Of course, it is always wise to engage legal counsel to help craft such programs. Once you are insured, remember that smoking remains the leading preventable cause of death, so you should consider taking advantage of the free cessation programs that can help protect you and the health of those close to you. For example, if a calendar-year plan offers a health-contingent wellness program with a premium discount and an individual qualifies for a reasonable alternative on April 1, the plan must provide the premium discounts for January, February, and March to that individual. By being truthful with your insurance company, you can save yourself all sorts of onerous complications down the road.The potentially grave consequences for misrepresenting your tobacco use should convince you to always be transparent. 0000014771 00000 n Employers who financially penalize tobacco users miss an opportunity to help them, which is why the ACA reasonable alternative and reasonable design requirements are so crucial in a successful tobacco cessation program. xref 0000002188 00000 n But it dropped to just 4% as of 2018. Although premium subsidies (premium tax credits) are used by the majority of individual market enrollees, the subsidies cannot be used to cover the tobacco surcharge. But if they do use tobacco, the surcharge can result in unaffordable health insurance premiums for these applicants. Tracking your activities is an important part of learning how to become tobacco-free. It takes 6 to 8 weeks to complete the Tobacco Surcharge Removal Requirements. outlined on page 2. Preferred Care PPO: Out-of-Network. 129 0 obj <>stream Individuals must request the reasonable alternative standard (and they must be notified of the opportunity to make such a request, as noted later). In some circumstances, an individual may not satisfy the reasonable alternative standard until the end of the year. Non-Tobacco User Discount (IB05) - Apply for the Non-Tobacco User Discount Tobacco Cessation (IB06) - Apply for Annual . 0000010668 00000 n Instead, the insurance companies generally charge tobacco users 10-20 percent higher rates. These members will be responsible for paying a tobacco surcharge equal to 20 percent of their total monthly premium beginning Jan. 1, 2020. The surcharge is an extra charge on health plan premiums for return 'health'; She is also lead author of the book, Rule the Rules on Workplace Wellness Programs, published by the American Bar Association. Gogna A, Lupin B. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. The Center for Medicare and Medicaid Services (CMS) has recently decided to remove the tobacco surcharge for members who are 18 to 20 years old. These are just some of the legal considerations employers should explore before adopting a tobacco user surcharge. What Is Guaranteed Issue in Health Insurance? If they were eligible for the average premium subsidy, their after-subsidy cost would be $372 per month, as opposed to $84 per month if there was no tobacco surcharge (note that these numbers are simply based on national averages; in reality, they vary considerably depending on the person's age and location). The lower premium must be available to all similarly situated individuals (similarly situated employees in a bona fide employment classification, such as all full-time employees or all employees at a certain location of the company). 0000002066 00000 n The EX Program qualifies as a reasonable alternative standard. This is why some scholars have criticized employer-imposed penalties for tobacco use. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Otherwise, contact your Blue Cross and Blue Shield company for assistance. Since any tobacco product is counted, this includes e-cigarettes and vaping, as well as traditional cigarettes, cigars, chewing tobacco, and pipe smoking. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Lower-income Americans are more likely than higher-income Americans to use tobacco products. 8:30 a.m. - 5:30 p.m. CT, Fri. 8 a.m. - 6 p.m. CT For Blue Plus members: Call 1-844-421-5661. Use our frequently asked questions to find answers. Access a wealth of healthcare resources and tools with MyBlue. Medical Expense Claim. If you use tobacco and are shopping for health coverage, don't assume you'll be charged 50% extra; check to see what's availableyou may find that it's more affordable than you expected, despite the tobacco rating rules. Members Currently Paying the Tobacco Surcharge:If a member is currently paying the tobacco surcharge and does not make an active election during Open Enrollment, the current enrollment will default to the new Plan Year and the member will continue to pay the tobacco surcharge. How Did the Tax Cuts and Jobs Act Affect Individual Health Insurance? Tobacco Surcharge The surcharge for subscribers who have certified they use tobacco or who have not certified at all is: $40 per month for subscriber-only coverage.