Blue Cross and Blue Shield

WELCOME TO Blue Cross and Blue Shield OF KANSAS CITY Waddell & Reed MyHealthToolkitKC.com Welcome We’re glad to have you here! By selecting Blu...
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WELCOME TO

Blue Cross and Blue Shield OF KANSAS CITY

Waddell & Reed

MyHealthToolkitKC.com

Welcome

We’re glad to have you here!

By selecting Blue Cross and Blue Shield of Kansas City (BCBSKC), you are now part of the largest health care network in the nation. You have access to the people, resources and tools to help you when you need it. At BCBSKC, we want to help you get the most out of your health care benefits. This guide will help you learn more about your benefits and how to use them. Here are some of the most popular items in this guide: 

Q Important terms



Q How to find a network doctor



Q Programs to keep you healthy



Q Easy guide to our secure member website, My Health Toolkit®

Useful symbols Throughout this guide, we have placed symbols to help you find more information about a topic. Phone: this service is delivered over the telephone Web: this service is delivered through the Internet Mail: this service is delivered through the mail Educational: this service is delivered through educational materials My Health Toolkit: go to MyHealthToolkitKC.com and log in to My Health Toolkit

My Health Toolkit

A quick reference guide

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Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association.

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REGISTRATION Click the Create a Profile button to be taken to the user registration. This is where users who have never logged in or haven’t logged on in the past six months will create a new user ID and password for My Health Toolkit.

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ENROLLMENT TOOLS Provides many tools — like the Doctor & Hospital Finder, Plan Comparison Tool, Treatment Cost Estimator — to be used by members to help them decide on the plan that best fits their needs. This is meant for enrolling members who do not yet have a username and password.

My Health Toolkit

A quick reference guide

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SITE NAVIGATION Displays a menu that provides members access to benefitsrelated links such as health claims, dental claims, pharmacy information, wellness-related links and other member resources

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BENEFITS AND CLAIMS Displays selected member’s or family’s deductible and out-ofpocket payment status Dental benefits and claims are displayed for members with dental coverage.

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QUICK LINKS Provides fast access to tools most often used by members

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HEALTH CLAIMS Provides a quick glance at the three most recent claims filed for the member selected

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FINANCIAL INFO Displays the status of any financial accounts for the selected member/family and also provides access to functions such as the “pay claims” feature

Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association.

Cost Estimator

Know before you go

Treatment Cost Estimator KNOW WHAT YOU WILL PAY BEFORE YOU GO TO THE DOCTOR

The new BCBSKC Treatment Cost Estimator provides health care quality and cost information, enabling you to make more informed decisions when choosing common medical tests, procedures and other services. This tool estimates total cost information derived from claims data from across the country and will calculate real-time estimates based on your current benefits plan, deductible and out-of-pocket status. This information is available to members after sign-in to the secure My Health Toolkit site. The member can access the tool either through the Doctor and Hospital Finder or by clicking on Treatment Cost Estimator under Resources.

My Health Toolkit

Now on your mobile phone!

My Health Toolkit mobile website Have you ever needed an urgent care facility while away from home and didn’t know where to find one? Have you been asked for your ID card at the doctor’s office and realized you left it at home? As a BCBSKC member, you can satisfy all of these needs and more — all from the convenience of your iPhone, Droid, Blackberry or other compatible smart phone.

The My Health Toolkit mobile website offers on-the-go members a myriad of features designed for smaller smart phone screens. Unlike some mobile tools, as a BCBSKC member you do not need to download an app. When you want to access the mobile site, simply navigate to MyHealthToolkitKC.com on your smart phone and: Q

Find the nearest doctor, urgent-care center or hospital with a GPS-enabled locator

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Access claims and benefit information

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View your financial account information — health savings account (HSA)/health incentive account (HIA)/flexible spending account (FSA)/health reimbursement account (HRA) balances (if applicable)

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View your ID card information

To use the mobile site, you must create a My Health Toolkit profile using your computer (not your phone). If you already have a profile created, you can begin using the mobile site now by scanning this code with your smart phone to be taken to My Health Toolkit mobile.

