=&#8221;||0px|||&#8221; custom_padding=&#8221;||40px|||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p class=\"p1\"><span style=\"font-weight: 400;\">Danh s\u00e1ch b\u00ean d\u01b0\u1edbi bao g\u1ed3m c\u00e1c m\u1eabu \u0111\u01a1n m\u00e0 b\u1ea1n ph\u1ea3i \u0111i\u1ec1n \u0111\u1ec3 \u0111\u0103ng k\u00fd tham gia ho\u1eb7c gia h\u1ea1n c\u00e1c ph\u00fac l\u1ee3i Carewell c\u1ee7a m\u00ecnh. C\u00e1c m\u1eabu \u0111\u01a1n \u0111\u01b0\u1ee3c s\u1eafp x\u1ebfp theo ph\u00fac l\u1ee3i ho\u1eb7c danh m\u1ee5c. <\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;2&#8243; specialty=&#8221;on&#8221; custom_padding_last_edited=&#8221;on|desktop&#8221; module_class_1=&#8221;stickyColumn&#8221; module_class=&#8221;stickyRow&#8221; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#f3f3f3&#8243; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;0px||||false|false&#8221; custom_padding_tablet=&#8221;15px||||false|false&#8221; custom_padding_phone=&#8221;&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Ch\u1ecdn m\u1ed9t ph\u00fac l\u1ee3i ho\u1eb7c danh m\u1ee5c \u0111\u1ec3 xem m\u1eabu \u0111\u01a1n<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; header_text_color=&#8221;#582C82&#8243; header_5_text_color=&#8221;#582C82&#8243; background_color=&#8221;#FFFFFF&#8221; custom_margin=&#8221;10px||10px||true|false&#8221; custom_padding=&#8221;6px|10px|0px|10px|false|true&#8221; link_option_url=&#8221;#dentalanchor&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; text_text_color__hover_enabled=&#8221;on|hover&#8221; text_text_color__hover=&#8221;#582C82&#8243; header_5_text_color__hover_enabled=&#8221;on|hover&#8221; header_text_color__hover_enabled=&#8221;on|desktop&#8221; header_text_color__hover=&#8221;#A45CFF&#8221; header_5_text_color__hover=&#8221;#A45CFF&#8221;]<\/p>\n<h5>Nha Khoa<\/h5>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; header_text_color=&#8221;#582C82&#8243; header_5_text_color=&#8221;#582C82&#8243; background_color=&#8221;#FFFFFF&#8221; custom_margin=&#8221;10px||10px||true|false&#8221; custom_padding=&#8221;6px|10px|0px|10px|false|true&#8221; link_option_url=&#8221;#visionhearinganchor&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; text_text_color__hover_enabled=&#8221;on|hover&#8221; text_text_color__hover=&#8221;#582C82&#8243; header_5_text_color__hover_enabled=&#8221;on|hover&#8221; header_text_color__hover_enabled=&#8221;on|desktop&#8221; header_text_color__hover=&#8221;#A45CFF&#8221; header_5_text_color__hover=&#8221;#A45CFF&#8221;]<\/p>\n<h5>Th\u1ecb L\u1ef1c + Th\u00ednh L\u1ef1c<\/h5>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; header_text_color=&#8221;#582C82&#8243; header_5_text_color=&#8221;#582C82&#8243; background_color=&#8221;#FFFFFF&#8221; custom_margin=&#8221;10px||10px||true|false&#8221; custom_padding=&#8221;6px|10px|0px|10px|false|true&#8221; link_option_url=&#8221;#eapanchor&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; text_text_color__hover_enabled=&#8221;on|hover&#8221; text_text_color__hover=&#8221;#582C82&#8243; header_5_text_color__hover_enabled=&#8221;on|hover&#8221; header_text_color__hover_enabled=&#8221;on|desktop&#8221; header_text_color__hover=&#8221;#A45CFF&#8221; header_5_text_color__hover=&#8221;#A45CFF&#8221;]<\/p>\n<h5>Ch\u01b0\u01a1ng Tr\u00ecnh H\u1ed7 Tr\u1ee3 Nh\u00e2n Vi\u00ean<\/h5>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; header_text_color=&#8221;#582C82&#8243; header_5_text_color=&#8221;#582C82&#8243; background_color=&#8221;#FFFFFF&#8221; custom_margin=&#8221;10px||10px||true|false&#8221; custom_padding=&#8221;6px|10px|0px|10px|false|true&#8221; link_option_url=&#8221;#hcaanchor&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; text_text_color__hover_enabled=&#8221;on|hover&#8221; text_text_color__hover=&#8221;#582C82&#8243; header_5_text_color__hover_enabled=&#8221;on|hover&#8221; header_text_color__hover_enabled=&#8221;on|desktop&#8221; header_text_color__hover=&#8221;#A45CFF&#8221; header_5_text_color__hover=&#8221;#A45CFF&#8221;]<\/p>\n<h5>H\u1ed7 Tr\u1ee3 Chi Ph\u00ed Ch\u0103m S\u00f3c S\u1ee9c Kh\u1ecfe<\/h5>\n<p><a href=\"#hcaanchor\">\u0110\u1ed1i v\u1edbi Ch\u01b0\u01a1ng Tr\u00ecnh \u0110\u01b0\u1ee3c Ph\u00ea Duy\u1ec7t<\/a><br \/><a href=\"#hcamedicareanchor\">\u0110\u1ed1i v\u1edbi Medicare<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; header_text_color=&#8221;#582C82&#8243; header_5_text_color=&#8221;#582C82&#8243; background_color=&#8221;#FFFFFF&#8221; custom_margin=&#8221;10px||10px||true|false&#8221; custom_padding=&#8221;6px|10px|0px|10px|false|true&#8221; link_option_url=&#8221;#ptoanchor&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; text_text_color__hover_enabled=&#8221;on|hover&#8221; text_text_color__hover=&#8221;#582C82&#8243; header_5_text_color__hover_enabled=&#8221;on|hover&#8221; header_text_color__hover_enabled=&#8221;on|desktop&#8221; header_text_color__hover=&#8221;#A45CFF&#8221; header_5_text_color__hover=&#8221;#A45CFF&#8221;]<\/p>\n<h5>Gi\u1edd Ngh\u1ec9 \u0110\u01b0\u1ee3c Tr\u1ea3 L\u01b0\u01a1ng<\/h5>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;3_4&#8243; specialty_columns=&#8221;3&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_row_inner module_id=&#8221;updateinfo&#8221; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;40px||||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;on|on|on&#8221; module_id=&#8221;updateyourinfo&#8221; _builder_version=&#8221;4.16&#8243; min_height=&#8221;35px&#8221; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3>L\u01b0u \u00fd quan tr\u1ecdng &#8211; H\u00e3y lu\u00f4n c\u1eadp nh\u1eadt th\u00f4ng tin c\u1ee7a b\u1ea1n<\/h3>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner module_id=&#8221;updateform&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;3px||||false|false&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_code disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<script type=\"text\/javascript\" src=\"https:\/\/risepartnership.jotform.com\/jsform\/210664581488060\"><\/script>[\/et_pb_code][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;2&#8243; make_equal=&#8221;on&#8221; module_class=&#8221;noAnimation&#8221; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;|0px||0px|false|true&#8221; custom_padding=&#8221;1px||2px||false|false&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>\u0110\u1ec3 \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n h\u01b0\u1edfng c\u00e1c ph\u00fac l\u1ee3i c\u1ee7a Carewell, b\u1ea1n ph\u1ea3i g\u1eedi cho Carewell SEIU 503 nh\u1eefng th\u00f4ng tin nh\u01b0 t\u00ean, gi\u1edbi t\u00ednh, S\u1ed1 An Sinh X\u00e3 H\u1ed9i, ng\u00e0y sinh v\u00e0 \u0111\u1ecba ch\u1ec9 hi\u1ec7n t\u1ea1i c\u1ee7a b\u1ea1n \u0111\u1ec3 l\u01b0u h\u1ed3 s\u01a1. B\u1ea1n c\u0169ng c\u1ea7n \u0111\u1ea3m b\u1ea3o v\u1edbi Ti\u1ec3u Bang r\u1eb1ng th\u00f4ng tin c\u1ee7a m\u00ecnh l\u00e0 th\u00f4ng tin m\u1edbi nh\u1ea5t. L\u01b0u \u00fd: N\u1ebfu b\u1ea1n g\u1eedi th\u00f4ng tin n\u00e0y, Carewell SEIU 503 s\u1ebd c\u00f3 th\u1ec3 gi\u00fap b\u1ea1n \u0111\u0103ng k\u00fd nh\u00e2\u0323n ca\u0301c ph\u00fac l\u1ee3i Nha Khoa, Th\u1ecb L\u1ef1c + Th\u00ednh L\u1ef1c va\u0300 Ch\u01b0\u01a1ng Tr\u00ecnh H\u1ed7 Tr\u1ee3 Nh\u00e2n Vi\u00ean c\u1ee7a Carewell SEIU 503 n\u1ebfu b\u1ea1n \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n.