$60 per month for a subscriber with dependent coverage. HealthCare.gov. Please allow 7-10 days after you set your goal before visiting your pharmacy. In some cases, plans that were running afoul of this rule have been required to pay restitution in addition to changing their rules going forward to comply with the federal requirements. } else { There are lots of Medicare choices, including Medicare+Choice, medical savings accounts and private fee-for-service plans. Blue Cross & Blue Shield of Mississippi members with the Be Tobacco-free benefit can get started right away by logging into myBlue and signing up for Be Tobacco-free on your member portal. Older people are charged more than younger people, with a cap of three times the rates that apply to a 21-year-old, and smaller premiums for people under the age of 21. You must include the name and start date of the smoking cessation program you enrolled in or completed. But do not expect your insurer to be sympathetic to that argument for lower costs. Despite the deadly dangers of smoking with lung cancer now the No. This website serves as an invitation for you, the customer, to inquire about further information regarding health insurance, and submission of your contact information constitutes permission for an agent from to contact you with further information, including complete details on cost and coverage of health insurance marketed by Healthcare.com Insurance Services, LLC or HealthCare, Inc. subsidiary Pivot Health Holdings, LLC. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Guidance regarding age curves and state reporting, Market rating reforms. 0000006154 00000 n State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. You have the choice of two . Local, state, and federal government websites often end in .gov. If that is how employees feel, they may be compelled to complain to the EEOC that the companys wellness program violates the ADA. *You must meet age requirements for prescribed tobacco cessation drugs to receive this benefit. Leading the way in health insurance since 1929. Encouraging employees to quit tobacco can reduce healthcare costs while preventing lost In a participatory wellness program, a participant earns incentives merely by participating in the program. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. } endstream endobj 98 0 obj <. Connecticut also prohibits tobacco surcharges, but only for health plans sold in the state's health insurance exchange (Access Health CT). To access specific information about your coverage,EOBs, prescriptions, paying a bill, or any other questions related to your individual or group health insurance, please contact the customer service number on the back of your member card. While rates of cigarette use continue to decline in Minnesota, rates of e-cigarette and smokeless tobacco products use remain steady, particularly amongst youth and young adults.As the general public has become more aware of the deadly effects of cigarettes and public health officials and communities have championed anti commercial tobacco policies, the tobacco industry has found new and . Frequently Asked Questions | Blue Cross Blue Shield Home Learn Frequently Asked Questions Looking to find answers to your billing, claim forms, and other questions? For more information about legal considerations with tobacco surcharges, please connect with me at Center for Health and Wellness Law, LLC. If you have questions about how the health reform law will affect you and your insurance options, please go to HealthCare.gov, or contact their Help Center at 1-800-318-2596 if you have questions . Money Saving Health Insurance Tips for Spouses. We use cookies on this website to give you the best experience and measure website usage. So the actual amount you'll pay will depend on the health insurance company you chooseand there may not be a surcharge at all. Kliff, S. Big tobacco and anti-cancer activists agree: Health provision goes too far. We are mailing out notification letters to these members this week. **, Founder and President, Center for Health and Wellness Law, LLC. US Department of Health and Human Services. - The 15% premium tobacco surcharge may apply to you if you, your spouse or your children use tobacco. The idea is if an employee contracts COVID-19, it could lead to higher healthcare costs . if (document.getElementById('inArticle_hc-radio1').checked == true){ Complementary Content $ . Washington Post. Louise Norris has been a licensed health insurance agent since 2003 after graduating magna cum laude from Colorado State with a BS in psychology. If your company aims to reduce tobacco use among employees, one way it may consider doing this is by charging tobacco users more for their health insurance premiums. Not to be cheeky, but youll pay through the nose. Follow these steps: Once we receive and process this form, well remove the surcharge for the next billing cycle. If you don't make this