Network Access

We’ve got you covered

Make the most of your coverage With our preferred provider organization (PPO), you get to choose who provides your care. For most services, you can use providers in or out of the network. To help you save money, choose a network doctor or specialist.

YOUR ID CARD Your ID card contains important information. We recommend you keep your member ID card with you at all times and show it to your providers during each visit.

If you use an out-of-network provider, you still enjoy benefits for most covered services. However, benefits are paid at a lower rate so you may pay a higher percentage of the bill. Your benefits summary is included in this guide and provides details on specific coverage. 1

LOCATING HEALTH CARE PROVIDERS You now have access to the largest health care network in the nation. No matter where you live, work or travel you are part of the BlueCard® network. So, finding a network provider nearby should be simple!

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Quickly and easily locate a network doctor, hospital, Blue Distinction Center and more with the Find a Doctor or Hospital tool — available any time day or night.

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If you have prescription drug coverage through BCBSKC, your pharmacy information will appear in this location.

You have the choice to search for a provider within Florida, nationwide or worldwide. Select the location where you would like to find a provider. To locate a provider:

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The copayment you are responsible for paying when you visit a doctor or specialist. Not all plans have copayments. Check your benefit summary for details.

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Please visit our website for additional tools and information.

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Simply go to MyHealthToolkitKC.com

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Log in to My Health Toolkit

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Under Resources, click Find a Doctor or Hospital

You will need information from your member ID card if you are searching for a provider nationwide or worldwide. You can always simply call the Member Services number on the back of your ID card for help locating the most convenient participating provider.

The back of your ID card lists important information, such as how to contact Member Services.

MEDICAL CLAIM FORMS If you use a network provider, you should not need to fill out a claim form. However, if you use a non-network provider, you will need to file a claim for services. You can get a claim form from your Human Resources department. You may also visit MyHealthToolkitKC.com, and log in to My Health Toolkit and look under the Resources tab.

Save Money

Using our network

BlueCard® Health care coverage wherever you go. When you’re a BCBSKC member, you take your health care benefits with you — across the country and around the world. The BlueCard program gives you access to doctors and hospitals almost everywhere. So, finding a provider is easy no matter where you live, work or travel, finding a network provider should be simple! To access a network provider, visit MyHealthToolkitKC.com, log into My Health Toolkit and click Find a Doctor or Hospital.

Blue Distinction Centers® Find facilities that provide quality specialty care. The specialty care and results received by patients can vary significantly across hospitals. You need the facts so you can make smart decisions about where to go for this care. Blue Distinction® is a quality designation given to hospitals delivering distinguished specialty care. It can help you make a smart, objective choice about your hospital. The Blue Distinction designation is awarded to hospitals by Blue Cross and Blue Shield based on a thorough, objective evaluation of their performance in the areas that matter to you – quality care, treatment expertise and overall patient outcomes. Current Blue Distinction Centers are available for Bariatric Surgery, Cardiac Care, Knee and Hip Replacement, Spine Surgery, Complex and Rare Cancers and Transplants. To learn more about Blue Distinction Centers, visit www.bcbs.com/bluedistinction.

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Save Money

Discount programs

BCBSKC offers you many ways to take charge of your health and save money. Through our discount programs, you have easy access to a variety of discounted, health-related products and services.

These programs are not covered under your health plan benefits. You are responsible for all costs associated with these services. As a BCBSKC member, you can receive discounts on: Q

Hearing screenings

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Hearing aids

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Cosmetic surgery

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Cosmetic dentistry

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Hair restoration

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Eye care

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Eyewear

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LASIK services

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Weight loss programs

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Allergy relief products

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Global health and dental care

You also have access to discounts on alternative medicine services. Visit MyHealthToolkitKC.com for information on discounts for: Q

Acupuncture

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Massage therapy

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Chiropractic services

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Fitness centers

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Diet and supplemental advisors

For complete details about all of our valueadded services and discount programs, visit MyHealthToolkitKC.com.

