Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services

Coverage Period: 01/01/2025 - 12/31/2025

: DATAONE SYSTEMS, LLC
Open Choice - HDHP
® Coverage for: Individual + Family | Plan Type: PPO
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would
share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately.
This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage,
https://www.aetna.com/sbcsearch/getpolicydocs?u=082800-100020-032416 or by calling 1-888-982-3862. For general definitions of common terms, such as
allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at
https://www.healthcare.gov/sbc-glossary/ or call 1-888-982-3862 to request a copy.
Important Questions Answers Why This Matters:
Generally, you must pay all of the costs from providers up to the deductible amount
What is the overall In-Network: Individual $3,300 / Family $6,600. before this plan begins to pay. If you have other family members on the plan, each
deductible? Out-of-Network: Individual $6,000 / Family $18,000. family member must meet their own individual deductible until the total amount of
deductible expenses paid by all family members meets the overall family deductible.
This plan covers some items and services even if you haven’t yet met the deductible
Are there services amount. But a copayment or coinsurance may apply. For example, this plan covers
Yes. In-network preventive care is covered before you
covered before you meet certain preventive services without cost sharing and before you meet your deductible.
your deductible? meet your deductible.
See a list of covered preventive services at
https://www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other
deductibles for specific No. You don’t have to meet deductibles for specific services.
services?
The out-of-pocket limit is the most you could pay in a year for covered services. If you
What is the out-of-pocket In-Network: Individual $4,000 / Family $8,000. have other family members in this plan, they have to meet their own out-of-pocket
limit for this plan? Out-of-Network: Individual $12,500 / Family $37,500.
limits until the overall family out-of-pocket limit has been met.
Premiums, balance-billing charges, health care this
What is not included in plan doesn't cover & penalties for failure to obtain Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
the out-of-pocket limit?
pre-authorization for services.
This plan uses a provider network. You will pay less if you use a provider in the plan’s
network. You will pay the most if you use an out-of-network provider, and you might
Yes. See http://www.aetna.com/docfind or call
Will you pay less if you receive a bill from a provider for the difference between the provider's charge and what
1-888-982-3862 for a list of in-network providers.
use a network provider? your plan pays (balance billing). Be aware, your network provider might use an
Select Open Choice® .
out-of-network provider for some services (such as lab work). Check with your provider
before you get services.
Do you need a referral to No. You can see the specialist you choose without a referral.
see a specialist?

082800-100020-032416 Page 1 of 6
Published: 10/29/2024
 All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.

What You Will Pay

Common Out–of–Network Limitations, Exceptions, & Other Important
Services You May Need In-Network Provider (You Provider
Medical Event (You will pay Information
will pay the least) the most)
Primary care visit to treat an injury or
0% coinsurance 30% coinsurance None
illness
Specialist visit 0% coinsurance 30% coinsurance None
If you visit a health care
provider’s office or clinic 30% coinsurance, You may have to pay for services that aren't
Preventive care /screening except no charge for preventive. Ask your provider if the services
No charge
/immunization immunizations up to needed are preventive. Then check what your
age 6 plan will pay for.
Diagnostic test (x-ray, blood work) 0% coinsurance 30% coinsurance None
If you have a test
Imaging (CT/PET scans, MRIs) 0% coinsurance 30% coinsurance None
30% coinsurance after
Copay/prescription: $10 for copay/prescription: $10
30 day supply (retail), $25 for 30 day supply
Preferred generic drugs
for 31-90 day supply (retail (retail), $25 for 31-90 Covers 30 day supply (retail), 31-90 day supply
& mail order) day supply (retail & (retail & mail order). Includes contraceptive
mail order) drugs & devices obtainable from a pharmacy,
If you need drugs to treat 30% coinsurance after oral fertility drugs, injectable fertility drugs for
your illness or condition Copay/prescription: $35 for copay/prescription: $35 preservation of fertility due to disease only. No
30 day supply (retail), for 30 day supply charge for preferred generic FDA-approved
More information about Preferred brand drugs
prescription drug $87.50 for 31-90 day (retail), $87.50 for women's contraceptives in-network. Review
coverage is available at supply (retail & mail order) 31-90 day supply (retail your formulary for prescriptions requiring
www.aetnapharmacy.com/a & mail order) precertification or step therapy for coverage.
dvancedcontrolaetna 30% coinsurance after Your cost will be higher for choosing Brand
Copay/prescription: $70 for copay/prescription: $70 over Generics; cost difference penalty doesn’t
30 day supply (retail), $175 for 30 day supply apply to out-of-pocket limit.
Non-preferred generic/brand drugs
for 31-90 day supply (retail (retail), $175 for 31-90
& mail order) day supply (retail &
mail order)
30% coinsurance after
Specialty drugs Copay/prescription: $200 copay/prescription: None
$200
If you have outpatient Facility fee (e.g., ambulatory surgery
surgery 0% coinsurance 30% coinsurance None
center)