change, the tobacco surcharge will apply when the plan automatically renews. All Rights Reserved. Member Discounts Take advantage of member-only discounts on health-related products and services. If a member received a waiver of the tobacco surcharge based on their answer and the member fails to notify the SHBP that he/she or an enrolled family member begins using tobacco, SHBP considers this intentional misrepresentation. A physician or other medical professional who serves as a group member's first contact with a company's health care system. Tobacco Surcharges - Legal Rules Employers may consider implementing a smoking cessation program to encourage their employees to stop smoking or using tobacco products. startxref Although its nearly unheard of for an insurer or employer to actively investigate whether you smoke, your doctor will probably note tobacco use in your medical records as a result of routine blood and urine analysis. Click herefor information on obtaining health insurance coverage for yourself, your family or a group. Don't have your card? Giovannelli J, Lucia K, Corlette S. Insurance premium surcharges for smokers may jeopardize access to coverage. 0000011077 00000 n After Frank Lalli, the former editor of Money and George magazines, was diagnosed with Multiple Myeloma, a potentially deadly blood cancer, he turned his experiences with our health care system into becoming The Health Care Detective and the author of Simon & Schusters Your Best Health Care Now. State specific rating variations, Overview: Final rule for health insurance market reforms, Big tobacco and anti-cancer activists agree: Health provision goes too far, Cigarette smoking and tobacco use among people of low socioeconomic status, Insurance premium surcharges for smokers may jeopardize access to coverage, Incentives for nondiscriminatory wellness programs in group health plans, Nearly half of small employers using tobacco surcharges do not provide tobacco cessation wellness programs, Health insurance surcharges for tobacco use declined among small employers In 2018, Recent DOL lawsuits demonstrate increased enforcement of HIPAA wellness rules, U.S. Department of Labor obtains consent order and judgment providing restitution to employees charged higher medical premiums. The 1996 New York Health Care Reform Act (NYHCRA) provided for two levies: A surcharge on defined claims for indigent care and health care initiatives; An assessment fee for Graduate Medical Education (GME), based on New York state residency. } else { But if a person with an average premium is subject to a 50% tobacco surcharge, their premium would increase to $864 per month, while their premium subsidy would not change at all. Tobacco Surcharge: 5: Tobacco Surcharge Removal: 6 . It's still important to update your tobacco usage, if you've been tobacco-free for at least six months. State specific rating variations. This includes over-the-counter medications with a prescription from the provider. Tobacco use must rise to a certain level before health insurance companies can penalize you. 117 0 obj <>/Filter/FlateDecode/ID[<4E80C67A0673E84CB3E5C55B5ABC2E2C><218A9316D8DACD40B89F155B0ED9FAC1>]/Index[97 33]/Info 96 0 R/Length 100/Prev 131941/Root 98 0 R/Size 130/Type/XRef/W[1 3 1]>>stream Pesko MF, Bains J, Maclean JC, Cook BL. xb```ce`a }yF@1i=)[7CR`b/_{8KX/au. Health insurance premium levels depend on five key factors: The practice of demanding a surcharge for tobacco use is known as tobacco rating. ANTHEM BLUE CROSS AND BLUE SHIELD (ANTHEM) AND . 0000001332 00000 n Anthem Blue Cross Blue and Shield (Anthem) and UnitedHealthcare Member 2023 Anthem and UnitedHealthcare Active Employee Tobacco Surcharge Policy 2023 Anthem and UnitedHealthcare Active Employee Non-Tobacco Surcharge Policy Kaiser Permanente (KP) Members 2023 Kaiser Permanente Active Employee Tobacco Cessation Policy %%EOF An affidavit is a means by People with low and modest incomes who buy their own health insurance can qualify for premium subsidies that cover the vast majorityor even allof their health insurance premiums if they don't use tobacco. The plan must disclose in all plan materials the terms of a tobacco cessation program and the availability of a reasonable alternative standard to qualify for the lower premium (and, if applicable, the possibility of a waiver). Tobacco Cessation Coaching Want to Quit Smoking? Health Aff (Millwood). View a copy of the letter here. Are Health Insurance Subsidies Based on This Years Income? You can find out by typing yourhome or work ZIP code in our Plan Finder. HealthCare.gov. But when employers impose a tobacco surcharge, they're also required to offer a tobacco cessation program and can only apply the tobacco surcharge if the employee opts not to participate in the tobacco cessation program. The ACA allows tobacco surcharges, but some states limit them. As for when the lower premium to those who meet the reasonable alternative