Know Your Benefits

Explanation of benefits

Your explanation of benefits (EOB) is provided in one form called a Summary EOB, which provides the status of health insurance claims for you and your covered family members. You will receive a Summary EOB if we process a claim for you or a covered family member during a certain period.

1 CLAIMS PROCESSED FROM (DATE) TO (DATE)

Below are the front and back pages of a sample Summary EOB, which provides an overview of claims processed during a specific time period. The inside pages break down the claims for each provider.

2 MEMBER ID NUMBER

The 21-day period covered by the Summary EOB. The covered member’s number. Please have this number handy if you need to call Customer Service.

3 CUSTOMER SERVICE INFORMATION If you have a question about your health plan or the information on your Summary EOB, here’s how to contact us.

4 PATIENT’S NAME The name of the person who received a service.

5 PATIENT RELATIONSHIP TO POLICYHOLDER This is the patient’s relationship to the member.

6 AMOUNT WE PAID YOUR PROVIDER(S) MO

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The total amount your health plan paid your provider, based on the terms of your health plan.

7 YOUR OTHER INSURANCE COMPANY PAID If you have other insurance coverage, the total amount it paid toward services you received.

www.MyHealthToolkitKC.com

8 MEDICARE PAID

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When Medicare applies, the total amount Medicare paid toward services you received.

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9 AMOUNT YOUR PROVIDERS MAY BILL YOU

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The total amount, if any, you need to pay the provider for this claim(s). There may be times when you owe nothing.

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10 HELPFUL DEFINITIONS We’ve included some definitions to help you better understand your Summary EOB.

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11 APPEAL OR REVIEW INFORMATION How to file an appeal if you disagree with your health plan’s coverage decision.

12 IMPORTANT MESSAGES Tips for becoming a wiser health care consumer, as well as other important messages.

13 GENERAL CLAIM INFORMATION

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Patient name and member ID number, patient’s relationship to policyholder, claim number, provider name and whether the provider participates in our network. Claims are grouped by patient on the Summary EOB.

14 DATE(S) OF SERVICE When a patient received services.

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15 AMOUNT PROVIDER MAY BILL YOU The amount, if any, you need to pay the provider for this claim. There may be times when you owe nothing.

16 YOUR PROVIDER CHARGED The amount the provider charged for the services.

17 AMOUNT NOT COVERED The amount, if any, for noncovered services or the amount that is above the allowed charge. Please refer to the remarks on the Summary Explanation of Benefits Claim Details section.

18 DEDUCTIBLE The amount, if any, you are responsible for paying before any amount is payable under your health plan. You do not send this amount to us. You must pay this amount to your provider. We credit you as having paid your deductible on the claims you and providers send to us.

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19 COPAYMENT The set fee you pay each time you receive a certain service. Some health plans or services do not have copayments.

20 ALLOWED AMOUNT The amount remaining after any noncovered, deductible or copayment amounts have been subtracted from the amount your provider charged. Your coinsurance, if applicable, will be determined from the allowed amount.

21 COINSURANCE The percentage of the allowed amount you pay as your share of the bill. For example, if your health plan pays 80 percent, then 20 percent would be your coinsurance.

22 OTHER INSURANCE PAID The amount paid by another health plan or insurance company toward services you received.

Tip: You can choose to receive paperless EOBs by logging in to My Health Toolkit and changing your preference in the Modify Profile section. You will receive an email whenever you have an EOB available.

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Know Your Benefits

Explanation of benefits

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23 AMOUNT WE PAID The amount paid, based on your health plan, for the services you received.

24 CDHP (CONSUMER DRIVEN HEALTH PLAN) PAID The amount paid from your Health Reimbursement Account, if applicable.

25 AMOUNT PAID TO YOUR PROVIDER The amount we paid your provider, based on your health plan.

26 DEDUCTIBLE AND OUT-OF-POCKET SUMMARY This area explains how much you have paid toward your deductible, if applicable. It shows how much of this claim went toward your out-of-pocket expenses and how much you’ve paid toward your out-of-pocket maximum so far this benefit period. It also shows how much we’ve paid in benefits for the patient during this benefit period.