082800-100020-032416 Page 2 of 6
Published: 10/29/2024
 What You Will Pay
Common Out–of–Network Limitations, Exceptions, & Other Important
Services You May Need In-Network Provider (You Provider
Medical Event (You will pay Information
will pay the least) the most)
Physician/surgeon fees 0% coinsurance 30% coinsurance None
Out-of-network emergency use paid the same
Emergency room care 0% coinsurance 0% coinsurance as in-network. No coverage for non-emergency
use.
If you need immediate
medical attention Out-of-network emergency use paid the same
Emergency medical transportation 0% coinsurance 0% coinsurance as in-network. Non-emergency transport: not
covered, except if pre-authorized.
Urgent care 0% coinsurance 30% coinsurance No coverage for non-urgent use.
Penalty of $400 for failure to obtain
If you have a Facility fee (e.g., hospital room) 0% coinsurance 30% coinsurance
pre-authorization for out-of-network care.
hospital stay
Physician/surgeon fees 0% coinsurance 30% coinsurance None
Office & other
Office & other outpatient
Outpatient services outpatient services: None
services: 0% coinsurance
If you need mental health, 30% coinsurance
behavioral health, or
substance abuse services
Penalty of $400 for failure to obtain
Inpatient services 0% coinsurance 30% coinsurance
pre-authorization for out-of-network care.

Office visits No charge 30% coinsurance Cost sharing does not apply for preventive
Childbirth/delivery professional services. Maternity care may include tests
0% coinsurance 30% coinsurance and services described elsewhere in the SBC
If you are pregnant services
(i.e., ultrasound). Penalty of $400 for failure to
Childbirth/delivery facility services 0% coinsurance 30% coinsurance obtain pre-authorization for out-of-network
care may apply.

082800-100020-032416 Page 3 of 6
Published: 10/29/2024
 What You Will Pay
Common Out–of–Network Limitations, Exceptions, & Other Important
Services You May Need In-Network Provider (You Provider
Medical Event (You will pay Information
will pay the least) the most)
60 visits/calendar year. Penalty of $400 for
Home health care 0% coinsurance 30% coinsurance failure to obtain pre-authorization for
out-of-network care.
30 visits/calendar year for Physical,
Rehabilitation services 0% coinsurance 30% coinsurance
Occupational & Speech Therapy combined.
Habilitation services 0% coinsurance 30% coinsurance None
If you need help
recovering or have other 60 days/calendar year. Penalty of $400 for
special health needs Skilled nursing care 0% coinsurance 30% coinsurance failure to obtain pre-authorization for
out-of-network care.
Limited to 1 durable medical equipment for
Durable medical equipment 0% coinsurance 30% coinsurance same/similar purpose. Excludes repairs for
misuse/abuse.
Penalty of $400 for failure to obtain
Hospice services 0% coinsurance 30% coinsurance
pre-authorization for out-of-network care.
Children's eye exam No charge 30% coinsurance 1 routine eye exam/24 months.
If your child needs dental
or eye care Children's glasses Not covered Not covered Not covered.
Children's dental check-up Not covered Not covered Not covered.
Excluded Services & Other Covered Services:
Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
• Bariatric surgery • Long-term care • Weight loss programs
• Cosmetic surgery • Non-emergency care when traveling outside the
• Dental care (Adult & Child) U.S.
• Glasses (Child) • Routine foot care

Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
• Acupuncture - 10 visits/calendar year for disease, • Infertility treatment - Limited to the diagnosis & • Private-duty nursing - 70- 8 hour shifts/calendar
injury & chronic pain. treatment of underlying medical condition, including year.
• Chiropractic care - 20 visits/calendar year. artificial insemination. • Routine eye care (Adult) - 1 routine eye exam/24
• Hearing aids - 1 hearing aid per ear/3 years. months.
Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is:
Texas Department of Insurance, 1-800-252-3439 (Consumer HelpLine), (512) 676-6000 (Local), (800) 578-4677 (Toll-Free),

082800-100020-032416 Page 4 of 6
Published: 10/29/2024
www.tdi.texas.gov/consumer/get-help-with-an-insurance-complaint.html.
● For more information on your rights to continue coverage, contact the plan at 1-888-982-3862.
● If your group health coverage is subject to ERISA, you may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA
(3272) or www.dol.gov/ebsa/healthreform.
● For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and
Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.
● If your coverage is a church plan, church plans are not covered by the Federal COBRA continuation coverage rules. If the coverage is insured, individuals should
contact their State insurance regulator regarding their possible rights to continuation coverage under State law.
Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about
the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596.
Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance
or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete
information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact:
● If your group health coverage is subject to ERISA, you may contact Aetna directly by calling the toll-free number on your Medical ID Card, or by calling our general
toll free number at 1-888-982-3862. You may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or
www.dol.gov/ebsa/healthreform.
● Texas Department of Insurance, 1-800-252-3439 (Consumer HelpLine), (512) 676-6000 (Local), (800) 578-4677 (Toll-Free),
www.tdi.texas.gov/consumer/get-help-with-an-insurance-complaint.html.
● For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and
Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.
● Additionally, a consumer assistance program can help you file your appeal. Contact Texas Department of Insurance, Consumer Protection, Mail Code 111-1A, 333
Guadalupe, P.O. Box 149091, Austin, TX 78714-9091, Phone toll-free: 1-800-252-3439, http://www.texashealthoptions.com, [email protected]
Does this plan provide Minimum Essential Coverage? Yes.
Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP,
TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit.
Does this plan meet Minimum Value Standards? Yes.
If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.
To see examples of how this plan might cover costs for a sample medical situation, see the next section.

082800-100020-032416 Page 5 of 6
Published: 10/29/2024
About these Coverage Examples:
This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be
different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharing
amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of
costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.

Peg is Having a Baby Managing Joe’s Type 2 Diabetes Mia’s Simple Fracture
(9 months of in-network pre-natal care and (a year of routine in-network care of a (in-network emergency room visit and
a hospital delivery) well-controlled condition) follow up care)

■ The plan’s overall deductible $3,300 ■ The plan’s overall deductible $3,300 ■ The plan’s overall deductible $3,300
■ Specialist coinsurance 0% ■ Specialist coinsurance 0% ■ Specialist coinsurance 0%
■ Hospital (facility) coinsurance 0% ■ Hospital (facility) coinsurance 0% ■ Hospital (facility) coinsurance 0%
■ Other coinsurance 0% ■ Other coinsurance 0% ■ Other coinsurance 0%

This EXAMPLE event includes services like: This EXAMPLE event includes services like: This EXAMPLE event includes services like:
Specialist office visits (prenatal care) Primary care physician office visits (including Emergency room care (including medical supplies)
Childbirth/Delivery Professional Services disease education) Diagnostic test (x-ray)
Childbirth/Delivery Facility Services Diagnostic tests (blood work) Durable medical equipment (crutches)
Diagnostic tests (ultrasounds and blood work) Prescription drugs Rehabilitation services (physical therapy)
Specialist visit (anesthesia) Diabetic supplies (glucose meter)

Total Example Cost $12,700 Total Example Cost $5,600 Total Example Cost $2,800
In this example, Peg would pay: In this example, Joe would pay: In this example, Mia would pay:
Cost Sharing Cost Sharing Cost Sharing
Deductibles $3,300 Deductibles $3,300 Deductibles $2,800
Copayments $10 Copayments $400 Copayments $0
Coinsurance $0 Coinsurance $0 Coinsurance $0
What isn't covered What isn't covered What isn't covered
Limits or exclusions $60 Limits or exclusions $20 Limits or exclusions $0
The total Peg would pay is $3,370 The total Joe would pay is $3,720 The total Mia would pay is $2,800

Note: These numbers assume the patient does not participate in the plan's wellness program. If you participate in the plan's wellness program, you may be able to
reduce your costs. For more information about the wellness program, please contact: 1-888-982-3862.