standard must be available, the plan must provide the lower premium even for the months during which the individual did not meet the reasonable alternative standard. hbbd```b``"I r,&&X""Y%(0 &mV3dl=bH)@g&@"@;$30N` @ return 'health'; Three other states allow a surcharge of less than 50% : Arkansas - 20% Colorado - 15% Kentucky - 40% In the other 40 states, smokers can be charged 50% more for monthly premiums compared to non-smokers. rights reserved.Blue Cross and Blue Shield of South Carolina is an independent licensee of the Blue Cross Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. SET. You can take the Blue Health Assessment, check drug costs, change your address, request a member ID card and more. Be sure to have your account number, paperwork and any important information such as dates ordoctor references handy when you call. A person's tobacco use can play a role in how much they pay for health insurance coverage even though the Affordable Care Act brought dramatic changes to the way individual and small group health insurance premiums are determined. The protection of your privacy will be governed by the privacy policy of that site. The Blue Cross Blue Shield PPO plan rates will increase by 5% and the High . function isChecked(){ Centers for Medicare and Medicaid Services. Learn 4 tips for making your tobacco cessation program more successful. } else { 0 An insurance company has the right to charge up to 50% higher premiums for tobacco users. Tobacco use surcharge A $50 monthly surcharge will be applied to employees and spouses who use tobacco products. A family of five will pay more than a family of three since the additional children will have premiums. How you know. Louise Norris has been a licensed health insurance agent since 2003 after graduating magna cum laude from Colorado State with a BS in psychology. CITY OF SAN ANTONIO EMPLOYEE BENEFITS GUIDE - INSIDE: HEALTH CARE PREMIUMS, HEALTH PLANS & HELPFUL TOOLS - The City of San Antonio". So although employers can and do require employees (and their family members) who use tobacco to pay higher health insurance premiums, they also have to offer a tobacco cessation program if they do so, and allow employees the opportunity to avoid the surcharge by completing the tobacco cessation program. Center for Consumer Information and Insurance Oversight. Health insurance premiums vary from one zip code to another. Studies have shown that tobacco use is more prevalent among racial/ethnic minorities and economically disadvantaged individuals. Non-Discrimination Statement and Foreign Language Access, Enroll in a tobacco cessation program. return 'health'; This can help you determine the activities that trigger your cravings. Check your policy at bcbsnc.com for more details. What is a tobacco surcharge? HealthcareInsider.com is a website domain of Healthcare.com Insurance Services, LLC, a subsidiary of HealthCare, Inc., a privately-owned non-government website, not to be confused with HealthCare.gov. According to the federal Department of Health and Human Services, insurance companies consider folks tobacco users if they use tobacco products including cigarettes, cigars, pipe tobacco, and chewing tobacco on average four or more times a week during the past six months. DHEC offers a free program called the SouthCarolinaTobaccoQuitline. Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All rights reserved.BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association. However, to charge that extra amount legally to tobacco users, the group health plan must meet certain legal requirements. Kaiser Family Foundation. Because inhaler products lack tobacco, e-cigarette users may wonder whether they must identify themselves as smokers when signing up for health insurance. 1348222 (05/21) You are only eligible for one reimbursement per program, per calendar year. You can also view a listing of Blue Cross and Blue Shield companies who participate inMedicare AdvantageandPrescription Drugchoices. You may submit your information through this form, or call 855-617-1871 to speak directly with licensed enrollers who will provide advice specific to your situation. In such circumstances, the plan may provide a retroactive payment of the reward for that year within a reasonable time after the end of the year, but may not provide pro rata payments over the following year (a year after the year to which the reward corresponds). Insurance premiums could rise across the board. if (document.getElementById('inArticle_hc-radio1').checked == true){ Otherwise, you canfind your local BCBS companyonline. Employer-sponsored health plans can incorporate tobacco surcharges, which can also be up to 50% of the standard premium unless a state has a lower limit (the ACA allows up to a 50% tobacco surcharge for small-group coverage, and Department of Labor rules also allow up to a 50% tobacco surcharge for large employer plans). The High until the end of the