27 BENEFIT PERIOD The period of time during which you must pay any deductible and coinsurance payments that may apply. Payment of claims begins once you meet the deductible. If you reach your out-of-pocket amount and deductible limits, we pay covered expenses in full for the rest of the benefit period, minus any copayments. Deductibles and coinsurance start over with each new benefit period.

28 AMOUNT PAID TO YOU The amount we paid you, based on your health plan.

29 TOTAL BENEFIT ALLOWED The amount we would have paid if another health plan or insurance company were not involved.

30 MEDICARE APPROVED AMT When Medicare applies, the amount Medicare approves for services you received.

31 MEDICARE PAID When Medicare applies, the amount Medicare paid toward services you received.

32 REMARKS SECTION This section explains any remarks included on your Summary EOB.

33 NUMBER OF PAGES The number of claims processed during this time period for you, your spouse and any dependents will determine the number of pages for each Summary EOB.

Know Your Benefits

Other health insurance

Your plan includes a coordination of benefits (COB) provision. COB applies when you or a covered family member is covered by another health insurance plan. COB makes sure the correct health plan processes your claims first. This prevents overpayment and duplications. COB helps make the most of your coverage and keeps health care costs lower for you and your employer. You may receive an “Other Health Insurance Questionnaire” in the mail. It is important that you complete and return the form, even if you or your covered family members do not have coverage with another health plan. BCBSKC needs the most current information regarding your health coverage. That way we can make sure your claims are processed quickly and accurately.

You can provide us with other health insurance information by logging in to My Health Toolkit, calling Member Services or using the paper questionnaire mailed to you. If you receive an Other Health Insurance Questionnaire in the mail, be sure to fill it out to ensure your claims are processed quickly and accurately.

Glossary

Useful terms

Sometimes the words used in your benefits information can be confusing. These definitions will help you better understand your coverage details.

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Remember, if you ever have any questions about your health care benefits, Member Services is just a phone call away. Our experienced representatives are here to help you.

BENEFITS

NETWORK PROVIDER

Items and services that are covered by your insurance plan.

Doctors, hospitals and other health care professionals that we have negotiated prices with and are part of our network. Network providers are also called “in-network” providers or “participating” network providers.

COINSURANCE You and your insurance plan share expenses. Each pays part of the total. For example, if your insurance plan pays 80 percent, then your coinsurance is 20 percent.

COPAYMENT A set dollar amount you pay each time you receive a covered service. You commonly have a copayment for doctors’ office visits and prescription drug purchases.

DEDUCTIBLE The amount you pay to providers for services received during each benefit period before the insurance plan pays.

IN-NETWORK SERVICES Services you receive from hospitals, physicians and other medical professionals who contract with BCBSKC. Participating providers are chosen because of their quality, accessibility and cost effectiveness.

MEDICAL CLAIM FORM A form you will need to fill out if you receive care from a doctor who is not in our network. Our network doctors normally file claim forms for you.

OUT-OF-POCKET MAXIMUM The maximum dollar amount you pay toward covered services. Once you have paid the maximum out-of-pocket amount, the plan pays 100 percent for the remainder of the benefit period. Most coinsurance payments count toward the out-of-pocket maximum.

PREFERRED PROVIDER ORGANIZATION (PPO) A health plan that encourages you to seek services from a network of participating providers. A PPO does not require a primary care physician or referrals to see specialists.

QUALIFYING EVENT You can make changes to your coverage in the middle of the benefit year if you have a major change in your life. Examples are change in marital status, employment status or number of dependents (birth, death, adoption or placing a child up for adoption). If you have a qualifying event that requires changing your coverage, contact your employer’s HR department as soon as you learn about the change.

Legal

Important Policy Details

NOTICE OF SPECIAL ENROLLMENT RIGHTS

PRE-EXISTING CONDITION EXCLUSION

If you decline enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

This plan imposes a pre-existing condition exclusion. This means that if you have a medical condition before coming to our plan, you might have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis, care or treatment was recommended or received within a six-month period. Generally, this sixmonth period ends the day before your coverage becomes effective. However, if you were in a waiting period for coverage, the six-month period ends on the day before the waiting period begins. The pre-existing condition exclusion does not apply to pregnancy, to a child who is enrolled in the plan within 30 days after birth, adoption or placement for adoption, or to a member enrolled before the age of 19.