The plan would be responsible for the other costs of these EXAMPLE covered services.
082800-100020-032416 Page 6 of 6
Published: 10/29/2024
Assistive Technology
Persons using assistive technology may not be able to fully access the following information. For assistance, please call 1-888-982-3862.
Smartphone or Tablet
To view documents from your smartphone or tablet, the free WinZip app is required. It may be available from your App Store.
Non-Discrimination
Aetna complies with applicable Federal civil rights laws and does not unlawfully discriminate, exclude or treat people differently based on their race, color, national
origin, sex, age, disability, gender identity or sexual orientation.
We provide free aids/services to people with disabilities and to people who need language assistance.
If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card.
If you believe we have failed to provide these services or otherwise discriminated based on a protected class noted above, you can also file a grievance with the Civil
Rights Coordinator by contacting:

Civil Rights Coordinator,

P.O. Box 14462, Lexington, KY 40512 (CA HMO customers: P.O. Box 24030, Fresno, CA 93779),
1-800-648-7817, TTY: 711,
Fax: 859-425-3379 (CA HMO customers: 860-262-7705), [email protected].
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building,
Washington, DC 20201, or at 1-800-368-1019, 800-537-7697 (TDD).

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
TTY: 711
Language Assistance:
For language assistance in your language call 1-888-982-3862 at no cost.

Albanian - Për shërbime përkthimi falas për ju, telefononi 1-888-982-3862.

Amharic - የቋንቋ አገልግሎቶችን ያለክፍያ ለማግኘት፣ በ 1-888-982-3862 ይደውሉ፡፡

Arabic - lahsol ola al-masadeh laghouia belghetke atsal balergham 1-888-982-3862 ‫ةفلكت يأ نود ةيوغللا تامدخلا ىلع لوصحلل‬، ‫مقرلا ىلع لاصتالا ءاجرلا‬
donne ei taklafa.

Armenian - Անվճար լեզվական ծառայություններից օգտվելու համար զանգահարեք 1-888-982-3862 հեռախոսահամարով:

Bahasa-Indonesia - Untuk bantuan dalam bahasa Indonesia, silakan hubungi 1-888-982-3862 tanpa dikenakan biaya.
Bantu-Kirundi - Kugira uronke serivisi z’indimi atakiguzi, hamagara 1-888-982-3862.

Bengali-Bangala - আপনাকে বিনামূকযে ভাষা পবিকষিা পপকে হকয এই নম্বকি পেবযক ান েরুন: 1-888-982-3862|

Bisayan-Visayan - Ngadto maakses ang mga serbisyo sa pinulongan alang libre, tawagan sa 1-888-982-3862.

Burmese - သင့္အေနျဖင့္ အခေၾကးေငြ မေပးရပဲ ဘာသာစကား၀န္ေဆာင္မႈမ်ား ရရွိႏုိင္ရန္ 1-888-982-3862 သို႕ ဖုန္းေခၚဆုိပါ။

Catalan - Per accedir a serveis lingüístics sense cap cost per vostè, telefoni al 1-888-982-3862.
Chamorro - Para un hago' i setbision lengguåhi ni dibåtde para hågu, ågang 1-888-982-3862.

Cherokee - ᏩᎩᏍᏗ ᏚᏬᏂᎯᏍᏗ ᎤᏳᎾᏓᏛᏁᏗ Ꮭ ᎪᎱᏍᏗ ᏗᏣᎬᏩᎳᏁᏗ ᏱᎩ, ᏫᎨᎯᏏᎳᏛᏏ 1-888-982-3862.