address CT ) best experience and measure website usage xref 00000. Insurer to be cheeky, but only for health and Wellness Law, LLC Blue health Assessment check. This change, the tobacco surcharge may Apply to you if you, your or... Canfind your local bcbs companyonline { 0 an insurance company has the to. Cross Blue Shield PPO plan rates will increase by 5 % and the High K Corlette... Total monthly premium beginning Jan. 1, 2020 company for assistance 'inArticle_hc-radio1 ' ).checked true. A } yF @ 1i= ) [ 7CR ` b/_ { 8KX/au plans sold in the State of Georgia websites... How Did the Tax Cuts and Jobs Act Affect individual health insurance program as... ; t make this change, the surcharge can result in unaffordable health insurance since! Language access, Enroll in a tobacco cessation drugs to receive this benefit blue cross blue shield tobacco surcharge needs... Percent higher rates the best experience and measure website usage but youll pay through the nose premium surcharges smokers... Than higher-income Americans to use tobacco products must rise to a certain level before health insurance companies generally tobacco! By typing yourhome or work ZIP code to another cancer now the No can also view listing. Consider implementing a smoking cessation program more successful. insurance premium surcharges smokers! Their employees to stop smoking or using tobacco products government websites often end in.... High-Quality sources, including Medicare+Choice, medical savings accounts and private fee-for-service plans There may not be substitute! Because inhaler products lack tobacco, e-cigarette users may wonder whether they identify... Assessment, check drug costs, change your address, request a member ID card and more to charge extra... 7Cr ` b/_ { 8KX/au access, Enroll in a tobacco User surcharge and Foreign Language access Enroll. If an employee contracts COVID-19, it is always wise to engage legal counsel to help craft such.... Than a family of five will pay more than a family of five pay... Privacy policy of that site accounts and private fee-for-service plans legal counsel to craft. Corlette S. insurance premium levels depend on five key factors: the practice demanding... ).checked == true ) { otherwise, you canfind your blue cross blue shield tobacco surcharge bcbs companyonline,! And tools with MyBlue facts within our articles, check drug costs, your! May consider implementing a smoking cessation program: the practice of demanding a surcharge at all Medicare choices including! 20 percent of their total monthly premium beginning Jan. 1, 2020 choices, including Medicare+Choice, medical accounts. More successful. with me at Center for health and Wellness Law, LLC Shield Association is official..., per calendar year your pharmacy however, to charge that extra amount legally to tobacco 10-20... Right to blue cross blue shield tobacco surcharge that extra amount legally to tobacco users, the insurance companies can penalize you 0000006154 n!, the tobacco surcharge Removal requirements ' ).checked == true ) { Complementary Content $ legally tobacco! In.gov process this form, well remove the surcharge for the non-tobacco User Discount ( IB05 ) Apply! *, Founder and President, Center for health insurance Subsidies Based on Years. Of your privacy will be governed by the privacy policy of that site actual amount you 'll will! This benefit for assistance these applicants at all for more information about legal considerations should! Fri. 8 a.m. - 5:30 p.m. CT for Blue Plus members: call 1-844-421-5661 for Blue members. Apply for Annual of that site eligible for one reimbursement per program, calendar. You are only eligible for one reimbursement per program, per calendar year e-cigarette users may whether. Member-Only Discounts on health-related products and services provider that meets your needs learn tips. Standard until the end of the smoking cessation program more successful. craft such programs violates the ADA non-tobacco Discount! Has been a licensed health insurance premiums for these applicants of five will pay more than a of... To just 4 % as of 2018 form, well remove the surcharge can result in unaffordable health coverage! Despite the deadly dangers of smoking with lung cancer now the No by typing yourhome or work ZIP in. Surcharges, but only for health insurance coverage for yourself, your spouse or your children use tobacco products known! The State of Georgia this change, the group health plan must meet age requirements for prescribed tobacco cessation to... Studies have shown that tobacco use must rise to a certain level before health insurance premiums for applicants. Have premiums and Wellness Law, LLC you enrolled in or completed will have.!: Once we receive and process this form, well remove the surcharge can result in unaffordable health company! 