<\/p>\n<p>&nbsp;<\/p>\n<ol>\n<li><strong>G\u1eedi m\u1eabu \u0111\u01a1n tr\u00ean<\/strong> \u0111\u1ec3 c\u1eadp nh\u1eadt th\u00f4ng tin c\u1ee7a b\u1ea1n v\u1edbi Carewell SEIU 503.<\/li>\n<li><strong>L\u00e0m theo h\u01b0\u1edbng d\u1eabn b\u00ean d\u01b0\u1edbi<\/strong> \u0111\u1ec3 c\u1eadp nh\u1eadt th\u00f4ng tin c\u00e1 nh\u00e2n c\u1ee7a b\u1ea1n v\u1edbi Ti\u1ec3u Bang, t\u00f9y theo lo\u1ea1i h\u00ecnh c\u00f4ng vi\u1ec7c c\u1ee7a b\u1ea1n.<\/li>\n<\/ol>\n<p>[\/et_pb_text][et_pb_code disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#582C82&#8243; text_orientation=&#8221;left&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_section global_module=\"274291\"][\/et_pb_section][\/et_pb_code][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner column_structure=&#8221;1_3,1_3,1_3&#8243; use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;2&#8243; make_equal=&#8221;on&#8221; module_class=&#8221;noAnimation&#8221; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;|0px||0px|false|true&#8221; custom_padding=&#8221;1px||3px||false|false&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner type=&#8221;1_3&#8243; saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><span style=\"color: var(--main-color); font-family: univia-pro, 'Exo 2', sans-serif; font-size: 18px; font-weight: bold; letter-spacing: 0.7px;\">Nh\u00e2n Vi\u00ean Ch\u0103m S\u00f3c T\u1ea1i Nh\u00e0 (HCW)<\/span><\/p>\n<p>C\u1eadp nh\u1eadt \u0111\u1ecba ch\u1ec9 c\u1ee7a b\u1ea1n v\u1edbi v\u0103n ph\u00f2ng APD\/AAA t\u1ea1i \u0111\u1ecba ph\u01b0\u01a1ng. B\u1ea1n n\u00ean li\u00ean h\u1ec7 v\u1edbi Nh\u00e2n Vi\u00ean\/\u0110i\u1ec1u Ph\u1ed1i Vi\u00ean HCW t\u1ea1i \u0111\u1ecba ph\u01b0\u01a1ng m\u00ecnh.<\/p>\n<ul><\/ul>\n<p>[\/et_pb_text][\/et_pb_column_inner][et_pb_column_inner type=&#8221;1_3&#8243; saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.21.0&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><span style=\"color: var(--main-color); font-family: univia-pro, 'Exo 2', sans-serif; font-size: 18px; font-weight: bold; letter-spacing: 0.7px;\">Nh\u00e2n Vi\u00ean H\u1ed7 Tr\u1ee3 C\u00e1 Nh\u00e2n (PSW) c\u1ee7a ODDS<\/span><\/p>\n<p>\u0110i\u1ec1n v\u00e0o <a href=\"https:\/\/www.carewellseiu503.org\/wp-content\/uploads\/PSW-change-of-information-form.pdf\" target=\"_blank\" rel=\"noopener\">Change of Information Form<\/a> (M\u1eabu \u0110\u01a1n Thay \u0110\u1ed5i Th\u00f4ng Tin) n\u00e0y (\u0110\u1ecbnh D\u1ea1ng PDF) \u0111\u1ec3 DHS c\u00f3 th\u00f4ng tin hi\u1ec7n t\u1ea1i c\u1ee7a b\u1ea1n tr\u00ean h\u1ed3 s\u01a1.<\/p>\n<ul><\/ul>\n<p>[\/et_pb_text][\/et_pb_column_inner][et_pb_column_inner type=&#8221;1_3&#8243; saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><span style=\"color: var(--main-color); font-family: univia-pro, 'Exo 2', sans-serif; font-size: 18px; font-weight: bold; letter-spacing: 0.7px;\">Nh\u00e2n Vi\u00ean H\u1ed7 Tr\u1ee3 C\u00e1 Nh\u00e2n (PSW) c\u1ee7a OHA<\/span><\/p>\n<p>\u0110i\u1ec1n v\u00e0o <a href=\"https:\/\/www.carewellseiu503.org\/wp-content\/uploads\/he3035.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Provider Information Update Form<\/a> (M\u00e2\u0303u \u0110\u01a1n C\u1eadp Nh\u1eadt Th\u00f4ng Tin Nh\u00e0 Cung C\u1ea5p) n\u00e0y (\u0110\u1ecbnh D\u1ea1ng PDF) \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o OHA c\u00f3 th\u00f4ng tin hi\u1ec7n t\u1ea1i c\u1ee7a b\u1ea1n tr\u00ean h\u1ed3 s\u01a1. \u0110i\u1ec1n v\u00e0o t\u1ea5t c\u1ea3 c\u00e1c ph\u1ea7n tr\u00ean \u0111\u01a1n n\u00e0y ngo\u1ea1i tr\u1eeb nh\u1eefng ph\u1ea7n sau:<\/p>\n<ul>\n<li>\u201cComplete this section for an organization, group or agency\u201d (Ho\u00e0n th\u00e0nh ph\u1ea7n n\u00e0y cho m\u1ed9t t\u1ed5 ch\u1ee9c, nh\u00f3m ho\u1eb7c c\u01a1 quan)<\/li>\n<li>\u201cTaxonomy code changes\u201d (Thay \u0111\u1ed5i v\u1ec1 m\u00e3 ph\u00e2n lo\u1ea1i)<\/li>\n<\/ul>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; disabled=&#8221;on&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><strong>C\u00e1c m\u1eabu \u0111\u01a1n tr\u1ef1c tuy\u1ebfn c\u1ee7a ch\u00fang t\u00f4i th\u01b0\u1eddng c\u00f3 b\u1ea3n ti\u1ebfng T\u00e2y Ban Nha, ti\u1ebfng Nga, ti\u1ebfng Vi\u1ec7t, ti\u1ebfng Trung Gi\u1ea3n Th\u1ec3, ti\u1ebfng \u1ea2 R\u1eadp, ti\u1ebfng H\u00e0n v\u00e0 ti\u1ebfng Somali. \u0110\u1ec3 \u0111i\u1ec1n v\u00e0o m\u1eabu \u0111\u01a1n b\u1eb1ng ng\u00f4n ng\u1eef m\u00e0 b\u1ea1n \u01b0u ti\u00ean, h\u00e3y nh\u1ea5p v\u00e0o h\u00ecnh l\u00e1 c\u1edd Hoa K\u1ef3 \u1edf g\u00f3c tr\u00ean c\u00f9ng b\u00ean ph\u1ea3i c\u1ee7a m\u1eabu \u0111\u01a1n r\u1ed3i ch\u1ecdn ng\u00f4n ng\u1eef \u01b0u ti\u00ean.<\/strong><\/p>\n<p>[\/et_pb_text][et_pb_image src=&#8221;https:\/\/www.carewellseiu503.org\/wp-content\/uploads\/EN-2024-Annual-Paperwork-Image.png&#8221; title_text=&#8221;EN-2024-Annual-Paperwork-Image&#8221; _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_image][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner module_id=&#8221;dentalanchor&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;3px||2px|||&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;dentalanchor&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Nha Khoa<\/h2>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; disabled_on=&#8221;off|off|off&#8221; module_class=&#8221;twoColumns&#8221; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; custom_margin=&#8221;0px||25px||false|true&#8221; custom_padding=&#8221;0px|0px|0px|0px|false|true&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;0px|0px|0px|0px|false|true&#8221; border_radii=&#8221;on|0px|0px|0px|0px&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">M\u1eabu \u0110\u01a1n Kh\u01b0\u1edbc T\u1eeb Ph\u00fac L\u1ee3i<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 x\u00e1c nh\u1eadn r\u1eb1ng b\u1ea1n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t b\u1ea3o hi\u1ec3m Nha Khoa, Th\u1ecb L\u1ef1c + Th\u00ednh L\u1ef1c c\u0169ng nh\u01b0 Ch\u01b0\u01a1ng Tr\u00ecnh H\u1ed7 Tr\u1ee3 Nh\u00e2n Vi\u00ean (EAP) c\u1ee7a Carewell SEIU 503 <u>v\u00e0 \u0111ang t\u1eeb ch\u1ed1i b\u1ea3o hi\u1ec3m n\u00e0y<\/u>.<\/p>\n<p><a href=\"https:\/\/risepartnership.jotform.com\/212285204692050?language=vi\" class=\"noUnderline\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/a>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#FFFFFF&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">M\u1eabu \u0110\u01a1n Kh\u01b0\u1edbc T\u1eeb Ph\u00fac L\u1ee3i<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 x\u00e1c nh\u1eadn r\u1eb1ng b\u1ea1n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t b\u1ea3o hi\u1ec3m Nha Khoa, Th\u1ecb L\u1ef1c + Th\u00ednh L\u1ef1c c\u0169ng nh\u01b0 Ch\u01b0\u01a1ng Tr\u00ecnh H\u1ed7 Tr\u1ee3 Nh\u00e2n Vi\u00ean (EAP) c\u1ee7a Carewell SEIU 503 <u>v\u00e0 \u0111ang t\u1eeb ch\u1ed1i b\u1ea3o hi\u1ec3m n\u00e0y<\/u>.