Chinese - 如欲使用免費語言服務，請致電 1-888-982-3862。

Choctaw - Anumpa tohsholi I toksvli ya peh pilla ho ish I paya hinla, I paya 1-888-982-3862.
Cushite - Tajaajiiloota afaanii garuu bilisaa ati argaachuuf,bilbili 1-888-982-3862.
Dutch - Voor gratis toegang tot taaldiensten, bell 1-888-982-3862.
French - Afin d'accéder aux services langagiers sans frais, composez le 1-888-982-3862.
French Creole - Pou jwenn sèvis lang gratis, rele 1-888-982-3862.
German - Um auf für Sie kostenlose Sprachdienstleistungen zuzugreifen, rufen Sie 1-888-982-3862 an.
Greek - Για να επικοινωνήσετε χωρίς χρέωση με το κέντρο υποστήριξης πελατών στη γλώσσα σας, τηλεφωνήστε στον αριθμό 1-888-982-3862.
Gujarati - તમારે કોઇ જાતના ખર્ચ વિના ભાષાની સેિાઓની પહોોંર્ માટે, કોલ કરો 1-888-982-3862.
Hawaiian - No ka walaʻau ʻana me ka lawelawe ʻōlelo e kahea aku i kēia helu kelepona 1-888-982-3862 Kāki ʻole ʻia kēia kōkua nei.

Hindi - आपके िलए िबना िकसी कीमत के भाषा सेवाओं का उपयोग करने के लिए, 1-888-982-3862 पर कॉल करें।
Hmong - Xav tau kev pab txhais lus tsis muaj nqi them rau koj, hu 1-888-982-3862.
Igbo - Iji nwetaòhèrè na ọrụ gasị asụsụ n'efu, kpọọ 1-888-982-3862.

Ilocano - Tapno maaksesyo dagiti serbisio maipapan iti pagsasao nga awan ti bayadanyo, tawagan ti 1-888-982-3862.

Indonesian - Untuk mengakses layanan bahasa tanpa dikenakan biaya, hubungi 1-888-982-3862.

Italian - Per accedere ai servizi linguistici, senza alcun costo per lei, chiami il numero 1-888-982-3862.

Japanese - 言語サービスを無料でご利用いただくには、1-888-982-3862 までお電話ください

Karen - v>w>furReh>fusd.ftw>frRp>Rtw>fzH;w>frRwz.fv>wtd.f'D;tyShRv>ub.f[h.ftDRt*D>fb.feh.f ud; 1-888-982-3862 wuh>f$

Korean - 무료 언어 서비스를 이용하려면 1-888-982-3862 번으로 전화해 주십시오.
Kru-Bassa - M̀ dyi wuɖu-dù kà kò ɖò ɓě dyi mɔ́uń nì Pídyi ní, nìí, ɖá nɔ̀ɓà nìà kɛ: 1-888-982-3862.
Kurdish - 1-888-982-3862 ‫ۆت ۆب نووچێت ێبەب نامز یرازوگتەمزخ ەب نتشيەگاڕێپسەد ۆب‬، ‫یەرامژ ەب ەکب یدنەويەپ‬

Laotian - ເພ ື່ອເຂ ົ້າໃຊົ້ການບໍລິການພາສາໂດຍບໍື່ເສຍຄື່າຕໍື່ກັບທື່ານ, ໃຫົ້ໂທຫາເບີ 1-888-982-3862.

Marathi - कोणत्याही शुल्कािशवाय भाषा सेवा प्राप्त करण्यासाठी 1-888-982-3862 वर फोन करा.

Marshallese - Nan etal nan jikin jiban ikijen Kajin ilo an ejelok onen nan kwe, kirlok 1-888-982-3862.
Micronesian Pwehn alehdi sawas en lokaia kan ni sohte pweipwei, koahlih 1-888-982-3862.
Pohnpeyan -
Mon-Khmer ដ ើម្បីទទួលបានដេវាកម្មភាសាដ លឥតគិតថ្លៃេម្រាប់ដោកអ្នក េូ ម្ដៅទូរេ័ព្ទដៅកាន់ដលខ 1-888-982-3862។.
Cambodian -
Navajo - T'áá ni nizaad k'ehjí bee níká a'doowol doo b33h ílínígóó koj8’ hólne' 1-888-982-3862.

Nepali - िनःशुल्क भाषा सेवा प्राप्त गनन 1-888-982-3862 मा टेिलफोन गनुनहोस् ।

Nilotic-Dinka - Të kɔɔr yïn wɛ̈ɛ̈r de thokic ke cïn wëu kɔr keek tënɔŋ yïn. Ke cɔl kɔc ye kɔc kuɔny ne nɔmba 1-888-982-3862.
Norwegian - For tilgang til kostnadsfri språktjenester, ring 1-888-982-3862.
Pennsylvania Dutch - Um Schprooch Services zu griege mitaus Koscht, ruff 1-888-982-3862.