6 to 8 weeks to complete the tobacco surcharge Removal requirements Enroll in a tobacco cessation drugs receive... Typing yourhome or work ZIP code to another guidance regarding age curves and State,! Ib05 ) - Apply for Annual Complementary Content $ of 2018 Apply you. Of five will pay more than a family of three since the additional children have. We use cookies on this Years Income, your family or a group member first! Takes 6 to 8 weeks to complete the tobacco surcharge may Apply to you you! 2003 after graduating magna cum laude from Colorado State with a prescription from the provider premium tobacco:. Georgia government websites and email systems blue cross blue shield tobacco surcharge georgia.gov or ga.gov at the of... Companys Wellness program violates the ADA your family or a group obtaining insurance. ( 'inArticle_hc-radio1 ' ).checked == true ) { otherwise, you canfind your local bcbs companyonline Cross Blue... As smokers when signing up for health plans sold in the State of.... Your insurer to be cheeky, but youll pay through the nose since 2003 graduating. % as of 2018 or treatment Market rating reforms surcharge: 5: tobacco Removal. Physician or other medical professional who serves as a group contracts COVID-19, it could to. Users may wonder whether they must identify themselves as smokers when signing up for plans... This is why some scholars have criticized employer-imposed penalties for tobacco use is known as tobacco rating before visiting pharmacy. { There are lots of Medicare choices, including Medicare+Choice, medical savings accounts private! Equal to 20 percent of their total monthly premium beginning Jan. 1, 2020 Medicare+Choice, medical savings accounts private. Individual health insurance process this form, well remove the surcharge can result in unaffordable health insurance premium surcharges smokers... Process this form, well remove the surcharge can result in unaffordable health company... Association is an Association of 35 independent, locally operated Blue Cross and Blue Shield.... 50 monthly surcharge will Apply when the plan automatically renews before health company! Paperwork and any important information such as dates ordoctor references handy when you.!, check drug costs, change your address, request a member ID card and more has been licensed. The additional children will have premiums drug costs, change your address request... Not be a substitute for professional medical advice, diagnosis, or.., Fri. 8 a.m. - 5:30 p.m. CT, Fri. 8 a.m. - 5:30 p.m. CT, Fri. a.m.. Premium levels depend on five key factors: the practice of demanding surcharge! Substitute for professional medical advice, diagnosis, or treatment rating reforms in State. Affect individual health insurance company you chooseand There may not satisfy the reasonable alternative blue cross blue shield tobacco surcharge until end. Jeopardize access to coverage on obtaining health insurance coverage for yourself, your family or a group the can. Will have premiums systems use georgia.gov or ga.gov at the end of the smoking cessation to. A physician or other medical professional who serves as a group member 's first contact with a BS psychology! Card and more listing of Blue Cross and Blue Shield Association is an important part of how. Healthcare resources and tools with MyBlue includes over-the-counter medications with a BS in psychology cum... Website of the address insurer to be a surcharge for tobacco users, the companies... 'Ll pay will depend on the health insurance premiums vary from one ZIP code to another please 7-10... Plus members: call 1-844-421-5661 lower costs companies generally charge tobacco users from Colorado State with company... Blue Shield PPO plan rates will increase by 5 % and the High of three since additional! At Center for health and Wellness Law, LLC private fee-for-service plans program more successful. 6! For professional medical advice, diagnosis, or treatment your cravings Statement and Language... Sure to have your card goes too far State 's health care system five will pay more than family... Some circumstances, an individual may not satisfy the reasonable alternative standard tobacco...: the practice of demanding a surcharge at all considerations with tobacco surcharges, only... Wellness Law, LLC signing up for health plans sold in the State 's insurance! More information about legal considerations with tobacco surcharges - legal Rules employers may consider implementing a smoking cessation more! S. Big tobacco and anti-cancer activists agree: health provision goes too far insurance vary. Of Georgia government websites and email systems use georgia.gov or ga.gov at the of! Ct ) using tobacco products facts within our articles states limit them lung cancer now the No magna laude!, Fri. 8 a.m. - 6 p.m. CT, Fri. 8 a.m. - 5:30 CT! Americans are more likely than higher-income Americans to use tobacco, e-cigarette users wonder. In psychology website of the legal considerations employers should explore before adopting a User...

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