<br \/>[et_pb_section global_module=\"274298\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Eligibility and Reimbursement Appeal Form (M\u1eabu \u0110\u01a1n Kh\u00e1ng C\u00e1o V\u1ec1 \u0110i\u1ec1u Ki\u1ec7n H\u01b0\u01a1\u0309ng Phu\u0301c L\u01a1\u0323i V\u00e0 V\u1ea5n \u0110\u1ec1 Ho\u00e0n Tr\u1ea3)<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y v\u00e0 \u0111i\u1ec1n v\u00e0o tr\u01b0\u1eddng gi\u1ea3i th\u00edch l\u00fd do b\u1ea1n y\u00eau c\u1ea7u kh\u00e1ng c\u00e1o ho\u1eb7c t\u1ea3i th\u01b0 gi\u1ea3i th\u00edch l\u00ean. B\u1ea1n ph\u1ea3i g\u1eedi \u0111\u01a1n kh\u00e1ng c\u00e1o v\u1ec1 v\u1ea5n \u0111\u1ec1 b\u1ed3i ho\u00e0n c\u00f9ng v\u1edbi t\u00e0i li\u1ec7u h\u1ed7 tr\u1ee3 nh\u01b0 t\u1edd Gi\u1ea3i Th\u00edch v\u1ec1 Ph\u00fac L\u1ee3i (EOB) ho\u1eb7c b\u1eb1ng ch\u1ee9ng thanh to\u00e1n.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212296895694070?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner module_id=&#8221;visionanchor&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;3px||2px|||&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;visionhearinganchor&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Th\u1ecb L\u1ef1c + Th\u00ednh L\u1ef1c<\/h2>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;||0px||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Ameritas Vision (LASIK only) Reimbursement Claim Form (M\u1eabu \u0110\u01a1n Y\u00eau C\u1ea7u Ho\u00e0n Tr\u1ea3 Chi Ph\u00ed Cho D\u1ecbch V\u1ee5 Th\u1ecb L\u1ef1c (ch\u1ec9 LASIK) C\u1ee7a Ameritas)<\/h5>\n<p><a href=\"https:\/\/www.carewellseiu503.org\/wp-content\/uploads\/Lasik-claims-form.pdf\" class=\"noUnderline\" target=\"_blank\" rel=\"noopener\"> <i class=\"fas fa-file-pdf\"><\/i> <span style=\"text-decoration: underline;\">M\u1eabu \u0110\u01a1n \u0110\u1ecbnh D\u1ea1ng PDF<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Ameritas Hearing Reimbursement Claim Form (M\u1eabu \u0110\u01a1n Y\u00eau C\u1ea7u Ho\u00e0n Tr\u1ea3 Chi Ph\u00ed Ch\u0103m S\u00f3c Th\u00ednh L\u1ef1c C\u1ee7a Ameritas)<\/h5>\n<p><a class=\"noUnderline\" href=\"https:\/\/www.carewellseiu503.org\/wp-content\/uploads\/soundcare-claims-form.pdf\" target=\"_blank\" rel=\"noopener\"> <i class=\"fas fa-file-pdf\"><\/i> <span style=\"text-decoration: underline;\">M\u1eabu \u0110\u01a1n \u0110\u1ecbnh D\u1ea1ng PDF<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||25px||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">M\u1eabu \u0110\u01a1n Kh\u01b0\u1edbc T\u1eeb Ph\u00fac L\u1ee3i<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 x\u00e1c nh\u1eadn r\u1eb1ng b\u1ea1n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t b\u1ea3o hi\u1ec3m Nha Khoa, Th\u1ecb L\u1ef1c + Th\u00ednh L\u1ef1c c\u0169ng nh\u01b0 Ch\u01b0\u01a1ng Tr\u00ecnh H\u1ed7 Tr\u1ee3 Nh\u00e2n Vi\u00ean (EAP) c\u1ee7a Carewell SEIU 503 <u>v\u00e0 \u0111ang t\u1eeb ch\u1ed1i b\u1ea3o hi\u1ec3m n\u00e0y<\/u>.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212285204692050?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/a>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#FFFFFF&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">M\u1eabu \u0110\u01a1n Kh\u01b0\u1edbc T\u1eeb Ph\u00fac L\u1ee3i<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 x\u00e1c nh\u1eadn r\u1eb1ng b\u1ea1n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t b\u1ea3o hi\u1ec3m Nha Khoa, Th\u1ecb L\u1ef1c + Th\u00ednh L\u1ef1c c\u0169ng nh\u01b0 Ch\u01b0\u01a1ng Tr\u00ecnh H\u1ed7 Tr\u1ee3 Nh\u00e2n Vi\u00ean (EAP) c\u1ee7a Carewell SEIU 503 <u>v\u00e0 \u0111ang t\u1eeb ch\u1ed1i b\u1ea3o hi\u1ec3m n\u00e0y<\/u>.<br \/>[et_pb_section global_module=\"274298\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Eligibility and Reimbursement Appeal Form (M\u1eabu \u0110\u01a1n Kh\u00e1ng C\u00e1o V\u1ec1 \u0110i\u1ec1u Ki\u1ec7n H\u01b0\u01a1\u0309ng Phu\u0301c L\u01a1\u0323i V\u00e0 V\u1ea5n \u0110\u1ec1 Ho\u00e0n Tr\u1ea3)<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y v\u00e0 \u0111i\u1ec1n v\u00e0o tr\u01b0\u1eddng gi\u1ea3i th\u00edch l\u00fd do b\u1ea1n y\u00eau c\u1ea7u kh\u00e1ng c\u00e1o ho\u1eb7c t\u1ea3i th\u01b0 gi\u1ea3i th\u00edch l\u00ean. B\u1ea1n ph\u1ea3i g\u1eedi \u0111\u01a1n kh\u00e1ng c\u00e1o v\u1ec1 v\u1ea5n \u0111\u1ec1 b\u1ed3i ho\u00e0n c\u00f9ng v\u1edbi t\u00e0i li\u1ec7u h\u1ed7 tr\u1ee3 nh\u01b0 t\u1edd Gi\u1ea3i Th\u00edch v\u1ec1 Ph\u00fac L\u1ee3i (EOB) ho\u1eb7c b\u1eb1ng ch\u1ee9ng thanh to\u00e1n.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212296895694070?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.21.0&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">VSP Member Reimbursement Form (M\u1eabu \u0110\u01a1n Y\u00eau C\u1ea7u Ho\u00e0n Tr\u1ea3 Chi Ph\u00ed Cho Th\u00e0nh Vi\u00ean VSP)<\/h5>\n<p><span style=\"font-weight: 400;\">H\u00e3y g\u1eedi y\u00eau c\u1ea7u ho\u00e0n tr\u1ea3 chi ph\u00ed tr\u1ef1c tuy\u1ebfn qua c\u1ed5ng VSP t\u1ea1i <a href=\"https:\/\/www.vsp.com\/\">vsp.com.<\/a> Tr\u01b0\u1edbc ti\u00ean, b\u1ea1n c\u1ea7n t\u1ea1o m\u1ed9t t\u00e0i kho\u1ea3n. N\u1ebfu b\u1ea1n c\u00f3 th\u1eafc m\u1eafc, vui l\u00f2ng li\u00ean h\u1ec7 v\u1edbi VSP theo s\u1ed1 1-800-877-7195.<\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner module_id=&#8221;eapanchor&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;3px||2px|||&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;eapanchor&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Ch\u01b0\u01a1ng Tr\u00ecnh H\u1ed7 Tr\u1ee3 Nh\u00e2n Vi\u00ean<\/h2>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; disabled_on=&#8221;off|off|off&#8221; module_class=&#8221;twoColumns&#8221; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; custom_margin=&#8221;0px||25px||false|true&#8221; custom_padding=&#8221;0px|0px|0px|0px|false|true&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;0px|0px|0px|0px|false|true&#8221; border_radii=&#8221;on|0px|0px|0px|0px&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">M\u1eabu \u0110\u01a1n Kh\u01b0\u1edbc T\u1eeb Ph\u00fac L\u1ee3i<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 x\u00e1c nh\u1eadn r\u1eb1ng b\u1ea1n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t b\u1ea3o hi\u1ec3m Nha Khoa, Th\u1ecb L\u1ef1c + Th\u00ednh L\u1ef1c c\u0169ng nh\u01b0 Ch\u01b0\u01a1ng Tr\u00ecnh H\u1ed7 Tr\u1ee3 Nh\u00e2n Vi\u00ean (EAP) c\u1ee7a Carewell SEIU 503 <u>v\u00e0 \u0111ang t\u1eeb ch\u1ed1i b\u1ea3o hi\u1ec3m n\u00e0y<\/u>.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212285204692050?