Persian - ‫ناگيار روط ەب نابز تامدخ ەب یسرتسد یارب‬، ‫ هرامش اب‬1-888-982-3862 ‫ديریگب سامت‬
Polish - Aby uzyskać dostęp do bezpłatnych usług językowych proszę zadzwonoć 1-888-982-3862.
Portuguese - Para acessar os serviços de idiomas sem custo para você, ligue para 1-888-982-3862.

Punjabi - ਤੁਹਾਡੇ ਲਈ ਬਿਨਾਂ ਬਿਸੇ ਿੀਮਤ ਵਾਲੀਆਂ ਭਾਸ਼ਾ ਸੇਵਾਵਾਂ ਦੀ ਵਰਤੋਂ ਿਰਨ ਲਈ, 1-888-982-3862 ‘ਤੇ ਫ਼ੋਨ ਿਰੋ।
Romanian - Pentru a accesa gratuit serviciile de limbă, apelați 1-888-982-3862.
Russian - Для того чтобы бесплатно получить помощь переводчика, позвоните по телефону 1-888-982-3862.
Samoan - Mo le mauaina o auaunaga tau gagana e aunoa ma se totogi, vala’au le 1-888-982-3862.
Serbo-Croatian - Za besplatne prevodilačke usluge pozovite 1-888-982-3862.
Spanish - Para acceder a los servicios de idiomas sin costo, llame al 1-888-982-3862.

Sudanic-Fulfulde - Heeba a nasta jangirde djey wolde wola chede bo apelou lamba 1-888-982-3862.
Swahili - Kupata huduma za lugha bila malipo kwako, piga 1-888-982-3862.
Syriac - ‫ܢ‬: ‫ ܿܝ ܬ̈ܐ ܼܕ ܿܗ ܿ ܠ ܸܼܚܠ ܼܡ ܿ ܐ ܝ̄ܬܼܘܢ ܵܥ ܵ ܸܐܢ ܣܢ ܼܝܩ‬.‫ ܩܪܼܝܡܘ ܵ ܐ ܼܡ ܵ ܿܓܢ ܵ ܢ ܵ ܐ ܵܒܠܫܸ ܵ ܪܬ‬،‫ ܐܼܝܬ‬1-888-982-3862 .
Tagalog - Para ma-access ang mga serbisyo sa wika nang wala kayong babayaran, tumawag sa 1-888-982-3862.

Telugu - మీరు భాష సేవలను ఉచితంగా అందుకున ందుకు, 1-888-982-3862 కు కాల్ చేయండి.

Thai - หากท่านต้องการเข้าถึงการบริการทางด้านภาษาโดยไม่มีค่าใช้จ่าย โปรดโทร 1-888-982-3862.

Tongan - Kapau ‘oku ke fiema’u ta’etōtōngi ‘a e ngaahi sēvesi kotoa pē he ngaahi lea kotoa, telefoni ki he 1-888-982-3862.
Trukese - Ren omw kopwe angei aninisin eman chon awewei (ese kamo), kopwe kori 1-888-982-3862.
Turkish - Sizin için ücretsiz dil hizmetlerine erişebilmek için, 1-888-982-3862 numarayı arayın.

Ukrainian - Щоб отримати безкоштовний доступ до мовних послуг, задзвоніть за номером 1-888-982-3862.
Urdu - .-‫ ےیل ےک ےنرک لصاح تامدخ ہقلعتم ےس نابز تمیقلاب‬1-888-982-3862 ‫ںیرک تاب رپ‬
Vietnamese - Nếu quý vị muốn sử dụng miễn phí các dịch vụ ngôn ngữ, hãy gọi tới số 1-888-982-3862.
Yiddish - 1-888-982-3862 ‫ רופן‬,‫צו צוטריט ךארפשַּ באדַינונגען אין קיין פרייַז צו איר‬
Yoruba - Lati wọnú awọn isẹ èdè l’ọfẹ fun ọ, pe 1-888-982-3862.