In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption or placement of adoption. You may be required to provide a written statement at the time of enrollment that coverage is being declined because you or your dependent has other group coverage or creditable coverage at that time. If you are required to provide a written statement and you do not provide one, the plan is not required to provide special enrollment to you or any of your dependents. To request special enrollment or to get more information, contact your employer’s benefit department.

This exclusion may last up to 12 months (18 months if you are a late enrollee) from your first day of coverage, or, if you were in a waiting period, from the first day of your waiting period. However, you can reduce the length of this exclusion period by the number of days of your prior “creditable coverage.” Most prior health coverage is creditable coverage and can be used to reduce the pre-existing condition exclusion if you have not experienced a break in coverage of at least 63 days. To reduce the 12-month (or 18-month) exclusion period by your creditable coverage, you should give us a copy of any certificates of creditable coverage you have. If you do not have a certificate, but you do have prior health coverage, we will help you get one from your prior plan or issuer. There are also other ways that you can show you have creditable coverage. Please contact us if you need help demonstrating creditable coverage. All questions about the pre-existing condition exclusion and creditable coverage should be directed to Columbia Service Center, P.O. Box 100300, Columbia, SC 29202, or call us at 800-868-2500.

Member-specific benefits for

Waddell & Reed

Your Health

Programs to keep you healthy

Access to health and wellness essentials 24-hour Nurse Advisor

Q A registered nurse is only a phone call away, 24/7. Simply call toll free 888-521-2583. Q Are you or one of your family members not feeling well? Did you experience a fall

and are unsure whether to go to the emergency room, urgent care or wait to make an appointment with your family doctor? We can help!

Health Management

Have you been diagnosed with diabetes, heart disease, migraines or chronic respiratory conditions? We can help you better understand your doctor’s plan of care and get your symptoms under control. Q You are assigned a dedicated health coach to answer your questions and give you

advice as often as you need. Q Call today at 888-376-6544.

Maternity Care

Pregnant? Congratulations! We encourage you to speak to one of our registered nurses who can provide support throughout your pregnancy. Q You’ll get a program kit including a book just for signing up! Q Call 888-376-6544 as soon as you find out you are pregnant to enroll.

Tobacco Cessation

Would you like to quit using tobacco? Tobacco Cessation is a confidential program designed to help you achieve your goal. Q Health coaches will help you assess your readiness to quit and offer support and

helpful tools for improved success. Q Call 888-376-6544 to enroll today.

Weight Management

Would you like to shed some unwanted pounds? Weight Management is a confidential program that provides information and support to help you achieve your weight loss goals. Q Call 888-376-6544 to enroll today.

What is the status of your relationship? A good patient-doctor relationship is the central part of your health care. WHEN VISITING A DOCTOR, YOU SHOULD: > Be honest — tell your doctor everything about your health and illness/symptoms. > Ask questions about care choices, symptoms, medicines or tests. > Take notes so you don’t forget when you leave the office. > Listen to your doctor and follow his or her instructions. > Follow up — ask when you should follow up if treatment doesn’t seem to be working or if you are having side effects. For an Ask-the-Doctor checklist, visit MyHealthToolkitKC.com.

no paper. no worries.

Do you want to protect both your personal health information and the environment? With online Paperless Explanation of Benefits (EOB) from Blue Cross and Blue Shield of Kansas City, that’s never been easier. Paperless EOBs are the quickest, most secure way to receive your claims information. You can access them anytime and anywhere you have Internet access. Simply visit MyHealthToolkitKC.com, log in to My Health Toolkit® and sign up for paperless EOBs. We will email you to let you know when you have a new EOB available online. It’s that easy!

Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. My Health Toolkit and MyHealthToolkitKC.com are products of an independent company that provides administrative support and services to your local Blue health plan.

MyHealthToolkitKC.com

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