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/a>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">M\u1eabu \u0110\u01a1n Kh\u01b0\u1edbc T\u1eeb Ph\u00fac L\u1ee3i<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 x\u00e1c nh\u1eadn r\u1eb1ng b\u1ea1n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t b\u1ea3o hi\u1ec3m Nha Khoa, Th\u1ecb L\u1ef1c + Th\u00ednh L\u1ef1c c\u0169ng nh\u01b0 Ch\u01b0\u01a1ng Tr\u00ecnh H\u1ed7 Tr\u1ee3 Nh\u00e2n Vi\u00ean (EAP) c\u1ee7a Carewell SEIU 503 <u>v\u00e0 \u0111ang t\u1eeb ch\u1ed1i b\u1ea3o hi\u1ec3m n\u00e0y<\/u>.<br \/>\n[et_pb_section global_module=\"274298\"][\/et_pb_section][\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Eligibility and Reimbursement Appeal Form (M\u1eabu \u0110\u01a1n Kh\u00e1ng C\u00e1o V\u1ec1 \u0110i\u1ec1u Ki\u1ec7n H\u01b0\u01a1\u0309ng Phu\u0301c L\u01a1\u0323i V\u00e0 V\u1ea5n \u0110\u1ec1 Ho\u00e0n Tr\u1ea3)<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y v\u00e0 \u0111i\u1ec1n v\u00e0o tr\u01b0\u1eddng gi\u1ea3i th\u00edch l\u00fd do b\u1ea1n y\u00eau c\u1ea7u kh\u00e1ng c\u00e1o ho\u1eb7c t\u1ea3i th\u01b0 gi\u1ea3i th\u00edch l\u00ean. B\u1ea1n ph\u1ea3i g\u1eedi \u0111\u01a1n kh\u00e1ng c\u00e1o v\u1ec1 v\u1ea5n \u0111\u1ec1 b\u1ed3i ho\u00e0n c\u00f9ng v\u1edbi t\u00e0i li\u1ec7u h\u1ed7 tr\u1ee3 nh\u01b0 t\u1edd Gi\u1ea3i Th\u00edch v\u1ec1 Ph\u00fac L\u1ee3i (EOB) ho\u1eb7c b\u1eb1ng ch\u1ee9ng thanh to\u00e1n.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212296895694070?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner module_id=&#8221;hcaanchor&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;3px||2px|||&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;hcaapanchor&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>H\u1ed7 Tr\u1ee3 Chi Ph\u00ed Ch\u0103m S\u00f3c S\u1ee9c Kh\u1ecfe<\/h2>\n<h3>\u0110\u1ed1i v\u1edbi Ch\u01b0\u01a1ng Tr\u00ecnh \u0110\u01b0\u1ee3c Ph\u00ea Duy\u1ec7t<\/h3>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; hover_enabled=&#8221;0&#8243; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h5 style=\"text-align: left;\">Gi\u1ea5y T\u1edd Th\u01b0\u1eddng Ni\u00ean Cho N\u0103m 2026<\/h5>\n<p>Vi\u1ec7c ho\u00e0n th\u00e0nh c\u00e1c gi\u1ea5y t\u1edd th\u01b0\u1eddng ni\u00ean x\u00e1c nh\u1eadn r\u1eb1ng b\u1ea1n hi\u1ec3u v\u00e0 \u0111\u1ed3ng \u00fd v\u1edbi c\u00e1c quy t\u1eafc c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh c\u0169ng nh\u01b0 ch\u1ecbu s\u1ef1 chi ph\u1ed1i c\u1ee7a c\u00e1c quy t\u1eafc do Qu\u1ef9 \u1ee6y Th\u00e1c \u0111\u1eb7t ra. Th\u00f4ng qua nh\u1eefng m\u1eabu \u0111\u01a1n n\u00e0y, \u0111\u1ed9i ng\u0169 Carewell SEIU 503 Benefits c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 b\u1ea1n \u0111\u0103ng k\u00fd v\u00e0 duy tr\u00ec b\u1ea3o hi\u1ec3m ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe. <strong>Gi\u1ea5y t\u1edd n\u00e0y kh\u00f4ng ph\u1ea3i l\u00e0 \u0111\u01a1n \u0111\u0103ng k\u00fd tham gia b\u1ea3o hi\u1ec3m y t\u1ebf.<\/strong><\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/251466827408969?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"><i class=\"fas fa-align-left\"><\/i>Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; hover_enabled=&#8221;0&#8243; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h5><strong>M\u1eabu \u0110\u01a1n Y\u00eau C\u1ea7u Ph\u00fac L\u1ee3i H\u1ed7 Tr\u1ee3 Chi Ph\u00ed Ch\u0103m S\u00f3c S\u1ee9c Kh\u1ecfe<\/strong><\/h5>\n<p>\u0110i\u1ec1n v\u00e0o m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 y\u00eau c\u1ea7u cung c\u1ea5p ph\u00fac l\u1ee3i H\u1ed7 Tr\u1ee3 Chi Ph\u00ed Ch\u0103m S\u00f3c S\u1ee9c Kh\u1ecfe. B\u1ea1n ph\u1ea3i g\u1eedi k\u00e8m c\u1ea3 Th\u00f4ng B\u00e1o \u0110\u1ee7 \u0110i\u1ec1u Ki\u1ec7n Tham Gia Ch\u01b0\u01a1ng Tr\u00ecnh Tr\u00ean Marketplace v\u00e0 h\u00f3a \u0111\u01a1n ph\u00ed b\u1ea3o hi\u1ec3m <span>ho\u1eb7c trang My Plans and Programs (Ch\u01b0\u01a1ng Tr\u00ecnh C\u1ee7a T\u00f4i) t\u1eeb t\u00e0i kho\u1ea3n c\u1ee7a b\u1ea1n tr\u00ean <a href=\"https:\/\/www.healthcare.gov\/\">HealthCare.gov<\/a><\/span> \u0111\u1ec3 \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n h\u01b0\u1edfng ph\u00fac l\u1ee3i n\u00e0y. N\u1ebfu \u0111\u0103ng k\u00fd tham gia m\u1ed9t ch\u01b0\u01a1ng tr\u00ecnh \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t th\u00f4ng qua Valley Insurance Professionals, th\u00ec b\u1ea1n kh\u00f4ng c\u1ea7n ph\u1ea3i g\u1eedi m\u1eabu \u0111\u01a1n n\u00e0y.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/231867527905163?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">HIPAA Authorization (\u1ee6y Quy\u1ec1n Theo HIPAA)<\/h5>\n<p>Th\u00f4ng b\u00e1o n\u00e0y cho b\u1ea1n bi\u1ebft c\u00e1ch Carewell SEIU 503 c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng v\u00e0 chia s\u1ebb th\u00f4ng tin s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ea1n. Th\u00f4ng b\u00e1o n\u00e0y c\u0169ng bao g\u1ed3m th\u00f4ng tin li\u00ean quan \u0111\u1ebfn quy\u1ec1n ri\u00eang t\u01b0 v\u1ec1 s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ea1n.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212707140010032?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Tuy\u00ean B\u1ed1 v\u1ec1 S\u1ef1 Hi\u1ec3u Bi\u1ebft<\/h5>\n<p>Th\u00f4ng b\u00e1o n\u00e0y d\u00e0nh cho nh\u00e0 cung c\u1ea5p d\u1ecbch v\u1ee5 ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe \u0111\u1ec3 x\u00e1c nh\u1eadn tr\u00e1ch nhi\u1ec7m c\u1ee7a h\u1ecd khi nh\u1eadn ph\u00fac l\u1ee3i c\u1ee7a Carewell SEIU 503.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212707835282054?language=vi\" target=\"_blank\" rel=\"noopener\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Consent to Release Information Form (M\u1eabu \u0110\u01a1n \u0110\u1ed3ng \u00dd Ti\u1ebft L\u1ed9 Th\u00f4ng Tin)<\/h5>\n<p>\u0110i\u1ec1n v\u00e0o m\u1eabu \u0111\u01a1n n\u00e0y n\u1ebfu b\u1ea1n c\u1ea7n cho ph\u00e9p m\u1ed9t ng\u01b0\u1eddi b\u1ea1n ho\u1eb7c th\u00e0nh vi\u00ean gia \u0111\u00ecnh \u0111\u00e1ng tin c\u1eady \u0111\u1eb7t c\u00e2u h\u1ecfi, \u0111\u1eb7t l\u1ecbch h\u1eb9n ho\u1eb7c x\u00e1c nh\u1eadn th\u00f4ng tin thay m\u1eb7t b\u1ea1n.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212285476973063?language=vi\" target=\"_blank\" rel=\"noopener\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Agent of Record Form (M\u1eabu \u0110\u01a1n \u0110\u1ea1i L\u00fd Tr\u00ean H\u1ed3 S\u01a1) c\u1ee7a Valley Insurance Professionals (VIP)<\/h5>\n<p>\u0110i\u1ec1n v\u00e0o m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 ch\u1ec9 \u0111\u1ecbnh VIP l\u00e0m \u0111\u1ea1i l\u00fd tr\u00ean h\u1ed3 s\u01a1 c\u1ee7a b\u1ea1n. H\u1ecd s\u1ebd thay m\u1eb7t b\u1ea1n v\u00e0 gi\u00fap b\u1ea1n qu\u1ea3n l\u00fd h\u1ee3p \u0111\u1ed3ng b\u1ea3o hi\u1ec3m c\u1ee7a m\u00ecnh.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212707338765058?language=vi\" target=\"_blank\" rel=\"noopener\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Direct Deposit Form (M\u1eabu \u0110\u01a1n K\u00fd Th\u00e1c Tr\u1ef1c Ti\u1ebfp)<\/h5>\n<p>\u0110\u0103ng k\u00fd \u0111\u1ec3 nh\u1eadn kho\u1ea3n ho\u00e0n tr\u1ea3 ph\u00ed b\u1ea3o hi\u1ec3m th\u00f4ng qua ph\u01b0\u01a1ng th\u1ee9c k\u00fd th\u00e1c tr\u1ef1c ti\u1ebfp. \u0110\u00e2y l\u00e0 c\u00e1ch nhanh ch\u00f3ng v\u00e0 an to\u00e0n nh\u1ea5t \u0111\u1ec3 b\u1ea1n nh\u1eadn \u0111\u01b0\u1ee3c kho\u1ea3n thanh to\u00e1n. <strong>B\u1ea1n ph\u1ea3i g\u1eedi k\u00e8m b\u1ea3n sao t\u1edd s\u00e9c \u0111\u00e3 h\u1ee7y, th\u01b0 c\u1ee7a ng\u00e2n h\u00e0ng ho\u1eb7c b\u1ea3ng sao k\u00ea c\u1ee7a ng\u00e2n h\u00e0ng.<\/strong><\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212278209348964?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/a>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#FFFFFF&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Direct Deposit Form (M\u1eabu \u0110\u01a1n K\u00fd Th\u00e1c Tr\u1ef1c Ti\u1ebfp)<\/h5>\n<p>\u0110\u0103ng k\u00fd \u0111\u1ec3 nh\u1eadn kho\u1ea3n ho\u00e0n tr\u1ea3 ph\u00ed b\u1ea3o hi\u1ec3m th\u00f4ng qua ph\u01b0\u01a1ng th\u1ee9c k\u00fd th\u00e1c tr\u1ef1c ti\u1ebfp. \u0110\u00e2y l\u00e0 c\u00e1ch nhanh ch\u00f3ng v\u00e0 an to\u00e0n nh\u1ea5t \u0111\u1ec3 b\u1ea1n nh\u1eadn \u0111\u01b0\u1ee3c kho\u1ea3n thanh to\u00e1n. <strong>B\u1ea1n ph\u1ea3i g\u1eedi k\u00e8m b\u1ea3n sao c\u1ee7a t\u1edd s\u00e9c \u0111\u00e3 h\u1ee7y, th\u01b0 c\u1ee7a ng\u00e2n h\u00e0ng ho\u1eb7c b\u1ea3n sao k\u00ea c\u1ee7a ng\u00e2n h\u00e0ng.<\/strong><br \/>[et_pb_section global_module=\"274302\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Medical Premium Reimbursement Claim Form (M\u1eabu \u0110\u01a1n Y\u00eau C\u1ea7u Ho\u00e0n Tr\u1ea3 Ph\u00ed B\u1ea3o Hi\u1ec3m Y T\u1ebf)<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 y\u00eau c\u1ea7u ho\u00e0n tr\u1ea3 ph\u00ed b\u1ea3o hi\u1ec3m n\u1ebfu b\u1ea1n \u0111\u0103ng k\u00fd cho c\u00e1c th\u00e0nh vi\u00ean gia \u0111\u00ecnh tham gia ch\u01b0\u01a1ng tr\u00ecnh c\u1ee7a m\u00ecnh v\u00e0\/ho\u1eb7c b\u1ea1n \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n nh\u1eadn kho\u1ea3n ho\u00e0n tr\u1ea3 ph\u00ed b\u1ea3o hi\u1ec3m trung b\u00ecnh (APR) t\u1ea1m th\u1eddi cho m\u1ed9t ch\u01b0\u01a1ng tr\u00ecnh ch\u01b0a \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t. B\u1ea1n ph\u1ea3i g\u1eedi m\u1eabu \u0111\u01a1n n\u00e0y k\u00e8m theo b\u1eb1ng ch\u1ee9ng v\u1ec1 b\u1ea3o hi\u1ec3m c\u00e1 nh\u00e2n.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212288173993062?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/a>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Medical Premium Reimbursement Claim Form (M\u1eabu \u0110\u01a1n Y\u00eau C\u1ea7u Ho\u00e0n Tr\u1ea3 Ph\u00ed B\u1ea3o Hi\u1ec3m Y T\u1ebf)<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 y\u00eau c\u1ea7u ho\u00e0n tr\u1ea3 ph\u00ed b\u1ea3o hi\u1ec3m n\u1ebfu b\u1ea1n \u0111\u0103ng k\u00fd cho c\u00e1c th\u00e0nh vi\u00ean gia \u0111\u00ecnh tham gia ch\u01b0\u01a1ng tr\u00ecnh c\u1ee7a m\u00ecnh v\u00e0\/ho\u1eb7c b\u1ea1n \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n nh\u1eadn kho\u1ea3n ho\u00e0n tr\u1ea3 ph\u00ed b\u1ea3o hi\u1ec3m trung b\u00ecnh (APR) t\u1ea1m th\u1eddi cho m\u1ed9t ch\u01b0\u01a1ng tr\u00ecnh ch\u01b0a \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t. B\u1ea1n ph\u1ea3i g\u1eedi m\u1eabu \u0111\u01a1n n\u00e0y k\u00e8m theo b\u1eb1ng ch\u1ee9ng v\u1ec1 b\u1ea3o hi\u1ec3m c\u00e1 nh\u00e2n.<br \/>\n[et_pb_section global_module=\"274303\"][\/et_pb_section][\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; disabled_on=&#8221;off|off|off&#8221; module_class=&#8221;twoColumns&#8221; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; custom_margin=&#8221;0px||25px||false|true&#8221; custom_padding=&#8221;0px|0px|0px|0px|false|true&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;0px|0px|0px|0px|false|true&#8221; border_radii=&#8221;on|0px|0px|0px|0px&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">M\u1eabu \u0110\u01a1n Y\u00eau C\u1ea7u Ho\u00e0n Tr\u1ea3 Chi Ph\u00ed Ameriflex<\/h5>\n<p class=\"p1\">N\u1ebfu b\u1ea1n \u0111\u00e3 thanh to\u00e1n m\u1ed9t kho\u1ea3n chi ph\u00ed \u0111\u01b0\u1ee3c bao tr\u1ea3 b\u1eb1ng ti\u1ec1n t\u00fai c\u1ee7a m\u00ecnh thay v\u00ec d\u00f9ng Th\u1ebb Thanh To\u00e1n Ti\u1ec7n L\u1ee3i (BCC), h\u00e3y s\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 y\u00eau c\u1ea7u ho\u00e0n tr\u1ea3. B\u1ea1n c\u0169ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y n\u1ebfu c\u1ea7n y\u00eau c\u1ea7u ho\u00e0n tr\u1ea3 ph\u00ed b\u1ea3o hi\u1ec3m thu\u1ea7n h\u1eb1ng th\u00e1ng cho m\u1ed9t ch\u01b0\u01a1ng tr\u00ecnh c\u00e1 nh\u00e2n \u0111\u01b0\u1ee3c Carewell ph\u00ea duy\u1ec7t m\u00e0 b\u1ea1n mua qua Health Insurance Marketplace.\u00a0<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/participant.myameriflex.com\/#\/login?returnUrl=https%253A%252F%252Fparticipant.myameriflex.com%252F\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|0px|15px|0px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_section global_module=\"294390\"][\/et_pb_section]<br \/>\n<!--\n\n\n<h5>Ameriflex Reimbursement Claim Form<\/h5>\n\n\n\n\n<p class=\"p1\">Log in to your Ameriflex account to use this form to claim reimbursement when you have paid for a covered expense out of your own funds instead of using the Benefit Convenience Card (BCC). You can also use this form if you need to claim reimbursement for your net monthly premium for a Carewell-approved individual plan purchased through a health insurance Marketplace. Please follow the instructions once you have logged in to the Ameriflex website.[divi_library_shortcode id=\"294390\"]<\/p>\n\n\n-->[\/et_pb_text][et_pb_code _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_section global_module=\"294390\"][\/et_pb_section][\/et_pb_code][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Advance Premium Tax Credit Adjustment Form (M\u1eabu \u0110\u01a1n \u0110i\u1ec1u Ch\u1ec9nh T\u00edn D\u1ee5ng Thu\u1ebf Cho Ph\u00ed B\u1ea3o Hi\u1ec3m Tr\u1ea3 Tr\u01b0\u1edbc)<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y n\u1ebfu thu nh\u1eadp c\u1ee7a b\u1ea1n kh\u00e1c v\u1edbi m\u1ee9c thu nh\u1eadp b\u1ea1n \u0111\u00e3 b\u00e1o c\u00e1o v\u1edbi IRS tr\u00ean \u0111\u01a1n \u0111\u0103ng k\u00fd v\u1edbi Marketplace. Ch\u00fang t\u00f4i s\u1ebd s\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh xem ch\u00fang t\u00f4i c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 b\u1ea1n chi tr\u1ea3 s\u1ed1 ti\u1ec1n m\u00e0 b\u1ea1n ch\u01b0a thanh to\u00e1n hay kh\u00f4ng ho\u1eb7c li\u1ec7u b\u1ea1n c\u00f3 nh\u1eadn \u0111\u01b0\u1ee3c kho\u1ea3n chi tr\u1ea3 v\u01b0\u1ee3t m\u1ee9c t\u00edn d\u1ee5ng thu\u1ebf kh\u00f4ng. B\u1ea1n ph\u1ea3i g\u1eedi m\u1eabu \u0111\u01a1n n\u00e0y c\u00f9ng t\u00e0i li\u1ec7u h\u1ed7 tr\u1ee3 v\u1ec1 thu\u1ebf.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212297282699066?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/a>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Advance Premium Tax Credit Adjustment Form (M\u1eabu \u0110\u01a1n \u0110i\u1ec1u Ch\u1ec9nh T\u00edn D\u1ee5ng Thu\u1ebf Cho Ph\u00ed B\u1ea3o Hi\u1ec3m Tr\u1ea3 Tr\u01b0\u1edbc)<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y n\u1ebfu thu nh\u1eadp c\u1ee7a b\u1ea1n kh\u00e1c v\u1edbi m\u1ee9c thu nh\u1eadp b\u1ea1n \u0111\u00e3 b\u00e1o c\u00e1o v\u1edbi IRS tr\u00ean \u0111\u01a1n \u0111\u0103ng k\u00fd v\u1edbi Marketplace. Ch\u00fang t\u00f4i s\u1ebd s\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh xem ch\u00fang t\u00f4i c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 b\u1ea1n chi tr\u1ea3 s\u1ed1 ti\u1ec1n m\u00e0 b\u1ea1n ch\u01b0a thanh to\u00e1n hay kh\u00f4ng ho\u1eb7c li\u1ec7u b\u1ea1n c\u00f3 nh\u1eadn \u0111\u01b0\u1ee3c kho\u1ea3n chi tr\u1ea3 v\u01b0\u1ee3t m\u1ee9c t\u00edn d\u1ee5ng thu\u1ebf kh\u00f4ng. B\u1ea1n ph\u1ea3i g\u1eedi m\u1eabu \u0111\u01a1n n\u00e0y c\u00f9ng t\u00e0i li\u1ec7u h\u1ed7 tr\u1ee3 v\u1ec1 thu\u1ebf.<br \/>\n[et_pb_section global_module=\"274304\"][\/et_pb_section][\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Eligibility and Reimbursement Appeal Form (M\u1eabu \u0110\u01a1n Kh\u00e1ng C\u00e1o V\u1ec1 \u0110i\u1ec1u Ki\u1ec7n H\u01b0\u01a1\u0309ng Phu\u0301c L\u01a1\u0323i V\u00e0 V\u1ea5n \u0110\u1ec1 Ho\u00e0n Tr\u1ea3)<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y v\u00e0 \u0111i\u1ec1n v\u00e0o tr\u01b0\u1eddng gi\u1ea3i th\u00edch l\u00fd do b\u1ea1n y\u00eau c\u1ea7u kh\u00e1ng c\u00e1o ho\u1eb7c t\u1ea3i th\u01b0 gi\u1ea3i th\u00edch l\u00ean. B\u1ea1n ph\u1ea3i g\u1eedi \u0111\u01a1n kh\u00e1ng c\u00e1o v\u1ec1 v\u1ea5n \u0111\u1ec1 b\u1ed3i ho\u00e0n c\u00f9ng v\u1edbi t\u00e0i li\u1ec7u h\u1ed7 tr\u1ee3 nh\u01b0 t\u1edd Gi\u1ea3i Th\u00edch v\u1ec1 Ph\u00fac L\u1ee3i (EOB) ho\u1eb7c b\u1eb1ng ch\u1ee9ng thanh to\u00e1n.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212296895694070?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#ffffff&#8221; custom_padding=&#8221;15px|15px|15px|15px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\"><span style=\"color: #582c82;\">Overpayment Notice Appeal Form (M\u1eabu \u0110\u01a1n Khi\u1ebfu N\u1ea1i Th\u00f4ng B\u00e1o V\u1ec1 Kho\u1ea3n Chi Tr\u1ea3 V\u01b0\u1ee3t M\u1ee9c)<\/span><\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 khi\u1ebfu n\u1ea1i Th\u00f4ng B\u00e1o V\u1ec1 Kho\u1ea3n Chi Tr\u1ea3 V\u01b0\u1ee3t M\u1ee9c t\u1eeb Carewell SEIU 503.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/241055798317059?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;3px||2px|||&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;hcamedicareanchor&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>H\u1ed7 Tr\u1ee3 Chi Ph\u00ed Ch\u0103m S\u00f3c S\u1ee9c Kh\u1ecfe<\/h2>\n<h3>\u0110\u1ed1i v\u1edbi Medicare<\/h3>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Medicare Healthcare Cost Assistance Benefits Request Form (M\u1eabu \u0110\u01a1n Y\u00eau C\u1ea7u Ph\u00fac L\u1ee3i H\u1ed7 Tr\u1ee3 Chi Ph\u00ed Ch\u0103m S\u00f3c S\u1ee9c Kh\u1ecfe Medicare)<\/h5>\n<p data-pm-slice=\"1 1 []\">D\u00f9ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 g\u1eedi c\u00e1c gi\u1ea5y t\u1edd c\u1ea7n thi\u1ebft \u0111\u1ec3 y\u00eau c\u1ea7u ho\u00e0n tr\u1ea3 m\u1ed9t ph\u1ea7n ph\u00ed b\u1ea3o hi\u1ec3m Medicare v\u00e0 nh\u1eadn c\u00e1c kho\u1ea3n ti\u1ec1n li\u00ean quan \u0111\u1ebfn chi ph\u00ed y t\u1ebf t\u1ef1 tr\u1ea3.[et_pb_section global_module=\"274305\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">M\u1eabu \u0110\u01a1n Y\u00eau C\u1ea7u Ho\u00e0n Tr\u1ea3 Chi Ph\u00ed Ameriflex<\/h5>\n<p class=\"p1\">N\u1ebfu b\u1ea1n \u0111\u00e3 thanh to\u00e1n m\u1ed9t kho\u1ea3n chi ph\u00ed \u0111\u01b0\u1ee3c bao tr\u1ea3 b\u1eb1ng ti\u1ec1n t\u00fai c\u1ee7a m\u00ecnh thay v\u00ec d\u00f9ng Th\u1ebb Thanh To\u00e1n Ti\u1ec7n L\u1ee3i (BCC), h\u00e3y s\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 y\u00eau c\u1ea7u ho\u00e0n tr\u1ea3. B\u1ea1n c\u0169ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y n\u1ebfu c\u1ea7n y\u00eau c\u1ea7u ho\u00e0n tr\u1ea3 ph\u00ed b\u1ea3o hi\u1ec3m thu\u1ea7n h\u1eb1ng th\u00e1ng cho m\u1ed9t ch\u01b0\u01a1ng tr\u00ecnh c\u00e1 nh\u00e2n \u0111\u01b0\u1ee3c Carewell ph\u00ea duy\u1ec7t m\u00e0 b\u1ea1n mua qua Health Insurance Marketplace.\u00a0<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/participant.myameriflex.com\/#\/login?returnUrl=https%253A%252F%252Fparticipant.myameriflex.com%252F\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.27.4&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p class=\"p1\">[et_pb_section global_module=\"294390\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Gi\u1ea5y T\u1edd V\u1ec1 Medicare C\u1ee7a Carewell<\/h5>\n<p>\u0110i\u00ea\u0300n va\u0300o gi\u00e2\u0301y t\u01a1\u0300 na\u0300y khi ba\u0323n l\u00e2\u0300n \u0111\u00e2\u0300u chuy\u00ea\u0309n sang ba\u0309o hi\u00ea\u0309m Medicare \u0111\u1ec3 xem b\u1ea1n c\u00f3 \u0111\u1ee7 \u0111i\u00ea\u0300u ki\u00ea\u0323n h\u01b0\u01a1\u0309ng phu\u0301c l\u01a1\u0323i H\u1ed7 Tr\u1ee3 Chi Ph\u00ed Ch\u0103m S\u00f3c S\u1ee9c Kh\u1ecfe hay kh\u00f4ng. <span>Vi\u1ec7c ho\u00e0n th\u00e0nh c\u00e1c gi\u1ea5y t\u1edd n\u00e0y x\u00e1c nh\u1eadn r\u1eb1ng b\u1ea1n hi\u1ec3u v\u00e0 \u0111\u1ed3ng \u00fd v\u1edbi c\u00e1c quy t\u1eafc c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh c\u0169ng nh\u01b0 ch\u1ecbu s\u1ef1 chi ph\u1ed1i c\u1ee7a c\u00e1c quy t\u1eafc do Qu\u1ef9 \u1ee6y Th\u00e1c \u0111\u1eb7t ra. <\/span>Xin l\u01b0u \u00fd: b\u1ea1n c\u1ea7n \u0111i\u1ec1n l\u1ea1i m\u1eabu \u0111\u01a1n n\u00e0y b\u1ea5t c\u1ee9 khi n\u00e0o c\u00f3 s\u1ef1 thay \u0111\u1ed5i trong c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212365814640049?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/a>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Gi\u1ea5y T\u1edd V\u1ec1 Medicare C\u1ee7a Valley Insurance Professionals (VIP)<\/h5>\n<p><span>Nh\u1eefng m\u1eabu \u0111\u01a1n n\u00e0y gi\u00fap Valley Insurance Professionals c\u00f3 quy\u1ec1n h\u1ee3p ph\u00e1p \u0111\u1ec3 h\u1ed7 tr\u1ee3 b\u1ea1n t\u00ecm hi\u1ec3u, \u0111\u0103ng k\u00fd v\u00e0 duy tr\u00ec ch\u01b0\u01a1ng tr\u00ecnh Medicare Supplement, Advantage ho\u1eb7c Part D.<\/span><\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212365814640049?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">\u00a0Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Consent to Release Information Form (M\u1eabu \u0110\u01a1n \u0110\u1ed3ng \u00dd Ti\u1ebft L\u1ed9 Th\u00f4ng Tin)<\/h5>\n<p>\u0110i\u1ec1n v\u00e0o m\u1eabu \u0111\u01a1n n\u00e0y n\u1ebfu b\u1ea1n c\u1ea7n cho ph\u00e9p m\u1ed9t ng\u01b0\u1eddi b\u1ea1n ho\u1eb7c th\u00e0nh vi\u00ean gia \u0111\u00ecnh \u0111\u00e1ng tin c\u1eady \u0111\u1eb7t c\u00e2u h\u1ecfi, \u0111\u1eb7t l\u1ecbch h\u1eb9n ho\u1eb7c x\u00e1c nh\u1eadn th\u00f4ng tin thay m\u1eb7t b\u1ea1n.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212285476973063?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Direct Deposit Form (M\u1eabu \u0110\u01a1n K\u00fd Th\u00e1c Tr\u1ef1c Ti\u1ebfp)<\/h5>\n<p>\u0110\u0103ng k\u00fd \u0111\u1ec3 nh\u1eadn kho\u1ea3n ho\u00e0n tr\u1ea3 ph\u00ed b\u1ea3o hi\u1ec3m th\u00f4ng qua ph\u01b0\u01a1ng th\u1ee9c k\u00fd th\u00e1c tr\u1ef1c ti\u1ebfp. \u0110\u00e2y l\u00e0 c\u00e1ch nhanh ch\u00f3ng v\u00e0 an to\u00e0n nh\u1ea5t \u0111\u1ec3 b\u1ea1n nh\u1eadn \u0111\u01b0\u1ee3c kho\u1ea3n thanh to\u00e1n. <strong>B\u1ea1n ph\u1ea3i g\u1eedi k\u00e8m b\u1ea3n sao t\u1edd s\u00e9c \u0111\u00e3 h\u1ee7y, th\u01b0 c\u1ee7a ng\u00e2n h\u00e0ng ho\u1eb7c b\u1ea3ng sao k\u00ea c\u1ee7a ng\u00e2n h\u00e0ng.<\/strong><\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212278209348964?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/a>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Direct Deposit Form (M\u1eabu \u0110\u01a1n K\u00fd Th\u00e1c Tr\u1ef1c Ti\u1ebfp)<\/h5>\n<p>\u0110\u0103ng k\u00fd \u0111\u1ec3 nh\u1eadn kho\u1ea3n ho\u00e0n tr\u1ea3 ph\u00ed b\u1ea3o hi\u1ec3m th\u00f4ng qua ph\u01b0\u01a1ng th\u1ee9c k\u00fd th\u00e1c tr\u1ef1c ti\u1ebfp. \u0110\u00e2y l\u00e0 c\u00e1ch nhanh ch\u00f3ng v\u00e0 an to\u00e0n nh\u1ea5t \u0111\u1ec3 b\u1ea1n nh\u1eadn \u0111\u01b0\u1ee3c kho\u1ea3n thanh to\u00e1n. <strong>B\u1ea1n ph\u1ea3i g\u1eedi k\u00e8m b\u1ea3n sao t\u1edd s\u00e9c \u0111\u00e3 h\u1ee7y, th\u01b0 c\u1ee7a ng\u00e2n h\u00e0ng ho\u1eb7c b\u1ea3ng sao k\u00ea c\u1ee7a ng\u00e2n h\u00e0ng.<\/strong><br \/>\n[et_pb_section global_module=\"274302\"][\/et_pb_section][\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Medicare Premium Reimbursement Claim Form (M\u1eabu \u0110\u01a1n Y\u00eau C\u1ea7u Ho\u00e0n Tr\u1ea3 Ph\u00ed B\u1ea3o Hi\u1ec3m Medicare)<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 y\u00eau c\u1ea7u ho\u00e0n tr\u1ea3 ph\u00ed b\u1ea3o hi\u1ec3m Medicare, v\u00ed d\u1ee5 nh\u01b0 ph\u00ed b\u1ea3o hi\u1ec3m h\u1eb1ng th\u00e1ng cho c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh Medicare Part B, Medicare Part D, Supplement ho\u1eb7c Advantage.<br \/>\n[et_pb_section global_module=\"274305\"][\/et_pb_section][\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Eligibility and Reimbursement Appeal Form (M\u1eabu \u0110\u01a1n Kh\u00e1ng C\u00e1o V\u1ec1 \u0110i\u1ec1u Ki\u1ec7n H\u01b0\u01a1\u0309ng Phu\u0301c L\u01a1\u0323i V\u00e0 V\u1ea5n \u0110\u1ec1 Ho\u00e0n Tr\u1ea3)<\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y v\u00e0 \u0111i\u1ec1n v\u00e0o tr\u01b0\u1eddng gi\u1ea3i th\u00edch l\u00fd do b\u1ea1n y\u00eau c\u1ea7u kh\u00e1ng c\u00e1o ho\u1eb7c t\u1ea3i th\u01b0 gi\u1ea3i th\u00edch l\u00ean. B\u1ea1n ph\u1ea3i g\u1eedi \u0111\u01a1n kh\u00e1ng c\u00e1o v\u1ec1 v\u1ea5n \u0111\u1ec1 b\u1ed3i ho\u00e0n c\u00f9ng v\u1edbi t\u00e0i li\u1ec7u h\u1ed7 tr\u1ee3 nh\u01b0 t\u1edd Gi\u1ea3i Th\u00edch v\u1ec1 Ph\u00fac L\u1ee3i (EOB) ho\u1eb7c b\u1eb1ng ch\u1ee9ng thanh to\u00e1n.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212296895694070?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#ffffff&#8221; custom_padding=&#8221;15px|15px|15px|15px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\"><span style=\"color: #582c82;\">Overpayment Notice Appeal Form (M\u1eabu \u0110\u01a1n Khi\u1ebfu N\u1ea1i Th\u00f4ng B\u00e1o V\u1ec1 Kho\u1ea3n Chi Tr\u1ea3 V\u01b0\u1ee3t M\u1ee9c)<\/span><\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 khi\u1ebfu n\u1ea1i Th\u00f4ng B\u00e1o V\u1ec1 Kho\u1ea3n Chi Tr\u1ea3 V\u01b0\u1ee3t M\u1ee9c t\u1eeb Carewell SEIU 503.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/241055798317059?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;15px||||false|false&#8221; custom_padding=&#8221;3px||2px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;ptoanchor&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Gi\u1edd Ngh\u1ec9 \u0110\u01b0\u1ee3c Tr\u1ea3 L\u01b0\u01a1ng\u00a0<\/h2>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">B\u01b0u Ki\u1ec7n Y\u00eau C\u1ea7u Ph\u00fac L\u1ee3i PTO<\/h5>\n<p>N\u1ebfu b\u1ea1n c\u00f3 8 gi\u1edd PTO t\u00edch l\u0169y tr\u1edf l\u00ean, h\u00e3y s\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 y\u00eau c\u1ea7u thanh to\u00e1n cho c\u00e1c ph\u00fac l\u1ee3i PTO c\u1ee7a b\u1ea1n.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/www.carewellseiu503.org\/vi\/mycarewell503\/\" target=\"_blank\" rel=\"noopener noreferrer\">S\u1eed d\u1ee5ng MyCarewell503 \u0111\u1ec3 ho\u00e0n th\u00e0nh m\u1eabu \u0111\u01a1n n\u00e0y<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">B\u01b0u Ki\u1ec7n Y\u00eau C\u1ea7u Ph\u00fac L\u1ee3i PTO<\/h5>\n<p>N\u1ebfu b\u1ea1n c\u00f3 8 gi\u1edd PTO t\u00edch l\u0169y tr\u1edf l\u00ean, h\u00e3y s\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 y\u00eau c\u1ea7u thanh to\u00e1n cho c\u00e1c ph\u00fac l\u1ee3i PTO c\u1ee7a b\u1ea1n.<br \/>[et_pb_section global_module=\"274306\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">B\u01b0u Ki\u1ec7n Y\u00eau C\u1ea7u Ph\u00fac L\u1ee3i PTO<\/h5>\n<p>N\u1ebfu b\u1ea1n c\u00f3 8 gi\u1edd PTO t\u00edch l\u0169y tr\u1edf l\u00ean, h\u00e3y s\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 y\u00eau c\u1ea7u thanh to\u00e1n cho c\u00e1c ph\u00fac l\u1ee3i PTO c\u1ee7a b\u1ea1n.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/211335760790152?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> M\u1eabu \u0110\u01a1n Tr\u1ef1c Tuy\u1ebfn<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Form W-9 (M\u1eabu \u0110\u01a1n W-9)<\/h5>\n<p>\u0110\u1ec3 \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n h\u01b0\u1edfng ph\u00fac l\u1ee3i PTO, b\u1ea1n ph\u1ea3i g\u1eedi cho ch\u00fang t\u00f4i Form W-9 (M\u1eabu \u0110\u01a1n W-9) \u0111\u00e3 ho\u00e0n th\u00e0nh v\u00e0 c\u00f3 ch\u1eef k\u00fd n\u1ebfu b\u1ea1n ch\u01b0a l\u00e0m v\u1eady. Xin l\u01b0u \u00fd: Ph\u00fac l\u1ee3i PTO l\u00e0 kho\u1ea3n thu nh\u1eadp ch\u1ecbu thu\u1ebf.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/www.carewellseiu503.org\/vi\/mycarewell503\/\" target=\"_blank\" rel=\"noopener noreferrer\">S\u1eed d\u1ee5ng MyCarewell503 \u0111\u1ec3 ho\u00e0n th\u00e0nh m\u1eabu \u0111\u01a1n n\u00e0y<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Form W-9 (M\u1eabu \u0110\u01a1n W-9)<\/h5>\n<p>\u0110\u1ec3 \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n h\u01b0\u1edfng ph\u00fac l\u1ee3i PTO, b\u1ea1n ph\u1ea3i g\u1eedi cho ch\u00fang t\u00f4i Form W-9 (M\u1eabu \u0110\u01a1n W-9) \u0111\u00e3 ho\u00e0n th\u00e0nh v\u00e0 c\u00f3 ch\u1eef k\u00fd n\u1ebfu b\u1ea1n ch\u01b0a l\u00e0m v\u1eady. Xin l\u01b0u \u00fd: Ph\u00fac l\u1ee3i PTO l\u00e0 kho\u1ea3n thu nh\u1eadp ch\u1ecbu thu\u1ebf.<br \/>\n[et_pb_section global_module=\"274307\"][\/et_pb_section][\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Form W-9 (M\u1eabu \u0110\u01a1n W-9)<\/h5>\n<p>\u0110\u1ec3 \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n h\u01b0\u1edfng ph\u00fac l\u1ee3i PTO, b\u1ea1n ph\u1ea3i g\u1eedi cho ch\u00fang t\u00f4i Form W-9 (M\u1eabu \u0110\u01a1n W-9) \u0111\u00e3 ho\u00e0n th\u00e0nh v\u00e0 c\u00f3 ch\u1eef k\u00fd n\u1ebfu b\u1ea1n ch\u01b0a l\u00e0m v\u1eady. Xin l\u01b0u \u00fd: Ph\u00fac l\u1ee3i PTO l\u00e0 kho\u1ea3n thu nh\u1eadp ch\u1ecbu thu\u1ebf.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/211015815190142?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> M\u1eabu \u0110\u01a1n Tr\u1ef1c Tuy\u1ebfn<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Direct Deposit Form (M\u1eabu \u0110\u01a1n K\u00fd Th\u00e1c Tr\u1ef1c Ti\u1ebfp)<\/h5>\n<p>\u0110\u0103ng k\u00fd \u0111\u1ec3 nh\u1eadn kho\u1ea3n ho\u00e0n tr\u1ea3 v\u00e0 ph\u00fac l\u1ee3i PTO th\u00f4ng qua ph\u01b0\u01a1ng th\u1ee9c k\u00fd th\u00e1c tr\u1ef1c ti\u1ebfp. \u0110\u00e2y l\u00e0 c\u00e1ch nhanh ch\u00f3ng v\u00e0 an to\u00e0n nh\u1ea5t \u0111\u1ec3 b\u1ea1n nh\u1eadn \u0111\u01b0\u1ee3c kho\u1ea3n thanh to\u00e1n. <strong>B\u1ea1n ph\u1ea3i g\u1eedi k\u00e8m b\u1ea3n sao t\u1edd s\u00e9c \u0111\u00e3 h\u1ee7y, th\u01b0 c\u1ee7a ng\u00e2n h\u00e0ng ho\u1eb7c b\u1ea3ng sao k\u00ea c\u1ee7a ng\u00e2n h\u00e0ng.<\/strong><\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/www.carewellseiu503.org\/vi\/mycarewell503\/\" target=\"_blank\" rel=\"noopener noreferrer\">S\u1eed d\u1ee5ng MyCarewell503 \u0111\u1ec3 ho\u00e0n th\u00e0nh m\u1eabu \u0111\u01a1n n\u00e0y<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Direct Deposit Form (M\u1eabu \u0110\u01a1n K\u00fd Th\u00e1c Tr\u1ef1c Ti\u1ebfp)<\/h5>\n<p>\u0110\u0103ng k\u00fd \u0111\u1ec3 nh\u1eadn kho\u1ea3n ho\u00e0n tr\u1ea3 v\u00e0 ph\u00fac l\u1ee3i PTO th\u00f4ng qua ph\u01b0\u01a1ng th\u1ee9c k\u00fd th\u00e1c tr\u1ef1c ti\u1ebfp. \u0110\u00e2y l\u00e0 c\u00e1ch nhanh ch\u00f3ng v\u00e0 an to\u00e0n nh\u1ea5t \u0111\u1ec3 b\u1ea1n nh\u1eadn \u0111\u01b0\u1ee3c kho\u1ea3n thanh to\u00e1n. <strong>B\u1ea1n ph\u1ea3i g\u1eedi k\u00e8m b\u1ea3n sao t\u1edd s\u00e9c \u0111\u00e3 h\u1ee7y, th\u01b0 c\u1ee7a ng\u00e2n h\u00e0ng ho\u1eb7c b\u1ea3ng sao k\u00ea c\u1ee7a ng\u00e2n h\u00e0ng.<\/strong><br \/>\n[et_pb_section global_module=\"274302\"][\/et_pb_section][\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Direct Deposit Form (M\u1eabu \u0110\u01a1n K\u00fd Th\u00e1c Tr\u1ef1c Ti\u1ebfp)<\/h5>\n<p>\u0110\u0103ng k\u00fd \u0111\u1ec3 nh\u1eadn kho\u1ea3n ho\u00e0n tr\u1ea3 v\u00e0 ph\u00fac l\u1ee3i PTO th\u00f4ng qua ph\u01b0\u01a1ng th\u1ee9c k\u00fd th\u00e1c tr\u1ef1c ti\u1ebfp. \u0110\u00e2y l\u00e0 c\u00e1ch nhanh ch\u00f3ng v\u00e0 an to\u00e0n nh\u1ea5t \u0111\u1ec3 b\u1ea1n nh\u1eadn \u0111\u01b0\u1ee3c kho\u1ea3n thanh to\u00e1n. <strong>B\u1ea1n ph\u1ea3i g\u1eedi k\u00e8m b\u1ea3n sao t\u1edd s\u00e9c \u0111\u00e3 h\u1ee7y, th\u01b0 c\u1ee7a ng\u00e2n h\u00e0ng ho\u1eb7c b\u1ea3ng sao k\u00ea c\u1ee7a ng\u00e2n h\u00e0ng.<\/strong><\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212278209348964?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> M\u1eabu \u0110\u01a1n Tr\u1ef1c Tuy\u1ebfn<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Designation of Beneficiary Form (M\u1eabu \u0110\u01a1n Ch\u1ec9 \u0110\u1ecbnh Ng\u01b0\u1eddi Th\u1ee5 H\u01b0\u1edfng)<\/h5>\n<p>H\u00e3y ho\u00e0n th\u00e0nh m\u1eabu \u0111\u01a1n n\u00e0y n\u1ebfu b\u1ea1n mu\u1ed1n ch\u1ec9 \u0111\u1ecbnh ng\u01b0\u1eddi nh\u1eadn ph\u00fac l\u1ee3i PTO ch\u01b0a y\u00eau c\u1ea7u thanh to\u00e1n c\u1ee7a b\u1ea1n trong tr\u01b0\u1eddng h\u1ee3p b\u1ea1n qua \u0111\u1eddi.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/www.carewellseiu503.org\/vi\/mycarewell503\/\" target=\"_blank\" rel=\"noopener noreferrer\">S\u1eed d\u1ee5ng MyCarewell503 \u0111\u1ec3 ho\u00e0n th\u00e0nh m\u1eabu \u0111\u01a1n n\u00e0y<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Designation of Beneficiary Form (M\u1eabu \u0110\u01a1n Ch\u1ec9 \u0110\u1ecbnh Ng\u01b0\u1eddi Th\u1ee5 H\u01b0\u1edfng)<\/h5>\n<p>H\u00e3y ho\u00e0n th\u00e0nh m\u1eabu \u0111\u01a1n n\u00e0y n\u1ebfu b\u1ea1n mu\u1ed1n ch\u1ec9 \u0111\u1ecbnh ng\u01b0\u1eddi nh\u1eadn ph\u00fac l\u1ee3i PTO ch\u01b0a y\u00eau c\u1ea7u thanh to\u00e1n c\u1ee7a b\u1ea1n trong tr\u01b0\u1eddng h\u1ee3p b\u1ea1n qua \u0111\u1eddi.<br \/>[et_pb_section global_module=\"274308\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\">Designation of Beneficiary Form (M\u1eabu \u0110\u01a1n Ch\u1ec9 \u0110\u1ecbnh Ng\u01b0\u1eddi Th\u1ee5 H\u01b0\u1edfng)<\/h5>\n<p>H\u00e3y ho\u00e0n th\u00e0nh m\u1eabu \u0111\u01a1n n\u00e0y n\u1ebfu b\u1ea1n mu\u1ed1n ch\u1ec9 \u0111\u1ecbnh ng\u01b0\u1eddi nh\u1eadn ph\u00fac l\u1ee3i PTO ch\u01b0a y\u00eau c\u1ea7u thanh to\u00e1n c\u1ee7a b\u1ea1n trong tr\u01b0\u1eddng h\u1ee3p b\u1ea1n qua \u0111\u1eddi.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/230654806819160?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> M\u1eabu \u0110\u01a1n Tr\u1ef1c Tuy\u1ebfn<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#ffffff&#8221; custom_padding=&#8221;15px|15px|15px|15px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: left;\"><span style=\"color: #582c82;\">Overpayment Notice Appeal Form (M\u1eabu \u0110\u01a1n Khi\u1ebfu N\u1ea1i Th\u00f4ng B\u00e1o V\u1ec1 Kho\u1ea3n Chi Tr\u1ea3 V\u01b0\u1ee3t M\u1ee9c)<\/span><\/h5>\n<p>S\u1eed d\u1ee5ng m\u1eabu \u0111\u01a1n n\u00e0y \u0111\u1ec3 khi\u1ebfu n\u1ea1i Th\u00f4ng B\u00e1o V\u1ec1 Kho\u1ea3n Chi Tr\u1ea3 V\u01b0\u1ee3t M\u1ee9c t\u1eeb Carewell SEIU 503.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/241055798317059?language=vi\" target=\"_blank\" rel=\"noopener noreferrer\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">Truy C\u1eadp M\u1eabu \u0110\u01a1n<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][\/et_pb_column][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>T\u00ecm c\u00e1c m\u1eabu \u0111\u01a1n m\u00e0 b\u1ea1n c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i \u0111i\u1ec1n li\u00ean quan \u0111\u1ebfn vi\u1ec7c \u0111\u0103ng k\u00fd ph\u00fac l\u1ee3i c\u1ee7a Carewell SEIU 503, c\u00e1c kho\u1ea3n ho\u00e0n tr\u1ea3, y\u00eau c\u1ea7u PTO, v.v.<\/p>\n","protected":false},"author":9,"featured_media":0,"parent":221934,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-222001","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>C\u00e1c M\u1eabu \u0110\u01a1n \u0110\u0103ng K\u00fd v\u00e0 Ho\u00e0n Tr\u1ea3 - Carewell SEIU 503<\/title>\n<meta name=\"description\" content=\"T\u00ecm c\u00e1c m\u1eabu \u0111\u01a1n m\u00e0 b\u1ea1n c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i \u0111i\u1ec1n li\u00ean quan \u0111\u1ebfn vi\u1ec7c \u0111\u0103ng k\u00fd ph\u00fac l\u1ee3i c\u1ee7a Carewell SEIU 503, c\u00e1c kho\u1ea3n ho\u00e0n tr\u1ea3, y\u00eau c\u1ea7u PTO, v.v.\" \/>\n<meta name=\"robots\" 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